Candida

GENERAL PRINCIPLES

• The severity of infection depends on the degree of the patient's immunosuppression.

• Candidiasis is common in the HIV-infected host.

• Other causes of esophagitis include HSV, CMV, and Histoplasma.

DIAGNOSIS

Location of infection can be oral, esophageal, or vaginal.

TREATMENT

• Oral and vaginal candidiasis usually responds to local therapy with troches or creams (nystatin or clotrimazole).

• For patients who do not respond or who have esophageal candidiasis, fluconazole, 100-200 mg PO daily for 14-21 days, is the treatment of choice.

SPECIAL CONSIDERATIONS

Fluconazole-resistant candidiasis is increasing, especially in patients with advanced disease who have been receiving antifungal agents for prolonged periods. Endoscopic sampling with culture and resistances may be beneficial in refractory cases.

• Caspofungin or micafungin, echinocandins, can be considered for refractory cases.

• Itraconazole oral suspension (200 mg bid) is occasionally effective, as is posaconazole oral solution, and posaconazole is generally better tolerated than itraconazole. Voriconazole may also be useful.