Candidiasis

Question 1

Define candidiasis.

Answer 1

Fungal infection caused by Candida species (candida albicans) = thrush

Question 2

List some conditions associated with candidiasis. Name a risk factor for each.

Answer 2

• Oral candidiasis and oesophageal thrush - immunocompromised
• Vulvovaginitis - diabetes, use of antibiotics
• Diaper rash
• Infective endocarditis - IV drug use
• Disseminated candidiasis - neutropenia

Question 3

How common is oral colonisation with candida?

Answer 3

Found in 40-70% of healthy children and adults

Higher incidence in children with carious teeth and older adults wearing dentures.

Question 4

What are the risk factors for candidiasis?

Answer 4

• Extremes of age
• DM
• Antibiotics
• Immunospuppression (long-term corticosteroids, inhalers, cytotoxics, malignancy, HIV)

Question 5

What can oropharyngeal candidiasis in an apparently healthy patient be suggestive of?

Answer 5

HIV

Question 6

What are the signs of oral candidiasis?

Answer 6

• White fur on tongue
• White patches/erythema of buccal mucosa
• Patches may be hard to remove and bleed if scraped

Question 7

What are the signs and symptoms of oral and oesophageal candidiasis?

Answer 7

• 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

Question 8

What are the signs and symptoms of systemic (disseminated) candidiasis?

Answer 8

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.

Question 9

What are the signs and symptoms of vaginal candidiasis (vaginitis)?

Answer 9

• 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)

Question 10

What investigations would you do for candidiasis?

Answer 10

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)