Candida questionnaire.xls

CANDIDA QUESTIONNAIRE AND SCORE SHEET
This questionnaire is designed for adults and the scoring system isn't appropriate for children. 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. Total your score and record it in the box at
the end of the section. Then move on to Section B and C and score as directed.
Filling out and scoring this questionnaire should help you and your physician 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
Have you taken tetracyclines (Sumycin, Panmycin, Vibramycin, Minocen, etc.) or other antibiotics for acne for 1 month (or longer)? Have you, at any time in your life, taken other "broad spectrum" antibiotics for respiratory, urinaryor other infections (for 2 months or longer, or in shorter courses 4 or or times in a 1-year pe- Have you taken a broad spectrum antibiotic drug* - even a single course? Have you, at any time in your life, been bothered by persistent prostatitis, vaginitis or other prob- Have you taken prednisone, Decadron or other cortisone-type drugs… Does exposure to perfumes, insecticides, fabric shop odors or other chemicals provoke… Are your symptoms worse on damp, muggy days or in moldy places? Have you had athlete's foot, ring worm, "jock itch" or other chronic fungous infections of the skin ornails? Have such infections been… 14 Does tobacco smoke really bother you? Total Score, Section A………………………………………………………………………………………… *Including Keflex, ampicilin, amoxicillin, Ceclor, Bactrim, and Spectra. Such antibiotics kill off the "good germs" while they're killing off those which cause infection.
SECTION B: MAJOR SYMPTOMS
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 severe…….…….….…….………….….
score 6 points.
If a symptom is severe and/or disabling………………………………….….….………
score 9 points.
Feeling "spacey" or "unreal" 15 Troublesome vaginal burning, itching or discharge 20 Cramps and/or other mentstral irregularities For each symptom which is present, enter the appropriate figure in the Point Score column: If a symptom is occasional or mild………………………………………………
If a symptom is frequent and/or moderately severe…………………………
If a symptom is severe and/or persistent……………………………………….
Add total score for this section and record it in the box at the end of this section.
POINT
SCORE
1 Drowsiness2 Irritability or jitteriness3 In-coordination4 Inability to concentrate5 Frequent mood swings6 Headache7 Dizziness/loss of balance8 Pressure above ears…feeling of head swelling9 Tendency to bruise easily 10 Chronic rashes or itching11 Psoriasis or recurrent hives12 Indigestion or heartburn13 Food sensitivity or intolerance14 Mucus in stools15 Rectal itching16 Dry mouth or throat17 Rash or blisters in mouth18 Bad breath19 Foot, hair or body odor not relieved by washing20 Nasal congestion or post nasal drip21 Nasal itching22 Sore throat23 Laryngitis, loss of voic24 Cough or recurrent bronchitis25 Pain or tightness in chest26 Wheezing or shortness of breath27 Urinary frequency, urgency, or incontinence28 Burning on urination29 Spots in front of eyes or erratic vision30 Burning or tearing of eyes31 Recurrent infections or fluid in ears32 Ear pain or deafness Total Score, Section C….….
Total Score, Section B….….
Total Score, Section A….….
GRAND TOTAL SCORE (Add up Total Score from Sections A, B, and C)
*While symptoms in this section occur commonly in patients with yeast-connected illness, theyalso occur commonly in patients who do not have candida.
SCORE SHEET FOR CANDIDA QUESTIONNAIRE
The Grand Total Score will help you and your physician decide if
your health problems are yeast-connected.
Scores in women will run higher as 7 times in the questionnaire apply exclusively to women, while only 2 apply exclusively to men.
If the total score on the three-page questionnaire is between 75 and 150
you are considered to have a MODERATE condition of Candida.
If your total score is 151 to 225 you are considered to have a SERIOUS
condition of Candida.
If your total score is 226 to 275 you are considered to have a SEVERE
condition of Candida.
If your total score is over 275 you may possibly have an EXTREME
condition of Candida.

Source: http://mcveanclinic.com/CandidaQuestionnaire.pdf