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Oral thrush
46%
123/268
Vaginitis
2%
5/268
Intertrigo
3%
9/268
Esophagitis
37%
100/268
Endocarditis
7%
20/268
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Esophagitis is the only of the given choices that would be a very rare diagnosis in an immunocompetent host. Candida is a normal part of the human bioflora but may cause life-threatening infections during immunocompromised states, especially AIDS or neutropenia. In addition to esophagitis, other examples of severe candidal infections include septicemia, disseminated candidiasis, and chronic mucocutaneous candidiasis. With oral thrush specifically, risk factors include diabetes, AIDS, neutropenia or inhaled corticosteroid use. Owen et al. discuss vulvovaginal candidiasis which presents with thick, white discharge, dysuria, vulvovaginal pruritus and swelling. It should be noted that these are not specific signs for this condition. Diagnosis depends on microscopic examination of a sample with potassium hydroxide preparation. Treatment involves topical azole and oral fluconazole. Cassone et al. discuss the relationship of oropharyngeal and esophageal candidiasis (OPC and OEC) in relation to HIV. These two conditions remain two of the most prevalent infections in the HIV patient, the host is unable to initiate a potent innate and adaptive immune response to restrict the growth of candida. Illustration A shows esophageal candidiasis as seen on endoscopy. Incorrect Answers: Answers 1-3: These infections may be seen in normal populations and patients with a mild immunosuppression (e.g., diabetes). Answer 5: Candidal endocarditis is seen predominantly in IV drug users.
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