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KEY CONCEPTS

KEY CONCEPTS

  • imageVulvovaginal candidiasis (VVC) is a fungal infection of the vagina that can be classified as uncomplicated or complicated. This classification is useful in determining appropriate pharmacotherapy.

  • imageCandida albicans is the major pathogen responsible for VVC. The number of cases of non–C. albicans species appears to be increasing.

  • imageSigns and symptoms of VVC are not pathognomonic, and reliable diagnosis must be made with laboratory tests including vaginal pH, saline microscopy, and 10% potassium hydroxide (KOH) microscopy.

  • imageC. albicans is the predominant species causing all forms of mucosal candidiasis. Important host and exogenous risk factors have been identified that predispose an individual to the development of mucosal candidiasis. In oropharyngeal and esophageal candidiasis, the key risk factor is impaired host immune system.

  • imageA topical antimycotic agent is the first choice for treating oropharyngeal candidiasis. Systemic therapy can be used in patients who are not responding to an adequate trial of topical treatment or are unable to tolerate topical agents and in those at high risk for systemic candidiasis. Fluconazole and itraconazole are the most effective azole antimycotic agents.

  • imageFor esophageal candidiasis, topical agents are not of proven benefit; oral fluconazole or itraconazole solution is the first choice.

  • imageOptimal antiretroviral therapy is important for the prevention of recurrent and refractory candidiasis in patients with human immunodeficiency virus (HIV) infection.

  • imagePrimary or secondary prophylaxis of fungal infection is not recommended routinely for HIV-infected patients; use of secondary prophylaxis should be individualized for each patient.

  • imageTopical antimycotic agents are first-line treatment for fungal skin infections. Oral therapy is preferred for the treatment of extensive or severe infection and those with tinea capitis or onychomycosis.

  • imageOral antimycotic agents such as terbinafine and itraconazole are first-line treatment for toenail and fingernail onychomycosis.

BEYOND THE BOOK

BEYOND THE BOOK

Watch the YouTube video entitled “Watch and Learn KOH preparation” by Richard Usatine, MD. This 4-minute video demonstrates the quickest and most accurate way to diagnose fungal skin infections. The video is useful in visualizing fungal elements such as hyphae and pseudohyphae.

INTRODUCTION

Superficial mycoses are among the most common infections in the world and the second most common vaginal infections in North America. Mucocutaneous candidiasis can occur in three forms—oropharyngeal, esophageal, and vulvovaginal disease—with oropharyngeal and vulvovaginal disease being the most common. Over the past 15 to 20 years, the occurrence rates of some fungal infections have increased dramatically. The prevalence of fungal skin infections varies throughout different parts of the world, from the most common causes of skin infections in the tropics to relatively rare disorders in the United States.

VULVOVAGINAL CANDIDIASIS

imageVulvovaginal candidiasis (VVC) refers to infections in individuals with or without symptoms who have positive vaginal cultures for Candida species. Depending on episodic frequency, VVC can be classified as either sporadic or recurrent.1 This classification is essential ...

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