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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the underlying pathophysiology of vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections.

  2. Identify symptoms of vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections.

  3. Identify the desired therapeutic outcomes for patients with uncomplicated and complicated vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections.

  4. Recommend appropriate lifestyle modifications and pharmacotherapy interventions for patients with vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections.

  5. Recognize when long-term suppressive therapy is indicated for a patient with vulvovaginal candidiasis.

  6. Recognize when topical versus oral treatment is indicated for a patient with oropharyngeal candidiasis, esophageal candidiasis, vulvovaginal candidiasis, and fungal skin infections.

  7. Educate patients about the disease state, appropriate lifestyle modifications, and medication therapy required for effective treatment of vulvovaginal candidiasis, oropharyngeal candidiasis, esophageal candidiasis, and fungal skin infections.

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KEY CONCEPTS

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  • Image not available. The predominant pathogen associated with vulvovaginal candidiasis is Candida albicans, although a small percentage of cases are caused by Candida glabrata, Candida tropicalis, Candida krusei, and Candida parapsilosis.

  • Image not available. A variety of factors may increase the risk of developing symptomatic vulvovaginal candidiasis, including antibiotic use, diabetes, and immunosuppression. No risk factors are consistently associated with all cases of vulvovaginal candidiasis.

  • Image not available. Asymptomatic vaginal colonization of Candida albicans is not diagnostic of vulvovaginal candidiasis since 10% to 20% of women are asymptomatic carriers of Candida species. Asymptomatic vaginal colonization does not require treatment.

  • Image not available. Selection of antifungal agents to treat uncomplicated vulvovaginal candidiasis is influenced by patient preference, including route of administration, duration of therapy, cost, risk of adverse effects, and potential for medication interactions.

  • Image not available. Recurrent vulvovaginal candidiasis, defined as four or more infections per year, requires long-term suppressive therapy for 6 months.

  • Image not available. The occurrence of oropharyngeal and esophageal candidiasis is an indicator of immune suppression, often developing in infants, the elderly, and the immunocompromised.

  • Image not available. Topical antifungal agents are first-line therapy for oropharyngeal candidiasis, although oral agents may be used for severe or unresponsive cases.

  • Image not available. Esophageal candidiasis is a severe form of extension of oropharyngeal candidiasis that requires oral antifungal therapy.

  • Image not available. Because dermatophyte hyphae seldom penetrate into the living layers of the skin, instead remaining in the stratum corneum, most mycotic infections of the skin can be treated with topical antifungals. Infections covering large areas of the body or infections involving nails or hair may require oral therapy.

  • Image not available. Onychomycosis, fungal infections involving the nails, requires oral antifungal therapy. Topical agents do not adequately penetrate the nail.

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VULVOVAGINAL CANDIDIASIS

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Vulvovaginal candidiasis (VVC), whether symptomatic or asymptomatic, refers to infections in women whose vaginal cultures are positive for Candida species.

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EPIDEMIOLOGY AND ETIOLOGY

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Vulvovaginal candidiasis, also known as moniliasis, is a common form of vaginitis, accounting for 20% to 25% of vaginitis cases. Although VVC is uncommon prior to menarche, nearly 50% of women will experience ...

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