Oropharyngeal candidiasis: Difference between revisions
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==Background== | ==Background== | ||
*Typically occurs when the normal host immunity or host flora are disrupted, allowing for overgrowth of Candida albicans | *Also known as thrush | ||
*Typically occurs when the normal host immunity or host flora are disrupted, allowing for overgrowth of [[Candida albicans]] | |||
*Most commonly seen in infants, immunocompromised, older adults with dentures | |||
===Risk Factors=== | ===Risk Factors=== | ||
*Extremes of age | *Extremes of age | ||
*[[Antibiotics]] | *[[Antibiotics]] | ||
*Corticosteroids | *[[Corticosteroids]] | ||
*Immunocompromised (AIDS, immunosuppressant medications) | *Immunocompromised ([[AIDS]], immunosuppressant medications) | ||
*[[Diabetes]] | |||
*Malignancy | |||
==Clinical Features== | ==Clinical Features== | ||
*White curd-like plaques that are difficult to remove and leave behind an erythematous base | [[File:Human tongue infected with oral candidiasis.jpg|thumb|[[Oral thrush]]]] | ||
[[File:Oral thrush Aphthae Candida albicans. PHIL 1217 lores.jpg|thumb|"Acute pseudomembranous candidiasis" is a classic form of oral candidiasis, commonly referred to as thrush.]] | |||
[[File:CandidiasisFromCDCinJPEG03-18-06.jpg|thumb|Pseudomembranous candidiasis in a person with [[HIV]].]] | |||
[[File:PMC3218701 hiv-2-089f1.png|thumb|View of posterior pharynx showing pseudomembranous oropharyngeal candidiasis in a patient with [[HIV]], with a distribution concerning for esophageal candidiasis (later found on scope).]] | |||
[[File:Thrush2010.jpg|thumb|Oral candidiasis in an infant.]] | |||
*White curd-like (pseudomembraneus) plaques that are difficult to remove and leave behind an erythematous base on the oral mucosa, tongue, palate, or oropharynx | |||
*Usually painless | *Usually painless | ||
*Cotton sensation in mouth | |||
*Angular cheilitis | |||
*Loss of taste | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Tongue DDX}} | ||
{{DDX oral rashes and lesions}} | |||
== | ==Evaluation== | ||
*Most cases are diagnosed clinically and need only one of the treatments listed below<ref name=management>Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.</ref> | |||
**May consider KOH prep of skin scrapings (using a tongue depressor), if available | |||
*Consider [[HIV]] testing if no other etiology is determined or if risk factors are present | |||
==Management== | ==Management== | ||
* | ''Treatment is targeted against Candida species'' | ||
* | *Topical agents | ||
* | **Patients with their first presentation of mild thrush | ||
*Azole therapy | |||
**Patients with moderate to severe oropharyngeal candidiasis or for those | |||
**Patients with recurrent disease | |||
**HIV-positive patients who are at risk of developing esophageal candidiasis (CD4 count <100 cells/microL) | |||
===Antifungals=== | |||
*[[Voriconazole]] 200mg BID up to 28 days until symptom resolution | |||
**only for Candida species resistant to fluconazole | |||
{{Thrush Antifungals}} | |||
==Disposition== | ==Disposition== | ||
*Thrush is typically self-limited and patients may be discharged home unless concomitant symptoms require further work-up | |||
==See Also== | ==See Also== | ||
*[[Tongue | *[[Tongue diagnoses]] | ||
*[[Candidiasis]] | |||
== | ==References== | ||
<references/> | <references/> | ||
[[Category:ENT]][[Category:ID]] | |||
[[Category:ENT]] | |||
Latest revision as of 18:49, 2 December 2021
Background
- Also known as thrush
- Typically occurs when the normal host immunity or host flora are disrupted, allowing for overgrowth of Candida albicans
- Most commonly seen in infants, immunocompromised, older adults with dentures
Risk Factors
- Extremes of age
- Antibiotics
- Corticosteroids
- Immunocompromised (AIDS, immunosuppressant medications)
- Diabetes
- Malignancy
Clinical Features
Pseudomembranous candidiasis in a person with HIV.
View of posterior pharynx showing pseudomembranous oropharyngeal candidiasis in a patient with HIV, with a distribution concerning for esophageal candidiasis (later found on scope).
- White curd-like (pseudomembraneus) plaques that are difficult to remove and leave behind an erythematous base on the oral mucosa, tongue, palate, or oropharynx
- Usually painless
- Cotton sensation in mouth
- Angular cheilitis
- Loss of taste
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
Oral rashes and lesions
- Angioedema
- Aphthous stomatitis
- Herpes gingivostomatitis
- Herpes labialis
- Measles (Koplik's spots)
- Perioral dermatitis
- Oral thrush
- Steven Johnson syndrome
- Streptococcal pharyngitis
- Tongue diagnoses
- Vincent's angina
Evaluation
- Most cases are diagnosed clinically and need only one of the treatments listed below[1]
- May consider KOH prep of skin scrapings (using a tongue depressor), if available
- Consider HIV testing if no other etiology is determined or if risk factors are present
Management
Treatment is targeted against Candida species
- Topical agents
- Patients with their first presentation of mild thrush
- Azole therapy
- Patients with moderate to severe oropharyngeal candidiasis or for those
- Patients with recurrent disease
- HIV-positive patients who are at risk of developing esophageal candidiasis (CD4 count <100 cells/microL)
Antifungals
- Voriconazole 200mg BID up to 28 days until symptom resolution
- only for Candida species resistant to fluconazole
- 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
References
- ↑ Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.