Candidiasis Flashcards
Define candidiasis.
Fungal infection caused by Candida species (candida albicans - type of yeast) = thrush
How common is oral colonisation with candida?
Found in 40-70% of healthy children and adults
Higher incidence in children with carious teeth and older adults wearing dentures.
What can oropharyngeal candidiasis in an apparently healthy patient be suggestive of?
HIV
What are the signs of oral candidiasis?
- White fur on tongue
- White patches/erythema of buccal mucosa
- Patches may be hard to remove and bleed if scraped
What are the risk factors for candidiasis?
- Extremes of age
- DM
- Antibiotics
- Immunospuppression (long-term corticosteroids, inhalers, cytotoxics, malignancy, HIV)
List some conditions associated with candidiasis. Name a risk factor for each.
- Oral candidiasis and oesophageal thrush - immunocompromised
- Vulvovaginitis - diabetes, use of antibiotics
- Diaper rash
- Infective endocarditis - IV drug use
- Disseminated candidiasis - neutropenia
What are the signs and symptoms of oral and oesophageal candidiasis?
- Dysphagia
- Burning oral pain
- Angular cheilitis - cracks, ulcers, crusted fissures at edges of mouth
- Lesions on the palate, dorsal aspect of tongue, gingival margin, confined to outline of dental prosthesis.
RF: hyposalivation, poor oral hygiene, malignancy, HIV etc
What are the signs and symptoms of systemic (disseminated) candidiasis?
There are no unique clinical findings to distinguish between bacterial and fungal septic shock.
- fever
- tachycardia
- tachypnoea
- hypotension
- poor cap refill
- confusion
- decreased UO
- low oxygen saturation
- maculopapular/nodular, erythematous rash (uncommon)
RF: use of central venous catheter, broad spectrum antibiotics, haemodialysis, surgery, parenteral nutrition, immunosuppression.
What are the signs and symptoms of vaginal candidiasis (vaginitis)?
- vaginal discharge - discharge is white, thick, cottage cheese-like, and odourless in Candida infections*
- dysuria
- Thick, white, cottage cheese-like discharge adherent to lateral vaginal walls in candidiasis
- pruritus
- vaginal dryness (atrophic vaginitis)
- erythema, pale, friable epithelium, decreased elasticity,
(thin, malodorous, and white in bacterial vaginosis; thin/thick, green, yellow, or white, frothy, and odorous in trichomoniasis)
What investigations would you do for candidiasis?
Swabs not routinely done - lesions have to be forcefully scraped and smeared on glass slide.
Other Ix used to rule out other causes:
- Urinalysis (UTI)
- Blood glucose
- Blood culture
- HIV antibody test
- Vaginal pH test (exclude STIs)
What is prescribed to treat vulvovaginal candidiasis in pregnant and non-pregnant women?
Non-pregnant
Antifungal treatment: can be local or oral
Local -
- clotrimazole pessary or cream (e.g. clotrimazole 500 mg PV stat)
Oral -
- itraconazole 200 mg PO BD for 1 day OR
- fluconazole 150 mg PO stat
Pregnant
Antifungal treatment: topical only
- intravaginal clotrimazole (e.g. clotrimazole 500 mg PV stat)
Do candidiasis treatments need to be prescribed?
No they are mostly all over the counter including:
- intravaginal clotrimazole (Canesten),
- oral fluconazole,
- topical clotrimazole
If the patient has vulval symptoms, what should you add to the oral or intravaginal treatment?
Vulval symptoms:
topical imidazole (clotrimazole, ketoconazole)
….in addition to an oral or intravaginal antifungal
What should you prescribe for 12-15 year olds with vulvovaginal candidiasis? What should not be prescribed?
Girls aged 12-15 years:
- consider prescribing topical clotrimazole 1% or 2% applied 2-3 times per day
(do not prescribe intravaginal or oral antifungal)
What lifestyle advice can be given to prevent recurrence of thrush?
Avoid predisposing factors:
- Washing and cleaning the vulval area with soap or shower gels, wipes and feminine hygiene products*
- Cleaning the vulval area more than once per day
- Washing underwear in biological washing powder and using fabric conditioners
- Vaginal douching
- Wearing tight-fitting and/or non-absorbent clothing
*Wash the vulval area with a soap substitute - used externally and not more than once per day
Use simple emollient to moisturise vulval area
Consider probiotics (e.g. live yoghurts) orally or topically to relieve symptoms
How can you distinguish between different candida species?
Grow them on chromogenic agar
Summarise the types of superficial candida infections and their tx.
Summarise the types of invasive candida infections and their tx.
