Candidiasis Flashcards
What is candidiasis commonly known us? (2 names)
- thrush
- yeast infection
What’s the pathogen causing candidiasis?
Candida albicans
- in 90% of cases
- it is a commensal (part of normal flora of GI tract)
- yeast-like fungus
Causes of candidiasis (2)
- weakened immune system → opportunistic infection
- hypersensitivity to the commensal organism (Candida Albicans) *genetics and oestrogen are thought to play a role
Risk factors of vulvovaginal candidiasis
- Pregnancy
- Diabetes
-
Use of broad spectrum antibiotics
- ( normal vaginal micro-biota is altered)
-
Use of corticosteroids
- immunosuppressive action → commensal candida grows excessively
-
Immunosuppression or compromised immune system
- For example in HIV or cancer patients. May be associated with a more advanced and potentially life-threatening candida infection, or recurrent candidiasis which is difficult to treat.
What’s that?
A speculum examination showing white curd-like plaque on an anterior vaginal wall → candidiasis
Symptoms of vulvovaginal candidiasis
- itchines → of the vulva, may extend to perianal region
- visual discharge → white, curd-like and non-offensive
- dysuria
Signs of vulvovaginal candidiasis
- erythema and swelling of the vulva
- satellite lesions (red, pustular lesions with pseudomembranous plaques that can be scrap off)
- curd-like discharge in the vagina
What’s uncomplicated candidiasis?
- a sporadic case of candiasis
- mild-moderate symptoms
- not associated with risk factors eg. diabetes, pregnancy, compromised immunity
Investigations of candidiasis in an uncomplicated case
- speculum exam
- measuring vaginal pH
Examples of complicated candidiasis
- associated with risk factors -> pregnancy, diabetes, immunosupression
- recurrent
Investigations in complicated candidiasis
- vaginal smear → microscopic investigation of the sample
*presence of spores and mycelia /grzybnia/ → indicative of candida (however these may be also present in non symptomatic woman as candida albicans is a commensal)
Initial treatment of uncomplicated candidiasis
- intravaginal anti-fungal → clotrimazole or fenticonazole
*usually inserted into vagina via applicator
What’s an alternative to the intra-vaginal treatment of candidiasis?
- oral anti-fungal → fluconazole or itraconazole
Treatment of candidiasis. What can be prescribed with the conjunction of intra-vaginal or oral treatment?
- Topical imidazole → this is to address vulval symptoms
What advice would you give with prescribing a topical Rx for candidiasis?
May weaken latex condoms
How many days would we expect the symptoms of candidiasis to settle down?
7-14 days
If it takes longer -> advise patient to return
What (3) factors may contribute for Rx failure of candidiasis
- alternative diagnosis -> take swabs for culture and microscopy, measure vaginal pH
- patient’s risk factors e.g. diabetic with a poor control - improve control
- non-concordance with medicaiton
When to refer a patient with candidiasis?
- if a treatment continues to fail
- if non-albicans Candida species have been identified
Advice given to a patient in order to prevent further candidal infections
- use soap substitutes (not soup)
- avoid cleaning the vaginal area more than once a day
- avoid potential irritants e.g. shower gels, vaginal deodorants, douches
- avoid wearing tight fitting underwear/tights
Why candidiasis in pregnancy is more likely in some women?
Oestrogen levels are thought to have an impact on the likelihood of developing a candidiasis infection:
- stimulate increased glycogen production → favourable environment for microorganisms to thrive
- oestrogen may have a direct influence on the candida organism→ promoting its growth and encouraging it to ‘stick’ to the walls of the vagina
Management of candidiasis in pregnancy
- intravaginal antifungal (e.g. clotrimazole)
*! Do not give oral antifungals such as fluconazole and itraconazole!
- Treat vulval symptoms with topical antifungal
- Advise the patient to be careful to avoid physical damage when inserting intravaginal treatment applicator
- When taking history note of any evidence of sexually transmitted diseases, as many STIs can affect the pregnancy. Refer to GUM (genito-urinary medicine) clinic if STI is suspected
- Advise patient to return if symptoms have not resolved within 7-14 days
Look at the pictures of candida
