Candidiasis

Question 1

Define

Answer 1

Causative organism = Candida albicans (90%) or Candida glabrata (5%)

Can be spontaneous or secondary to disruption of normal vaginal flora (2nd most common infection after BV)

Classification = Oral (local invasion of oral tissue) or Invasive (systemic invasion of sterile sites)

 

Risk factors:

• Oestrogen exposure (more common in pregnancy, reproductive years)
• Immunocompromise (HIV)
• Diabetes (poorly controlled)
• Recent ABx (i.e. for a UTI)
• Intercourse

Question 2

Signs, symptoms and investigations

Answer 2

Clinical – vulva itching, soreness, irritation, ‘cottage-cheese’-type discharge

No investigations usually required (pH low/normal (<4.5) à if high, consider BV or TV)

Diagnostic = HVS – microscopy, culture and gram stain (speckled gram +ve spores, pseudohyphae)

Other = MSU (UTIs), HbA1c (diabetes)

N.B. pseudohyphae ONLY in C. albicans

Question 3

Management

Answer 3

1st line – clotrimazole pessary (500mg, PV, STAT) + 1% clotrimazole cream (BD, topical)

2nd line / severe / recurrent – fluconazole (150mg, PO, STAT)

 

General advice = avoid tight fitting synthetic clothing, avoid local irritants (perfume), do not wash female area with soap/shower gels (or wash >1 day), do not douche, use simple emollients to moisturise

• Recurrent = ≥4 proven symptomatic episodes
• Check adherence, recheck initial diagnosis
• high vaginal swab for microscopy and culture
• consider a blood glucose test to exclude diabetes
• Ex lichen sclerosis
• Tx with induction and maintenance fluconazole
• induction: oral fluconazole every 3 days for 3 doses
• maintenance: oral fluconazole weekly for 6 months
• If pregnant, only use topical treatment

Question 4

Complications

Answer 4

Hepatotoxicity associated with systemic azole antifungal therapy – monitor LFT

Oesophageal candidiasis or disseminated candidiasis in immunocompromised

It is important to ensure that the patient is not taking SSRI medications or has hypersensitivity to ‘azole’ antifungal medications.