Candidiasis in Emergency Medicine Follow-up

Updated: Oct 12, 2017
  • Author: Sukhveer (Sukhi) Bains, MD, MA; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
  • Print
Follow-up

Further Outpatient Care

Uncomplicated vaginal and cutaneous candidiasis: When treated in the ED and discharged with medication, patients should be instructed to see their primary physician if symptoms persist or worsen. For recurrent vulvovaginitis, patients should be screened for HIV infection, diabetes mellitus, leukemia, or other immunologic dysfunction.

Severe candidiasis: If an underlying disorder is suspected, patients should be referred for workup of possible primary causes leading to the immunocompromised state.

Next:

Further Inpatient Care

Patients with invasive candidiasis often have a prolonged inpatient course and may require several weeks of parenteral antifungal therapy.

Removal of invasive catheters with positive fungal culture results is an essential step in management. [31]

Previous
Next:

Inpatient & Outpatient Medications

Localized mucocutaneous infections are treated with outpatient topical and oral medication. Patients with invasive infections that have stabilized may be discharged with parenteral medications administered at home.

Previous
Next:

Transfer

Patients with invasive candidiasis may require transfer to a facility where intensive care and specialty consultations are available.

Previous
Next:

Deterrence/Prevention

Multiple studies have been performed evaluating fluconazole prophylaxis in the ICU; however, the studies had either limited numbers or were performed in only one center, thereby limiting the ability to apply the evidence to the general population. [32]

Candida prevention in the neonatal ICU is also controversial. Fluconazole prophylaxis can lead to the emergence of Candida species that are not susceptible to fluconazole. This is a concern, as mortality varies substantially by Candida species. C glabrata is associated with the highest mortality rate in neonates. Studies have demonstrated that less frequent dosing may delay the emergence of antifungal resistance, but more evidence-based data are required.

Screening pregnant women for vaginal infection and subsequently treating the infection, including vaginal candidiasis, reduces preterm delivery rates by 50%.

Oral candidiasis can be prevented in patients who wear dentures (ie, immunocompromised population) by various methods of disinfections, which include microwave irradiation and sodium hypochlorite soaks. [33, 34]

Previous
Next:

Complications

Untreated candidemia can lead to metastatic foci of virtually any organ system and may lead to blindness, organ failure, and death.

Previous
Next:

Prognosis

The prognosis of candidal infection varies based on location of infection. Local mucocutaneous infections typically respond well to medical therapy. Response to invasive infection is determined by how quickly infection with Candida is recognized and treatment is initiated, as well as underlying host immune response and comorbidities.

Previous
Next:

Patient Education

Patients should be informed that immunocompromising agents and widespread administration of antibiotics may increase the likelihood of developing candidal infections.

Patients should be educated to follow diets low in refined sugars and to avoid clothing that is tight and/or synthetic. Cotton underclothing may be beneficial.

For patient education resources, see the Yeast and Fungal Infections Center; Children's Health Center; and Skin, Hair, and Nails Center, as well as Candidiasis (Yeast Infection), Understanding Vaginal Yeast Infection Medications, Yeast Infection Diaper Rash, and Yeast Infection Skin Rash.

Previous