Candidiasis

Armie Jade S. Gante, RN

Candidiasis
A fungal infection commonly caused by Candida albicans It usually occurs in the mouth and pharynx, but may also occur in the esophagus Candidiasis can become a source of systemic dissemination, particularly in high-risk persons

PATHOPHYSIOLOGY AND ETIOLOGY

 More common with immunosuppression from disease states or treatment regimens

HIV infection, chemotherapy, corticosteroids

Altered oral environment from loss of epithelial layer, antibiotic therapy, preexisting infections, poor oral hygiene or nutritional status, wearing dentures

CLINICAL MANIFESTATIONS

 Oral discomfort, burning, altered taste, erythema White, raised, painless plaques, loosely adherent

Possible spread to the esophagus with pain on swallowing and chest pain

DIAGNOSTIC EVALUATION

 Microscopic smear of plaques shows characteristic hyphae Fungal culture positive for C. albicans Occasionally, biopsy of lesions may be necessary to rule out leukoplakia (premalignant plaques).

MANAGEMENT

 Topical antifungal agents in oral rinses, troches, or creams

clotrimazole (Mycelex) nystatin

Systemic treatment is indicated if topical agents fail or for esophageal cases with fluconazole (Diflucan), ketoconazole (Nizoral), or amphotericin B (Fungizone)

 Analgesics for pain Oral prostheses are also treated to avoid harboring and reintroducing infection

COMPLICATIONS

 Candidal infection throughout the GI tract

Candidal sepsis

NURSING MANAGEMENT

Attaining Adequate Nutrition

Administer analgesics, as prescribed, 3060 min before meals. Provide soft foods, soothing liquids; avoid temperature extremes. Encourage saline and sodium bicarbonate rinses as prescribed.

Provide gentle suctioning if pain becomes so severe that patient cannot handle secretions, and provide I.V. fluids.

Ensuring Adequate Therapy

Administer antifungal agents as prescribed Observe the patient for proper use of topical preparation.
Make sure that mouth is clean and free of food debris before administering drug. For swish-and-swallow preparations, tell the patient to swish and hold in mouth for at least 5 minutes (preferably 20 minutes) before swallowing. For troches, have the patient suck until dissolved, more than 20 minutes.

 Observe for signs and symptoms of systemic drug adverse effects: nausea; vomiting; diarrhea; renal, bone marrow, cardiovascular, hepatic, or neurologic toxicities Explain the importance of continuing therapy for duration prescribed, usually at least 3 weeks.