Candidiasis

Question 1

Definition

Answer 1

Opportunistic infection caused by the yeast-like fungus = Candida Albicans.
- Candida is part of the normal flora of the GI tract.
However, colonisation with Candida can occur when host defences are lowered or mucosal barriers are disrupted, leading to Candida infection (candidiasis)

Question 2

Sites of infection

Answer 2

• Oral candidiasis
• Vulvovaginal candidiasis
• Oesophageal candidiasis
• Invasive disease affecting organs or the bloodstream = Invasive candidiasis

Question 3

Epidemiology and risk factors

Answer 3

Older adults
Younger children/infants (immature immunity)
Immunocompromised (HIV)
Smoking
Broad spec Abx
Pregnancy

Question 4

Signs and symptoms oral candidiasis

Answer 4

Curd-like, white or yellowish plaques can occur in the month, affecting the:
- cheeks
- gums
- palate
- tongue

Question 5

Signs and symptoms oesophageal candidasis

Answer 5

Impaired eating/chewing or dysphagia/odynophagia
May be have signs of associated conditions (e.g HIV)

Question 6

Signs and symptoms vaginal candidiasis

Answer 6

Vulva itching
Vulval soreness and irritation
‘Cottage cheese’ Vaginal discharge (usually white and non-offensive)
Superficial dyspareunia
Dysuria

Question 7

Diagnosis

Answer 7

Clinical diagnosis
Consider:
- Vaginal pH testing : is recommended initially - a pH of <4.5 supports a diagnosis of candidiasis
- High-vaginal swab : can be performed to identify candida fungal infection

Question 8

Treatment Oral

Answer 8

FIRST LINE = Miconazole oral gel for 7 days: mild
Exclude risk factors: diabetes and nutritional deficiencies such as folic acid deficiency
Second line =
- Nystatin suspensions
- Oral fluconazole 50mg once for 7 days
- Biopsy: considered in people with chronic plaque-like oral candidiasis that is unresponsive.

Question 9

Treatment esophageal

Answer 9

In a HIV positive patient:
Oral fluconazole 100mg for 7 days
Consider admission: if widespread candida infection

Question 10

Vaginal Treatment

Answer 10

FIRST LINE = oral fluconazole 150 mg as a single dose
- clotrimazole 500 mg intravaginal pessary as a single dose if oral therapy is contraindicated
- If there are vulval symptoms, consider adding a topical imidazole in addition to an oral or intravaginal antifungal
- if pregnant then only local treatments (e.g. cream or pessaries) may be used - oral treatments are contraindicated

Question 11

Recurrent vaginal candidiasis diagnosis and treatment

Answer 11

BASHH define recurrent vaginal candidiasis as 4 or more episodes per year
- compliance with previous treatment should be checked
- confirm the diagnosis of candidiasis
- high vaginal swab for microscopy and culture
- consider a blood glucose test to exclude diabetes
- exclude differential diagnoses such as lichen sclerosus
FIRST LINE TREATMENT: consider the use of an induction-maintenance regime
- induction: oral fluconazole every 3 days for 3 doses
- maintenance: oral fluconazole weekly for 6 months

Question 12

Complications

Answer 12

Chronic pain and/or discomfort
Gastrointestinal effects:
Invasive candidiasis
Candidaemia