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  • image Vulvovaginal 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.
  • image Signs 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.
  • image A 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.
  • image For esophageal candidiasis, topical agents are not of proven benefit; fluconazole or itraconazole solution is the first choice.
  • image Optimal antiretroviral therapy is important for the prevention of recurrent and refractory candidiasis in patients with human immunodeficiency virus (HIV) infection.
  • image Primary or secondary prophylaxis of fungal infection is not recommended routinely for HIV-infected patients; use of secondary prophylaxis should be individualized for each patient.
  • image Topical 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.
  • image Oral antimycotic agents such as terbinafine and itraconazole are first-line treatment for toenail and fingernail onychomycosis.

On completion of the chapter, the reader will be able to:

  1. Differentiate between uncomplicated and complicated vulvovaginal candidiasis.

  2. Identify the pathogens responsible for causing vulvovaginal candidiasis (VVC).

  3. Identify risk factors that can influence the occurrence of VVC.

  4. Describe the classic signs and symptoms of VVC, and state the expected result from laboratory investigation.

  5. Discuss the treatment options for uncomplicated and complicated VVC.

  6. Identify the risk factors for development of oropharyngeal and/or esophageal candidiasis, as well as pathogens that can cause the infection.

  7. Describe the relationship between oropharyngeal candidiasis (OPC) and/or esophageal candidiasis (EPC) incidence and the progression of human immunodeficiency virus (HIV) disease state.

  8. Discuss the relationship between OPC incidence and level of immune suppression.

  9. List signs and symptoms of OPC and/or EPC according to the underlining medical state of the individual.

  10. Identify appropriate treatment options for OPC and/or EPC for HIV and non-HIV infected patients.

  11. Define antifungal refractory oral mucosal candidiasis, and discuss its treatment options.

  12. State the pathogens responsible for causing mycotic infection of the skin, nail and hair.

  13. Identify the risk factors for developing a mycotic infection of the skin, nails, and hair.

  14. List the common mycotic infections seen in North America and their corresponding treatment options.

  15. Explain the varying presentations of onychomycosis, ...

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