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Oral Candidiasis
Oral Candidiasis

Oral Candidiasis

Introduction

This is a fungal infection of the oral mucosa caused by Candida infection mainly Candida albicans. Acute oral candidiasis (thrush) is seen most commonly in the malnourished, the severely ill, neonates and HIV-AIDS patients or patients on long term oral corticosteroid use. In chronic oral candidiasis dense white plaques of keratin are formed. Other risks for candidiasis include chronic diseases like diabetes mellitus, prolonged use of antibiotics and ill/poorly fitting dentures.

Pathophysiology

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Signs and symptoms

• White or yellow patches on inner cheeks, tongue, tonsils, gums, or lips
• Burning mouth
• A cotton-like sensation in mouth
• Dry and cracked skin at the corners of mouth
• Difficulty swallowing
• A bad taste
• A loss of taste sensation

Diagnostic criteria

Pseudomembranous

• White creamy patches/plaque
• Cover any portion of mouth but more on tongue, palate and buccal mucosa
• Sometimes may present as erythematous type whereby bright erythematous mucosal lesions with only scattered white patches/plaques

Hyperplastic

• White patches leukoplakia-like which are not easily rubbed-off.
• Angular cheilitis (angular stomatitis)
• Soreness, erythema and fissuring at the angles of the mouth
• Commonly associated with denture mastitis but may represent a nutritional deficiency or it may be related to orofacial granulomatosis or HIV infection

Investigation

Not recommended

To rule out other causes the following investigation maybe recommended

• Biopsy for testing of C. albicans
• Endoscopy to confirm throat
• Culture of throat swab

Treatment

Non-pharmacological

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Pharmacological

    Nystatin (suspension) 100,000IU (1 ml) mixture held in the mouth for at least 3minutes before swallowing, 4 times a day (after each feed)

    OR

    Miconazole (PO) gel 25mg/ml 5–10mls in mouth –hold in the mouth for 60 seconds before swallowing.

    The treatment should be continued for 5 days after cure/clearance.

    Where topical application has failed or candida infection has been considered severe use;

    • Fluconazole (PO) 150mg once daily for 7 days

    OR

    • Itraconazole (PO) 200mg once daily 7 days

    Note: Candidiasis has several risk factors; it is recommended that for HIV/AIDS patients with candidiasis the HIV guidelines should be referred to.

Prevention

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Updated on,

4 Novemba 2020 08:52:44

References

1.STG
2.BMJ journals. Oral candidiasis.https://pmj.bmj.com/content/78/922/455. Accessed 4. 11.2020
3. Healthline. Oral thrush. https://www.healthline.com/health/thrush#is-thrush-contagious. Accessed 4. 11.2020

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