Internal Medicine

0521779407-C01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

272 Candidiasis Candidiasis: Oral

■Candiduria rarely associated with candidemia; candiduria with a

Foley catheter does not require therapy

■Other invasive disease, especially in the immunocompromised

patient, treated with amphotericin B; once clinical improvement

occurs, fluconazole orally can be used if the organism is sensitive

follow-up

■Symptoms usually resolve in several days with appropriate therapy.

■With candidemia, blood cultures should be obtained every other day

until negative.

With candidemia, once blood cultures are clear, obtain ophthal-

mologic evaluation to rule out candida chorioretinitis or endophtha-

lmitis.

complications and prognosis

■Complications uncommon in competent host; esophageal or bowel

perforation, secondary seeding in candidemia (joints, CNS, heart,

eye, liver and spleen) occur infrequently even in compromised host

■Prognosis superb for superficial infections; invasive disease asso-

ciated with significant mortality, especially if immunosuppression

cannot be reversed

Candidiasis: Oral....................................

SOL SILVERMAN JR, DDS

history & physical

■recent onset associated with discomfort, pain, halitosis, dysgeusia

■can appear as white (pseudomembranous), red (erythematous), or

white-red combination

■can be isolated or wide-spread on any mucosal surface

■risk increased in immunosuppression, diabetes, anemia, xerosto-

mia, antibiotics, dentures

tests

■clinical appearance and response to antifungal medications

■smear for hyphae or culture

differential diagnosis

■leukoplakia, dysplasia, carcinoma, hypersensitivity, immunosup-

pression