Oropharyngeal candidiasis

Background

• Typically occurs when the normal host immunity or host flora are disrupted, allowing for overgrowth of Candida albicans.

Risk Factors

• Extremes of age
• Antibiotics
• Corticosteroids
• Immunocompromised (AIDS, immunosuppressant medications)

Clinical Features

Oral thrush

• White curd-like plaques that are difficult to remove and leave behind an erythematous base
• Usually painless

Differential Diagnosis

Tongue diagnoses

• Tongue laceration
• Strawberry tongue
• Black hairy tongue
• Oropharyngeal candidiasis (oral thrush)
• Hairy Oral Leukoplakia
• Tongue swelling
  • Trauma
  • Angioedema
    • Hereditary
    • Allergic (ACE)
    • Idiopathic

Workup

• Most cases are diagnosed clinically and need only one of the treatments listed below.
• Consider HIV testing if no other etiology is determined or if risk factors are present.

Management

Treatment is targeted against Candida species

Antifungals

• Nystatin oral suspension 400,000-600,000 units (swish and swallow) Q6H until 48 hours after symptoms disappear OR
• Clotrimazole 10 mg troches 5 times/day for 14 consecutive days OR
• Fluconazole 200 mg (Peds: 6 mg/kg) PO on day one, followed by 100 mg (Peds: 3 mg/kg_ daily for two weeks.
  • Fluconazole is reserved for moderate to severe disease

Pediatric Dosing

If the patient is breast feeding it is important for the mother to treat her nipples before and after feeding

• Nystatin Oral Suspension
  • 100,000 units/ml for 14 days for all ages
  • Premature infants should only have 0.5 - 1 mL given to each side of the mouth every 6 hours
• Clotrimazole 10mg PO five times daily for 14 days
  • reserved for patients > 3 years old

Disposition

• Thrush is typically self-limited and patients may be discharged home unless concomitant symptoms require further work-up

See Also

• Tongue Diagnoses