Download Candidiasis

Candidiasis
Recommend
 Provide education on predisposing factors and personal hygiene
Background
 Candidiasis is a yeast infection usually confined to the skin, nails, mucus membranes and
gastrointestinal tract
 Predisposing factors include diabetes, pregnancy, oral contraceptives and antibiotics (for vulvovaginal
infections), obesity, occlusive and tight fitting garments, humid conditions, immunocompromised
status and corticosteroid use
Related topics:
 Oral thrush, page 250
 Vaginal discharge, vaginitis, page 480
1.
May present with:
 Cutaneous candidiasis
 has a predilection for moist skin folds
 consists of itchy red macerated areas of skin with nearby smaller red areas of involvement
(satellite lesions)
 common locations include the groin and genitals, armpits, between the buttocks, under
pendulous breasts, between the folds of skin on the abdomen and between the digits
 Vaginal candidiasis
 patients present with a thick white “cheesy” vaginal discharge associated with burning or itching
and sometimes dysuria
 it may spread to the labia and perineal areas
 Oral candidiasis
 see Oral thrush
2.
Immediate management: not applicable
3.
Clinical assessment:
 Obtain a complete patient history including
 past episodes, any predisposing factors – such as those listed above
 ask patient to describe? Is it itchy? red?
 ask if any measures have been used to treat thrush? creams / ointments? yoghurt? current
medications
 Perform standard clinical observations + BGL if diabetic or candidiasis persistent or
recurrent
 Review nutritional status
 Perform physical examination of skin
 inspect all skin surfaces particularly skin folds, moist areas
 is the skin / mucous membrane red? inflamed?
 are there white patches / curd like material on a red base?
 are there other skin conditions present?
4.
Management:
 Remove / modify predisposing factors where possible [6]
 investigate for diabetes, treat other skin conditions if present
 Provide education on personal hygiene and not sharing towels etc
 Vaginal Candidiasis: See Vaginal discharge: vaginitis
 Cutaneous Candidiasis: treat with a topical agent such as Miconazole
2% or Clotrimazole 1%
DTP
IHW / SRH / IPAP / NP
Authorised Indigenous Health Workers, Sexual and Reproductive Health Endorsed Registered Nurses and Isolated Practice
Area Paramedics may proceed
Nurse Practitioners may proceed
Schedule
2
Miconazole
Form
Strength
Cream
2%
Route of
Administration
Topical
Recommended Dosage
Duration
Apply topically 2-3 times
daily
Apply until lesion clears plus a few
days
Management of Associated Emergency: Consult MO
Or:
DTP
IHW / SRH / IPAP / NP
Authorised Indigenous Health Workers, Sexual and Reproductive Health Endorsed Registered Nurses and Isolated Practice
Area Paramedics may proceed
Nurse Practitioners may proceed
Route of
Form
Strength
Recommended Dosage
Duration
Administration
Apply until lesion clears plus a few
Lotion
1%
Topical
Apply topically 2-3 times daily
days
Management of Associated Emergency: Consult MO
Schedule
2
Clotrimazole
5.
Follow up:
 Review the patient in 2 weeks
 See next MO clinic
 if persistent or recurrent candidiasis
 if fingernails or toenails involved
(these patients may require oral antifungal treatment (eg. Ketoconazole)
6.
Referral / Consultation:
 Consult MO as above