Candidiasis

AIDS (acquired immunodeficiency syndrome) is the final stage of disease caused by infection with HIV. In this stage, the vims infection has severely affected the immune system, causing a depletion of CD4+ T-helper cells. AIDS is characterized by the manifestation of typical diseases caused by opportunistic infections (Pneumocystis carinii pneumonia, CMV retinitis, candidiasis of the esophagus, cerebral toxoplasmosis), neurological manifestations, cachexia, or certain tumors (Kaposi sarcoma of the skin, B-cell lymphoma). 

Inhaled steroids (commonly used are beclomethasone, budesonide, triamcinolone, fluticasone, flunisolide) appear to attenuate the inflammatory response, to reduce bronchial hyperreactivity, to decrease exacerbations and to improve health status they may also reduce the risk of myocar dial infar ction, but they do not modify the longterm decline in lung function. Whether- steroids affect mortality remains unclear. Many patients appear to be resistant to steroids and large, long-term trials have shown only limited effectiveness of inhaled corticosteroid ther apy. Certainly, the benefit from steroids is smaller in COPD than in asthma. Topical side-effects of inhaled steroids are oropharyngeal candidiasis and hoarse voice. At the normal doses systemic side-effects of inhaled steroids have not been firmly established. The current recommendation is that the addition of inhaled gluco-coiticosteroids to bronchodilator treatment is appropriate for patients with severe to veiy sever e COPD. 

Generally, inhaled glucocorticoids have few side effects, the appearance of which depends on the dose, the frequency of administration, and the delivery system used. The most common side effect is dysphonia (hoarseness), which affects approximately one third of treated patients. Oropharyngeal candidiasis (thrush)... 

AA A1 A01.014 Candidapepsin SAP1 Epithelial damage in vaginal candidiasis... 

Penicillins should be used cautiously in patients witii renal disease, pregnancy (Pregnancy Category C), lactation (may cause diarrhea or candidiasis in die infant), and in tiiose witii a history of allergies. Any indication of sensitivity is reason for caution. The drug is also used witii caution in patients witii asthma, renal disease, bleeding disorders, and gastrointestinal disease. 

On occasion amphotericin B may be administered as an oral solution for oral candidiasis. The patient is instructed to swish and hold the solution in the mouth for several minutes (or as long as possible) before swallowing. The oral solution may be used for as long as 2 weeks. 

CORTICOSTEROID INHALANTS. The inhalers, particularly die corticosteroid or mast cell aerosols, may cause tiiroat irritation and infection with Candida albicans. The nurse instructs the patient to use strict oral hygiene, cleanse die inhaler as directed in die package directions, and use die proper technique when taking an inhalation. These interventions will decrease die incidence of candidiasis and help to soodie die throat. Occasionally an antifungal drug may be prescribed by die primary health care provider to manage the candidiasis. 

Miconazole (Micatin), ciclopirox (Loprox), and econazole (Spectazole)—used for treatment of tinea pedis (athlete s foot), tinea cruris (jock itch), tinea corporis (ringworm), and superficial candidiasis... 

In severe cases, or those refractory to treatment, truncal and limb weakness may be accompanied by involvement of masticatory, bulbar, and respiratory muscles. However the most life-threatening clinical manifestations are those affecting the gastrointestinal tract, since stomach ulceration can occur and death from perforation and peritonitis are not unknown. Medication with steroidal antiinflammatory agents is necessary but weakens the childrens resistance to infection, so that systemic spread of usually self-limiting disorders, such as candidiasis, may occasionally occur. 

ATC J02AC01 J02AX Use antifungal (treatment of vaginal, oropharyngeal and atrophic oral candidiasis)... 

Ahrens, J., Graybill, J., Craven, P., and Taylor, R. (1984). Treatment of experimental murine candidiasis with liposome-associated amphotericin B, Sabouraudia, 22, 263-265. 

E. M., and Juliano, R. L. (1984c). Liposome-encapsulated amphotericin B for treatment of disseminated candidiasis in neutropenic mice, J. Infect. Pis., 150, 278-283. 

Tremblay, C., Barza, M., Flore, C., and Szoka, F. (1984). Efficacy of liposome-intercalated Amphotericin B in the treatment of systemic candidiasis in mice, Antimicrob. Ag. Chemother.. 

Nystatin has a specific action on C. albicans and is of no value in the treatment of any other type of infection. It is poorly absorbed from the gastrointestinal tract even after very large doses, the blood level is insignificant. It is administered orally in the treatment of oral thrush and intestinal candidiasis infections. 

Local adverse effects of inhaled corticosteroids include oral candidiasis and dysphonia. The incidence of local adverse... 

Because all inhaled corticosteroids are equally effective if given in equipotent doses, product selection should be individualized based on the available dosage form, delivery device, and patient preference. In infants, administration may require the use of a nebulizer or spacer/holding chamber with a facemask. Caregivers should use a soft, damp cloth to wipe the face of infants receiving an inhaled corticosteroid via a facemask to prevent topical candidiasis.18... 

Monitor for adverse events from medications, including candidiasis and dysphonia from inhaled corticosteroids. 

Assess the patient for adverse effects, particularly candidiasis and dysphonia associated with inhaled corticosteroids. 

The most common adverse effects from inhaled corticosteroids include oropharyngeal candidiasis and hoarse voice. These can be minimized by rinsing the mouth after use and by using a spacer device with metered-dose inhalers. Increased bruising and decreased bone density have also been reported the clinical importance of these effects remains uncertain.1,2,19... 

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