HISTORY. Question the patient carefully to elicit a history of risk factors or a history of repeated episodes of candidiasis. Factors such as cigarette smoking, tobacco chewing, or pipe smoking are often associated with Candida infections. Take a careful medication history, and pay particular attention to use of antibiotics, corticosteroids, or other immunosup-pressive drugs. A reproductive history, including current pregnancy or oral contraceptive use, is important.

The patient may complain of a burning or painful sensation in the mouth or difficulty in swallowing. The patient also may report regurgitation. Patients with vaginal infections will describe itchiness, irritation, and swelling of the labia. Patients may also describe a white, cheesy vaginal discharge.

PHYSICAL EXAMINATION. Inspect the patient's lips for color, texture, hydration, and lesions. Assess the patient's mouth thoroughly for bleeding, edema, white patches, nodules, or cysts. Inspect the mucosa; the roof and floor of the mouth; the tongue, including under the surface and the lateral borders; the gums; and the throat. Palpate any lesions or nodules. Inspect the patient's nail beds for swelling, redness, darkening, purulent discharge, or separation from the nails. Inspect the patient's skin for an erythematous, macular rash. Inspect the patient's vagina for vulval rash; erythema; inflammation; cheesy exudate; or lesions of the labia, vaginal walls, or the cervix. Palpate lesions for texture and tenderness.

Systemic infection causes symptoms that can include a high, spiking fever; lowered blood pressure; rashes; and chills. Pulmonary infection may produce a cough. Renal infection may produce painful or cloudy urination and blood or pus in the urine. If the infection occurs in the brain, symptoms can include headache and seizures. Eye infection can cause blurred vision, orbital or periorbital pain, scotoma (blind gap in visual field), and exudate. If the infection occurs in the endocardium, symptoms can include systolic or diastolic murmur or chest pain.

PSYCHOSOCIAL. Because of pain, severe oral cases may cause the patient to have difficulty eating and drinking, which may contribute to depression. Severe skin and vaginal infections can cause pain, itching, and unsightly lesions that may cause self-consciousness because of a change in body image. Because of painful symptoms, vaginal infection may affect sexual behavior.

176 Candidiasis (Moniliasis)

Diagnostic Highlights

Test Normal Result

Abnormality with Condition


Potassium hydroxide Negative


Opportunistic infection

(KOH) cultures of

Bacterial Vaginosis Facts

Bacterial Vaginosis Facts

This fact sheet is designed to provide you with information on Bacterial Vaginosis. Bacterial vaginosis is an abnormal vaginal condition that is characterized by vaginal discharge and results from an overgrowth of atypical bacteria in the vagina.

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