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    usmlemate is offline Junior Member
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    Oral Candidiasis

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    A 39-year-old HIV-infected male presents to the clinic with a 5-day history of a mild burning sensation in his mouth that is accentuated when eating acidic or spicy foods. The patient has no discomfort when swallowing. He was diagnosed with HIV infection in 1997, but has remained asymptomatic up until now. Most recent laboratory studies performed 2 months earlier showed a CD4 count of 264 cells/mm3 and an HIV RNA level of 36,350 copies/ml. Currently he is not taking any medications. The intra-oral examination shows erythema of the hard palate (Figure 1) and flat erythematous areas on the dorsal tongue surface that resembled "bald patches." No visible white patches or plaques are visualized. A tentative clinical diagnosis of oral candidiasis is made.

    Which of the following is TRUE regarding oral candidiasis in this patient?

    A. The patient likely has the erythematous (atrophic) form of oral candidiasis and this is a CDC category B condition as defined by the CDC classification system.

    B. The diagnosis of oral candidiasis is likely inaccurate considering the patient does not have any visible white patches or white plaques.

    C. If the patient has oral candidiasis, itraconazole (Sporonox) tablets would be more effective than itraconazole solution (assuming the same dose of the two preparations is used).

    D. If the patient has oral candidiasis, clotrimazole (Mycelex) troches would clearly provide a more effective clinical response than fluconazole (Diflucan) and clotrimazole would have a lower rate of return of symptoms.

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    Asclepius1 is offline Ultimate Member 537 points
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    A

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    Asclepius1 is offline Ultimate Member 537 points
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    Quote Originally Posted by Anonymous
    A
    Very good. The answer is A.

    Oral candidiasis in HIV-infected patients most often presents as either pseudomembranous candidiasis (thrush) or atrophic (erythematous) candidiasis; some patients will present with a combination of the two types. This patientís clinical presentation and examination is most consistent with the erythematous form of candidiasis. Patients with erythematous candidiasis typically have alterations in taste sensation and they frequently complain of a burning discomfort that is most evident when eating acidic or spicy foods. Oral candidiasis in an HIV-infected patient is a category B condition as defined by the CDC classification system.

    Answer B is incorrect. The patient has erythematous (atrophic) candidiasis and this form of candidiasis occurs frequently in HIV-infected persons. The absence of white patches or white plaques does not rule out oral candidiasis.

    Answer C is incorrect. Available data suggest that itraconazole solution achieves higher serum levels, while also providing topical coverage, and is clinically more effective than itraconazole tablets.

    Answer D is incorrect. Available data suggest that fluconazole provides similar clinical responses and a lower rate of return of symptoms when compared with clotrimazole. The advantage of clotrimazole is that it is less likely to lead to the development of azole-resistant Candida.

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