Candidiasis

Question 1

Oral candidiasis

Answer 1

• common fungal indection of oral cavity
• caused by candida albicans (yeast-like fungus)

Question 2

Risk factors for oral candidiasis

Answer 2

• elderly
• infants
• immunosuppressed (e.g. HIV)
• dentures
• malnutrition
• cancer & cancer treatments
• pregnancy
• recent antibiotics

Question 3

Clinical features of oral candidiasis

Answer 3

• creamy white/yellow plaques on oral mucosa
• burning oral pain
• unpleasant taste in mouth
• angular cheilitis

Question 4

Managing oral candidiasis

Answer 4

Moderate:
- topical antifungal (e.g. clotrimazole oropharnyngeal)

Severe:
- systemic antifungal (e.g. fluconazide)

Question 5

Vaginal candidiasis

Answer 5

• ‘thrush’
• extremely common condition
• many women diagnose and treat themselves
• caused by candida albicans (80%)

Question 6

Risk factors for vaginal candidiasis

Answer 6

• diabetes mellitus
• antibiotics, steroids
• pregnancy
• immunosuppressed (e.g. HIV, iatrogenic)

Question 7

Clinical features of vaginal candidiasis

Answer 7

• ‘cottage cheese’, non-offensive discharge
• vulvitis (superficial dyspareunia, dysuria)
• itch
• vulval erythema, fissuring, satellite lesions

Question 8

Investigating vaginal candidiasis

Answer 8

High vaginal swab

Question 9

Managing vaginal candidiasis

Answer 9

Local treatments:
- clotrimazole pessary

Oral treatments:
- itraconazole
- fluconazole stat

Question 10

Managing recurrent vaginal candidiasis

Answer 10

‘more than 4 episodes per year’
- ensure compliance with previous treatments
- confirm diagnosis
- blood test to exclude diabetes
- exclude differentials - e.g. lichen sclerosus
- induction-maintenance regime

Question 11

Induction-maintenance regime for recurrent vaginal candidiasis

Answer 11

Induction:
- oral fluconazole every 3 days for 3 doses

Maintenance:
- oral fluconazole weekly for 6 months