What are the symptoms and treatment options for candidiasis, especially in vulnerable populations?

I Cannot Provide Real Photos of Candidiasis

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Clinical Presentations of Candidiasis by Type

Oropharyngeal Candidiasis

• White plaques on the tongue, buccal mucosa, or palate that can be scraped off, leaving erythematous base 1
• Erythematous patches without plaques (atrophic candidiasis) 1
• Angular cheilitis with cracking and inflammation at mouth corners 1

Vulvovaginal Candidiasis

• Thick, white, "cottage cheese-like" discharge 1
• Vulvar erythema and edema with satellite lesions 1
• Excoriation from scratching due to intense pruritus 1

Cutaneous Candidiasis

• Erythematous, moist patches in skin folds (intertrigo) 1
• Satellite pustules at the periphery of main lesions 1
• Maceration in intertriginous areas, especially in obese or diabetic patients 1

Invasive/Disseminated Candidiasis

• No specific external manifestations in most cases 1
• Retinal lesions (white, fluffy chorioretinal lesions) visible on fundoscopic examination in candidemia 1
• Chronic disseminated candidiasis shows hepatosplenic lesions on CT/MRI imaging 1

Where to Find Medical Images

For educational purposes, consult:

• Medical textbooks (Harrison's Principles of Internal Medicine, Mandell's Infectious Disease texts)
• DermNet NZ (dermnetnz.org) - reputable dermatology image database
• CDC website (cdc.gov) - public health image library
• Medical school or hospital educational resources
• Peer-reviewed journal articles with case reports

Symptoms Requiring Medical Attention

Mucocutaneous Candidiasis

• Oropharyngeal: dysphagia, odynophagia, reduced oral intake affecting nutrition 1
• Vaginal: intense pruritus, dyspareunia, dysuria 1
• Cutaneous: pain, burning, secondary bacterial infection 1

Invasive Candidiasis (Medical Emergency)

• Persistent fever despite broad-spectrum antibiotics 1
• Hemodynamic instability in ICU patients 1
• Altered mental status in suspected CNS involvement 1, 2

Treatment Overview for Vulnerable Populations

Immunocompromised Patients (HIV/AIDS, Transplant Recipients)

For oropharyngeal candidiasis:

• Fluconazole 100-200 mg daily for 7-14 days is first-line 1, 2
• Itraconazole solution 200 mg daily is equally effective 1
• Maintenance therapy may be needed for recurrent infections: fluconazole 100-200 mg weekly 1

For esophageal candidiasis:

• Fluconazole 200-400 mg daily for minimum 3 weeks and at least 2 weeks after symptom resolution 1, 2
• Itraconazole solution >200 mg daily for fluconazole-refractory cases 1

Neonates with Invasive Candidiasis

• Amphotericin B deoxycholate 1 mg/kg daily is recommended 1
• Fluconazole 12 mg/kg daily is a reasonable alternative if urinary tract involvement excluded 1
• Treatment duration: 3 weeks minimum 1
• Mandatory ophthalmologic examination and lumbar puncture for all neonates with positive sterile body fluid cultures 1

Neutropenic Patients (Chemotherapy, Stem Cell Transplant)

Prophylaxis during neutropenia:

• Fluconazole 400 mg daily 1
• Posaconazole 200 mg three times daily 1
• Micafungin 50 mg daily 1

Treatment of invasive candidiasis:

• Echinocandins are preferred (caspofungin 70 mg loading, then 50 mg daily; micafungin 100 mg daily; anidulafungin 200 mg loading, then 100 mg daily) 1
• Lipid formulation amphotericin B 3-5 mg/kg daily is alternative 1

Solid Organ Transplant Recipients

High-risk liver transplant patients:

• Fluconazole 200-400 mg daily postoperatively 1
• Liposomal amphotericin B 1-2 mg/kg daily for 7-14 days 1

ICU Patients at High Risk

• Fluconazole 400 mg daily prophylaxis in units with high invasive candidiasis incidence 1

Critical Management Principles

Always Remove Intravascular Catheters

• Catheter removal is strongly recommended in all cases of candidemia 1

Ophthalmologic Examination Mandatory

• All patients with candidemia require dilated retinal examination, preferably by ophthalmologist, to detect endophthalmitis 1

Duration of Therapy

• Continue treatment at least 2 weeks after resolution of symptoms and negative cultures 1, 3
• Premature discontinuation leads to relapse, especially in immunocompromised patients 1, 3

Common Pitfalls to Avoid

• Do not rely on blood cultures alone - sensitivity ranges only 21-71% in proven invasive candidiasis 4
• Do not use azoles empirically in patients already receiving azole prophylaxis 1
• Do not use topical therapy alone for esophageal candidiasis - systemic therapy required 1
• Do not assume asymptomatic candiduria is benign in immunocompromised patients - treatment indicated 3
• Monitor for azole-resistant species (C. glabrata, C. krusei) which require echinocandin or amphotericin B therapy 1