CANDIDIASIS ASSOCIATED WITH HIV
Associated Clinical Features
Oral infections are seen in over half of all HIV patients. Oral candidiasis can occur at all stages of HIV disease. The severity of the infection depends on the degree of immunosuppression. The most common species is Candida albicans. Candida tropicalis can cause severe infections. Another 150 different species of Candida have become increasingly resistant because of the chronic use of systemic antifungal therapy.
Oral thrush is classified as pseudomembranous, angular, or erythematous. Pseudomembranous candidiasis involves removable whitish plaques on the tongue and buccal mucosa (Fig. 20.2). Patients with angular cheilitis demonstrate erythema and fissures at the angles of the mouth. Erythematous thrush appears as smooth red patches along the soft and hard palate. Oral candidiasis can be diagnosed clinically and by microscopic observation of hyphae with 10% KOH preparation.
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Esophageal candidiasis frequently accompanies oral candidiasis. The most common symptoms are dysphagia and odynophagia. Barium swallow and endoscopy aid in making the diagnosis. Typical findings observed with an air-contrast barium swallow are ulcerative plaques, causing filling defects along the long axis of the esophagus and producing the classic "shaggy" mucosal appearance. Endoscopy provides for the definitive diagnosis (Fig. 20.3), and allows the examiner to obtain biopsies and viral, bacterial, and fungal cultures. |
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Like other conditions in immunocompromised patients, vaginal candidiasis can be severe, causing a whitish discharge and vulvar erythema. Women will commonly present to the ED for evaluation of vaginal candidiasis as their first clinical manifestation of the HIV infection. |
