Candida

Question 1

What is oral candida

Answer 1

Opportunistic infection - disease of the diseased

Question 2

Risk factors candida

Answer 2

Age extremes
INhaled CCS eg astham
Immunocomp - haem cancer, chemo and radio, HIV and AIDS
Recurrent broad spec/CCS use
DM
Endocrine disturb - hypothyroidism, addisons, pregnany
Dental - prosthetics, poor hygeine
SMOKING
poor diet/iron deficinecy
Impaired salivary function

Question 3

Presentation oral candidiasis

Answer 3

Curdlike white yellow patches anywhere in the mouth
Easily removed -> red underbase
burning/itching

Acute erythematiys/atrophic -> soreness and erythema esp on tongue -> smoothed
Denture stomatitis - red in denture bearing area - effects most denture users

Angular chelitis - old, young, vit B12 deficiencu

Chronic plaque - white patches not easily removed

Question 4

Managmenet oral candidiasis

Answer 4

Check for diabetes, optimise immunodeficiencies, haematinics - ferritin

Advise on good dental hygeine, smoking cessation, inhaled CCS technique and rinsing mouth out etc

Miconazole oral gel first line for 7 dyas after lesions healed

Nystatin second line - 7 days. Continue taking til 48 hrs after lesions healed

Question 5

Management severe or extensive oral candidiasis

Answer 5

Fluconazole 200-400mg day one
100-299g once daily 7-21 days

Follow up in 14 dyas - stop treat if resolved, if not extend 7 dyas, swab and specialist

Question 6

What drugs interact with miconazole

Answer 6

Sulfonylurea eg gliclazide
Wardarin
Statin - use nystatin instead of luconazolw

Question 7

First line oral candida child

Answer 7

TOPICAL antofungal - miconazole oral gel
Oral nystatin suspension if CI

Question 8

When admit with oral cnadidiasis

Answer 8

Widespread infection eg oedophageal
Systemic illness - candidaemia
Low threshold if immunocomp

Question 9

What immunocomp people ask for specialist help for before treat in primary care

Answer 9

On cisplatin or oral tacrolimus esp if for transplant
Chemotherapy

Question 10

When prescribed oral fluconazole immediately for oral cnadida and when review

Answer 10

HIV positive

Review in 7 days

Question 11

Which oral candida increases malignancy risk

Answer 11

Chronic plaque like oral candidiases
Consider referring for biopsy if unresponsive to treatment

Question 12

Fluconazole absolute contraindications drug

Answer 12

Acute porphyria
Pregnancy
Breastfeeding women - high or repeated dose

Question 13

What effect on CYP2450 is fluconazole drug

Answer 13

INHIBITOR

Increases potency or length of other drug actions - persists 4-5 ays after stop as long half life

Question 14

Drug contraindications fluconazole

Answer 14

Ergotamine
Erythomycin - QT and torsades
Pimozide - as above
Quetiapine
Reboxtine

Dose adjust:
Amino and theophylline
Ciclosporin
Warfarin
Diazepam
Fentanyl
Phenytoin
Rifabutin - Uveitis
Statins - myopathy and rhabdomyolysis - DO CK if concern
Sulfonylureas
Tacrolimus
Tretinoin
Zidovudine - toxiity
Clopidogrel, rifampacin

Question 15

Fluconazole caution contraindications drug

Answer 15

At risk QT prilingation - any anrrhtyhmias or electrolyte abnormalities or drugs eg TCAs, antipsychotics
Hepatic impairment or hepatotoxic drugs -> hepatic necorsis
Renal impairment eGFR<50
Contraindicated durgs

Question 16

Common side effects fluconazole DRUG

Answer 16

Abdo discomfort D + V + N
Headache
Rash - discontinue if systemic or invasice

UNCOMMON
Alopecia.
Adrenal insufficiency.
Dizziness.
Vomiting, dyspepsia, and taste disturbance.
Hepatic disorders.
Hyperlipidaemia.
Seizures.
Pruritus, anaphylaxis, angioedema (in children), hypersensitivity reactions (in adults), Stevens-Johnson syndrome, and toxic epidermal necrolysis.

Question 17

Complications oral candidiasis

Answer 17

Chronic pain or discomfort, impaired speech, eating and chewing -
Spread - oesophageal candidiasis in immunocomp -> dysphagia and odonyphagia
Malignancy - chronic plaque
Candidaemia
Systemic.invasive candidiasis -> sepsis and effect heart, CNS, eyes, bones, joints etc - 80% mortality

Question 18

Cutaneous candida presentation

Answer 18

Papules and pustules on red base
Intertrigo - in skin folds - red and moist, -> fringed irregular edges
Scales - > white yellow substance

Question 19

When do swabs skin candida

Answer 19

Immunocompromised
Secondary bacterial infection
Uncertain diagnosis

Question 20

Managemnet skin candida if local and no immunocomp

Answer 20

Topical imidazole eg clotrimazole OR terbinafine

Child - only topical antifungal

Question 21

If widespread disease or immunocompromised. management of oral candida

Answer 21

Oral fluconazole for 2 weeks if >16 (under -> speicailist)

Question 22

Signs systemic candida

Answer 22

Meningitis
Peritonitis