American Board of Internal Medicine (ABIM) Certification Practice Exam

Under what conditions should antifungal therapy be considered for patients with asymptomatic candiduria?

1. When there are papular lesions present

2. Only for older adults

3. In patients who are neutropenic or undergoing urinary procedures

4. When symptoms develop

The correct answer is: In patients who are neutropenic or undergoing urinary procedures

Antifungal therapy for patients with asymptomatic candiduria should be considered primarily in specific high-risk situations. In the case of patients who are neutropenic or undergoing urinary procedures, the risk of developing systemic complications from candiduria is significantly increased. Neutropenic patients have compromised immune systems, making them more vulnerable to infections, including those caused by Candida species. If these patients are also undergoing urinary procedures, the risk of disseminated infection can further increase due to the potential for introducing pathogens into the bloodstream during catheterization or surgical intervention. That said, asymptomatic candiduria is generally not treated in the majority of cases, particularly in the absence of risk factors. The other scenarios, such as the presence of papular lesions or only treating older adults, are not comprehensive criteria for initiating antifungal treatment. Symptoms developing might warrant consideration, but they are not a primary condition under which antifungal therapy is mandated. Thus, the specific combination of neutropenia and urinary procedures highlights why this scenario is critical for intervention.