The availability of new antifungal agents has simplified the management of candidiasis, but as a consequence significant disorders that may be heralded by this infection may be missed. How should patients presenting with suspected candidiasis be investigated?
- Classical oropharyngeal candidiasis is usually a straightforward diagnosis, but Candida infection may also manifest as angular cheilitis, erythematous mucositis or candida leucoplakia.
- Candidiasis follows increased colonisation of Candida and altered host factors.
- Initial evaluation of patients with candidiasis may include exclusion of neutropenia, significant lymphopenia, diabetes and HIV infection.
- Subsequent evaluation may include examination for lymphadenopathy, splenomegaly or hepatomegaly and measurement of CD4 T-cell counts and iron, vitamin B12 and folate status.
- Popularisation of mystical entities like the ‘candida hypersensitivity syndrome’ has engendered confusion and been associated with the development of non-orthodox laboratory tests and the inappropriate use of antifungal agents.