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Review Question - QID 101493

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QID 101493 (Type "101493" in App Search)
A 43-year-old HIV positive woman presents with signs and symptoms concerning for a fungal infection. She is currently not on antiretrovirals, and her CD4 count is 98 cells/mm^3. Which of the following candidal infections could be seen in this patient but would be very rare in an immunocompetent host?

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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