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Candida questionnaire and score sheet for adults
CANDIDA QUESTIONNAIRE AND SCORE SHEET FOR ADULTS
This questionnaire is designed for adults. It lists factors in your medical history which promote the growth of the common yeast, Candida albicans
(section A), and symptoms commonly found in individuals with yeast-connected illness (sections B and C). For each “Yes” answer in Section A, circle the point score in that section. Then move on to sections B and C and score as directed. By filling out and scoring this questionnaire it should help you and your health care professional evaluate the possible role of yeasts in contributing to your health problems. Yet it will not provide an automatic “yes” or “no” answer.
SECTION A: HISTORY SCORE
1. Have you taken tetracyclines (Sumycin, Panmycin, Vibramiycin, Minocin, etc.)? 35
2. Have you, at any time in your life, taken other “broad spectrum” antibiotics for respiratory, urinary or other infections (for 2 months or longer, or in shorter courses 4 or more times in a 1-year period)? 35
3. Have you taken a broad spectrum antibiotic drug – even a single course? (Including Keflex, ampicillin, amoxicillin, Ceclor, Bactrim and Septra) 6
4. Have you, at any time in your life, been bothered by persistent prostatitis, vaginitis or other problems affecting your reproductive organs? 25
5. Have you been pregnant 2 or more times? 5 1 time? 3
6. Have you taken birth control pills for more that 2 years? 15 For 6 months to 2 years? 8
7. Have you taken prednisone, Decadron or other cortisone-type drugs for more than 2 weeks? 15 For 2 weeks or less? 6
8. Does exposure to perfumes, insecticides, fabric shop odors of other chemicals provoke moderate to severe symptoms? 20 Mild symptoms? 5
9. Are your symptoms worse on damp days or in molding places? 20
10. Have you had athlete’s foot, ring worm, “jock itch” or other chronic fungus infections of the skin or nails? Have such infections been severe or persistent? 20 Mild to moderate? 10
14. Does tobacco smoke really
bother you? TOTAL SCORE, Section A
For each symptom which is present, enter the appropriate figure in the Point Score column:
If a symptom is occasional or mild
………………….score 3 points.
If a symptom is frequent and/or moderately s
evere.score 6 points.
If a symptom is severe and/or disabling….
…………score 9 points.
Add total score for this section and record it in the box at the end of this section. SECTION B: MAJOR SYMPTOMS SCORE
14. Bloating, belching or intestinal gas ______
15. Vaginal burning, itching or discharge ______
18. Loss of sexual desire or feeling ______
20. Cramps and/or other menstrual irregularities ______
23. Cold hands or feet and/or chilliness ______
24. Shaking or irritable when hungry ______
TOTAL SCORE, Section B
For each symptom which is present, enter the appropriate figure in the Point Score column
If a symptom is occasional or mild…………….score 1 point If a symptom is frequently and/or moderately severe…………score 2 points If a symptom is severe and /or persistent…………….score 3 points
Add total score for this section and record it in the box at the end of this section.
SECTION C: OTHER SYMPTOMS SCORE
8. Pressure above ears.feeling of head swelling
19. Foot, hair or body odor not relieved by washing
SECTION C: OTHER SYMPTOMS (continued)
27. Urinary frequency, urgency, or incontinence
29. Spot in front of eyes or erratic vision
31. Recurrent infections or fluid in ears
TOTAL SCORE, Section C
TOTAL SCORE, Section B
TOTAL SCORE, Section A
GRAND TOTAL SCORE
The Grand Total Score will help you and your health care professional decide if your Health problems are yeast-connected. Scores in women will run higher as 7 items in the questionnaire apply exclusively to women, while only 2 apply exclusively to men. Yeast-connected health problems are almost certainly present in women with scores over 180, and in men with scores over 140. Yeast-connected health problems are probably present in women with scores over 120, and in men with scores over 90. Yeast-connected health problems are possibly present in women with scores over 60, and in men with scores over 40. With scores of less than 60 in women and 40 in men, yeasts are less apt to cause health problems. While the symptoms in this section occur commonly in patients with yeast-connected illness, they also occur commonly in patients who do not have candida, but have such problems as Chronic Fatigue Syndrome, Epstein-Barr syndrome, borderline hypothyroid- ism and other neuroimmune disorders.
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