Chapter 83. Superficial Fungal Infections
Case for questions 1 and 2.
AL is a 28-year-old, type-2 diabetic woman who presents with a chief complaint of vaginal itching accompanied by "cottage cheese" like discharge. According to AL, she experienced a similar issue last year and was treated with "suppositories."
When reviewing her current medications, she mentions to you that was prescribed a course of oral prednisone for a recent allergic reaction. What would you recommend for treating her infection?
A. An over-the-counter topical azole or a single dose of oral fluconazole 150 mg
B. Long-term suppressive therapy
D. Dual antifungal therapy with topical azoles
Option A: Correct. The patient should be treated with over-the-counter topical azole or a single dose of oral fluconazole 150 mg which are first-line agents.
Option B: Incorrect. Long-term suppressive therapy is not recommended as the patient does not have recurrent candidiasis.
Option C: Incorrect. The first step would be treatment.
Option D: Incorrect. Dual antifungal therapy with azoles is not recommended.
Although AL may have other risk factors that we cannot yet identify, what known risk factor does she have for the development of this diagnosis?
A. Broad-spectrum antibiotic use
Option A: Incorrect. While broad-spectrum antibiotic use is a risk factor for developing vaginal candidiasis—this patient is currently not being treated with antibiotics.
Option B: Correct. Diabetes is a known risk factor of developing vaginal candidiasis.
Option C & D: Incorrect. Both risk factors for VVC, but neither current risk factors the patient has.
CW, a 42-year-old woman, presents with complaints of vaginal itching, burning and curd like discharge. CW has been experiencing these symptoms and getting treated every other month for the past year. To achieve remission, CW should be treated with:
B. 14 days of boric acid capsules intravaginally
C. Two doses of oral fluconazole 150 mg dosed 3 days apart
D. One dose of oral fluconazole 150 mg