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Clinical investigations from the RACP

Investigating patients with oropharyngeal candidiasis

Karl W Baumgart

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Abstract

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?

Key Points

  • 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.

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