Oropharyngeal candidiasis
Revision as of 18:13, 28 February 2016 by Neil.m.young (talk | contribs)
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
- 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
- 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
- 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