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Microsoft word - candida questionnaire and score sheet pdf.doc
Candida Questionnaire and Score Sheet*
This questionnaire lists factors in your medical history that 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). *Filling out and scoring this questionnaire should help you and your physician evaluate how Candida Albicans may be contributing to your health problems. Yet it will not provide an automatic yes or no answer. A comprehensive history and physical examination are important. In addition, laboratory studies, x-rays, and other types of tests may also be appropriate. For each yes answer in Section A, circle the Point Score. Total your score, and record it at the end of the section. Then move on to Sections B and C, and score as directed.
Section A: History
1. Have you taken tetracyclines (Sumycin®, Panmycin®, Vibramycin®,Minocin®, etc.) or other antibiotics for acne for 1 month (or longer)? Point score-50 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 for shorter periods 4 or more times in a 1-year span? Point score-50 3. Have you taken a broad spectrum antibiotic drug – even for one period? Point score-6 4. Have you, at any time in your life, been bothered by persistent prostatitis, vaginitis, or other problems affecting your reproductive organs? Point score-25 5. Have you been pregnant 2 or more times? Point score-5 Pregnant 1 time? Point score-3 6. Have you taken birth control pills for more than 2 years? Point score-15 Taken birth control pills 6 months to 2 years? Point score-8 7. Have you taken prednisone, Decadron®, or other cortisone-type drugs by mouth or inhalation** for more than 2 weeks? Point score-15 Taken these drugs 2 weeks or less? Point score-6 8. Does exposure to perfumes, insecticides, fabric shop odors, or other chemicals provoke moderate to severe symptoms? Point score-20 Does exposure produce mild symptoms? Point score-5 9. Are your symptoms worse on damp, muggy days or in moldy places? Point score-20 10.Have you had athlete’s foot, ringworm, "jock itch" or other chronic fungus infections of the skin or nails that have been severe or persistent? Point score-20 Mild or moderate? Point score-10 11. Do you crave sugar? Point score-10 12. Do you crave breads? Point score-10 13. Do you crave alcoholic beverages? Point score-10 14. Does tobacco smoke really bother you? Point score-10
**The use of nasal or bronchial sprays containing cortisone and/or other steroids promotes overgrowth in the respiratory tract.
Section B: Major Symptoms
For each symptom that is present, enter the appropriate number 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.
Total the score for this section, and record it at the end of this section.
2. Feeling of being "drained" _______
4. Feeling "spacey" or "unreal" _______
6. Numbness, burning or tingling _______
10. Pain and/or swelling in joints _______
14. Bloating, belching or intestinal gas _______
15. Troublesome vaginal burning, itching or discharge _______
18. Loss of sexual desire or feeling _______
19. Endometriosis or infertility _______
20. Cramps and/or other menstrual irregularities _______
22. Attacks of anxiety or crying _______
23. Cold hands or feet and/or chilliness _______
24. Shaking or irritable when hungry _______ Total Score, Section B _______
Section C: Other Symptoms
For each symptom that is present, enter the appropriate number 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
persistent, score 9 points. Total the score for this section and record it in the box at the end of this section.
1. Drowsiness _______
8.Pressure above ears, feeling of head swelling _______
11. Psoriasis or recurrent hives _______
13. Food sensitivity or intolerance _______
19. Foot, hair or body odor not relieved by washing _______
20. Nasal congestion or post nasal drip _______
24. Cough or recurrent bronchitis _______
26. Wheezing or shortness of breath _______
27. Urinary frequency, urgency or incontinence _______
29. Spots in front of eyes or erratic vision _______
31. Recurrent infections or fluid in ears _______
*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.
Section C _______ Total Score, Section B _______ Total Score, Section A _______
Grand Total Score (add totals from Sections A, B and C) _______
The Grand Total Score will help you and your physician decide if your health problems are yeast-connected.
Scores for women will run higher, as 7 items in this 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 less than 60 for women and 40 for men,
yeast are less apt to cause health problems.
This questionnaire is available in quantity from Professional Books, Inc., P.O. Box 3246, Jackson, TN 38302. Prices upon request. Copyright 1984. The
Yeast Connection by William G. Crook, M.D. Reprinted with permission.
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