oropharyngeal candidiasis (thrush)
Jump to navigation
Jump to search
Etiology
- Candida albicans (most common)
- other species of Candida
- risk factors
Clinical manifestations
- white, cottage cheese-like, non-adherent, mucosal plaques (hyphae)[2] (pseudomembranous candidiasis)
- circumscribed patches of mucosal erythema
- grayish-white membrane with an erythematous base[1]
- distribution commonly buccal mucosa, throat, tongue & gingivae
- angular cheilosis
- classic thrush can be found on any mucosal surface
- erythematous candidiasis most commonly occurs on the palate
Laboratory
- yeast forms or pseudohyphae in KOH preparations of lesion scrapings
- fungal culture
- biopsy
- HIV testing
- Candida isolated from sputum not useful, including patients with mechanical ventilation[1]
Complications
- dysphagia suggests esophageal candidiasis
Differential diagnosis
- oral leukoplakia
- patches or plaques of the oral mucosa, associated with tobacco or chronic trauma
- oral hairy leukoplakia
- adherent white plaques, associated with EBV, HIV1 infection
- oral lichen planus
- occurs in older persons, associated with chronic trauma or medications
- lesions variable: reticular white plaques of the oral mucosa
- erosions & ulcerations may be painful
- geographic tongue
- appearance of denuded red patches migrating across the surface of the tongue
- map-like erythematous patches with white hyperkeratotic rims on dorsal surface of tongue[12]
Management
- topical therapy for mild-moderate disease (7-14 days)
- clotrimazole troches
- miconazole
- nystatin swish & swallow
- fluconazole
- amphotericin B mouthwash
- liquid formula itraconazole
- 1/2 strength OTC hydrogen peroxide (3%) gargle BID[4]
- systemic therapy for more severe disease (7-14 days) or evidence of esophageal candidiasis[1]
- resistant organisms
- switching to an alternate agent may be effective
- intravenous amphotericin B is usually effective
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 18. American College of Physicians, Philadelphia 1998, 2009, 2012, 2018.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 2.0 2.1 2.2 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016 - ↑ UpToDate Online 12.3, 2004
- ↑ 4.0 4.1 Veterans Administration, Infectious Disease, VISN21 Mather, CA
- ↑ Kaplan JE, Benson C, Holmes KH et al Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009 Apr 10;58(RR-4):1-207 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19357635
- ↑ Sharon V, Fazel N. Oral candidiasis and angular cheilitis. Dermatol Ther. 2010 May-Jun;23(3):230-42 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20597942
- ↑ Giannini PJ, Shetty KV. Diagnosis and management of oral candidiasis. Otolaryngol Clin North Am. 2011 Feb;44(1):231-40, vii. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21093632
- ↑ 8.0 8.1 Wikipedia: Oral candidiasis (image) https://en.wikipedia.org/wiki/Oral_candidiasis
- ↑ 9.0 9.1 DermNet NZ. Oral candidiasis (images) http://www.dermnetnz.org/fungal/oral-candidiasis.html
- ↑ Williams D, Lewis M. Pathogenesis and treatment of oral candidosis. J Oral Microbiol. 2011 Jan 28;3. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21547018 Free PMC Article
- ↑ Manfredi M, Polonelli L, Aguirre-Urizar JM et al Urban legends series: oral candidosis. Oral Dis. 2013 Apr;19(3):245-61. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22998462
- ↑ 12.0 12.1 NEJM Knowledge+