Oct 27, 2007
Recently I have been admitted into the hospital for what appears to be Thrush or Candida. My symptoms include small white spots on the tonsils, white coating of the tongue, a white curd-like spot on the roof of my mouth when easily scraped away bled somewhat, inability to tolerate anything orally due to severe headpain after ingesting food, medications or fluids. Each visit to the hospital they would perform a series of tests to include, MRI, CAT Scan, Blood Culture, LP, EGD, Urinalisys and CBC only to reveal that luckily each test was negative. My suspicion, although never confirmed by any test results is that I have Intestinal Candida because when put on anti-fungal IV, my symptoms improve dramatically. My T-cells are 170 and VL <50.
I am aware that most doctors that are not HIV specialists dont believe that Candida is a disease and dont regard it as something that is potentially life threatening because Candida is found in small amounts in every person and they dont have standardized testing for such for most people. However, with my past diagosis of Ulcer, high sugar diet (ice cream to help ease the ulcer pain), Antibiotic use and a recurant (what seems to be with the research I've done but not concluded by test results) Intestinal Candida, and with anti-fungal treatment dramatically improving my symptoms, I can only gather on my own that what I have is Candida each time. However, no test from the previous three times admitted into the hospital did they conclude I had a fungal infection-because I was not tested for that specifically. On one test from the EGD, it did reveal that I did have Esophogitis though. From what I've read and gathered from literature and online resources is that if the muscosal barrier in the GI tract is comprimised with no protection from certain pathogens, it is possible that those pathogen could potentially penetrate the intestinal wall structure and cause many problems.
Before being admitted to the hospital as my symptoms get worse, I would start back on a course of Diflucan 200 mg and usually my symptoms would be alleviated. However this last time, my symptoms did not improve and went into the hospital to be treated. I have not been told by my HIV doctors that I should be on anti-fungal maintenance therapy, but have been treated empirically by them but never given a timeframe as to how long I need to continue treatment to keep the supposed Candida and Thrush in check.
My questions are, are there any tests that can be performed to rule out a Candida infection without having to go through the myriad of tests that doctors need to perform? Would a fungal test come back negative if i was already taking an anti-fungal medication? With my diagnosis of Ulcer, is there a probability that my GI tract has become susceptible to various pathogens including Candida? Does a high sugar diet contribute to Candida or Thrush? What is the protocal of most doctors when it comes to testing and treating Candida? Are there any standardized testing for Candida?
I would like to shed light on this very serious situation to better bring a better understanding to myself and the medical community who may not be aware of the potential adverse effects of Candida and initialize through medical advisory boards a standardized protocol testing with respect to certain individuals who are at risk.
Thank you for any information you can share on this very important subject.
Response from Dr. Conway
Candida is a common fungus that, as you say, is present in almost everyone to some extent. With more advanced HIV disease (such as you have with a CD4 count below 200=, it can cause symptoms. This has little to do with diet or other things. It has a lot to do with a weak immune system, and often teh fact that you maz be taking antibitoics that would allow the Candida to grow more easily. My approach in zour case, rather than doing more tests, would be to see if we could minimize to use of anitbiotics and place you a course of Diflucan for a month or so and see what happens. The ulcer is not candida, but may be another infection (helicobacter) that could be easily treated with a short course of antibiotics. Good luck with this longstanding problem...
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