Candidiasis, Oral

Key Features

• Fluctuating throat or mouth discomfort

• Systemic or local immunosuppression

• Erythema of oral cavity or oropharynx with creamy-white, curd-like patches

• Rapid resolution of symptoms with appropriate treatment

Clinical Findings

• Painful creamy-white curd-like patches

• White patches can be easily rubbed off by a tongue depressor, unlike leukoplakia or lichen planus, revealing an underlying irregular erythema

• Often the first manifestation of HIV infection

• Angular cheilitis is also a sign of HIV infection, although it can be seen in nutritional deficiencies

• Risk factors

  • Dentures

  • Debilitated states

  • Poor oral hygiene

  • Diabetes mellitus

  • Anemia

  • Chemotherapy or local irradiation

  • Use of corticosteroids (oral or systemic) or broad-spectrum antibiotics

Diagnosis

• Clinical

• A wet preparation using potassium hydroxide will reveal spores and may show nonseptate mycelia

• Biopsy will show intraepithelial pseudomycelia of Candida albicans

Treatment

• Medications

  • Fluconazole (100 mg daily orally for 7 days); shorter duration therapy is also effective

  • Ketoconazole (200–400 mg orally with breakfast [requires acidic gastric environment for absorption] for 7–14 days)

  • Clotrimazole troches (10 mg dissolved orally five times daily)

  • Nystatin mouth rinses (500,000 units [5 mL of 100,000 units/mL] held in the mouth before swallowing three times daily)

• In HIV infection, longer courses of fluconazole therapy may be needed, and itraconazole (200 mg daily orally) may be indicated in fluconazole-refractory cases

• Newer agents, eg, voriconazole, may be needed since many Candida species are resistant to first-line azole drugs

• 0.12% chlorhexidine or half-strength hydrogen peroxide mouth rinses may provide local relief

• Nystatin powder (100,000 units/g) applied to dentures and rinsed off three or four times daily for several weeks may help denture wearers