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For further information, see CMDT Part 38-02: Candidiasis
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Essentials of Diagnosis
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Common normal flora but opportunistic pathogen
Typically, mucosal disease, particularly vaginitis and oral thrush/esophagitis
Persistent, unexplained oral or vaginal candidiasis: check for HIV or diabetes mellitus
(1,3)-β-D-glucan results may be positive in candidemia even when blood cultures are negative
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General Considerations
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Candida albicans can be cultured from the mouth, vagina, and feces of most people
Persistent oral or vaginal candidiasis should raise suspicion of HIV infection
Risk factors for invasive candidiasis include
Although C albicans remains the most common cause of both mucocutaneous and systemic candidiasis, non-albicans strains are of considerable importance in certain contexts, and may impact therapy owing to antifungal resistance
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Invasive candidiasis
Blood cultures are positive in only about 50% of cases while Candida species are often isolated from mucosal sites in the absence of invasive disease
Consecutively positive 1,3-β-D-glucan results can guide empiric therapy in high-risk patients even in the absence of positive blood cultures
Hepatosplenic candidiasis: blood cultures are generally negative
Candidal endocarditis: diagnosis is established definitively by culturing Candida from emboli or from vegetations at the time of valve replacement
Esophageal candidiasis best confirmed by endoscopy with biopsy and culture
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Vulvovaginal candidiasis
Fluconazole
Clotrimazole 100 mg vaginally once daily for 7 days, or miconazole 200 mg vaginally once daily for 3 days
In azole-resistant disease, alternative therapies (such as intravaginal boric acid) may be ...