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For further information, see CMDT Part 8-17: Oral Candidiasis

KEY FEATURES

  • Fluctuating throat or mouth discomfort

  • Associated with systemic or local immunosuppression, such as recent corticosteroid, chemotherapy, or antibiotic use

  • 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 human immunodeficiency virus (HIV) infection

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

  • Risk factors

    • Dentures

    • Debilitated state, with poor oral hygiene

    • Diabetes mellitus

    • Anemia

    • Chemotherapy or local irradiation

    • Use of corticosteroids (oral or systemic)

    • Use of 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

  • HIV testing should be considered in patients with no known predisposing cause for Candida overgrowth

TREATMENT

  • Medications

    • Fluconazole (100 mg orally daily 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 orally daily) may be indicated in fluconazole-refractory cases

  • Newer agents, such as voriconazole, may be needed since many Candida species are resistant to first-line azole medications

  • 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 patients who wear dentures

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