Oral candidiasis - Oral Mucosal Lesion
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Synopsis
Risk factors include hyposalivation states leading to dry mouth (especially medication-related xerostomia and post-head and neck radiation-related xerostomia), antibiotic therapy, oral leukoplakia, a carbohydrate-rich diet, medications such as inhaled corticosteroids, fluid and electrolyte imbalance, smoking, diabetes mellitus, and immunosuppression. For angular cheilitis, dentures that do not adequately support the oral musculature, causing drooping of the corners of the mouth and pooling of saliva, may predispose.
Patients may complain of a sore, sensitive, or burning sensation. Itching has also less frequently been described. Others may be wholly asymptomatic.
Pseudomembranous candidiasis (thrush) usually develops fairly rapidly over a few days, while the erythematous and hyperplastic forms tend to be chronic and present for weeks or months.
Candida albicans is the most commonly implicated species in oral candidiasis. Species of Candida that are occasional causes of disease, particularly in AIDS-infected patients and patients with a history of head and neck radiation, are Candida glabrata (formerly known as Torulopsis glabrata), Candida tropicalis, Candida krusei, Candida dubliniensis, and others.
Immunocompromised Patient Considerations:
Oral candidiasis is seen with greater frequency in patients with leukemia or other malignancies, individuals with AIDS, and individuals receiving immunosuppressive agents (eg, systemic corticosteroids, azathioprine, cyclosporine A, or tacrolimus). Patients with diabetes are also predisposed. Risk factors for oral candidiasis in the HIV-positive population include low CD4 count (< 200 cells/microl), being antiretroviral naïve, and current smoking.
Codes
ICD10CM:B37.0 – Candidal stomatitis
SNOMEDCT:
79740000 – Oral candidiasis
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Lichen planus – Usually reticulated and erythematous rather than plaque-like, although 20% of oral lichenoid lesions will have superimposed candidiasis.
- Geographic tongue – Usually affects lateral / dorsal, rather than midline posterior, tongue.
- Oral hairy leukoplakia – An HIV-associated disease; often has an associated secondary candidal infection and is most common on the lateral borders of the tongue, often (but not always) in a bilateral and symmetric distribution.
- Aphthous ulcers – Much more painful and episodic than candidiasis.
- Chronic cheek chewing – Usually painless with a gelatinous, shaggy consistency.
- Leukoplakia
- Squamous cell carcinoma – Even early lesions should have some degree of induration and possibly ulceration, which would not be consistent with candidiasis.
- Erythroplakia – Affects areas where squamous cell carcinoma develops.
- Hypersensitivity reaction to denture base material – Rare.
- Diphtheria – The membrane in diphtheria can be mistaken for candidiasis, although in diphtheria there may be hemorrhagic crusts around the mouth and nares.
- Hairy tongue – This is hyperkeratosis of the filiform papillae, not a yeast infection.
- White sponge nevus – There may be a family history of this very uncommon genodermatosis.
- Uremic stomatitis
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:10/22/2017
Last Updated:02/10/2023
Last Updated:02/10/2023
Patient Information for Oral candidiasis - Oral Mucosal Lesion
Overview
Thrush (oral candidiasis), also known as oral moniliasis, is a yeast infection of the mouth or throat (the oral cavity). The yeast that most commonly causes oral candidiasis is Candida albicans.Who’s At Risk
Thrush is very common in infants. Adults who develop thrush include:- People with diabetes or other glandular (endocrine) disorders
- Denture wearers
- People taking antibiotics
- Persons undergoing chemotherapy
- Drug users
- People with poor nutrition
- Persons who have an immune deficiency, such as HIV
- People who use inhaled steroids for certain lung conditions
- Pregnant women or women on birth control pills
Signs & Symptoms
Thrush may appear as white or pale yellow spots on the inner surfaces of the mouth and throat, the tongue, and the lips. It may resemble cottage cheese or milk curds. However, scraping off these membranes may be difficult and may leave slightly bleeding sores.Thrush may be associated with a burning sensation in the mouth or throat.
Self-Care Guidelines
Thrush may make eating and drinking uncomfortable, and people with thrush may become dehydrated. It is important to maintain good nutrition and hydration while infected with thrush.Thrush needs medications prescribed by a health care practitioner.
When to Seek Medical Care
Thrush requires prescription medication after a quick visit to the physician. People with an immune system deficiency need even prompter and more aggressive treatment to make certain that the yeast does not enter the bloodstream or infect other organs. If the white or yellow membranes of thrush are accompanied by fever, chills, vomiting, or generalized illness, more immediate medical attention is warranted.Treatments
Although meticulous oral hygiene practices must be followed, treatments center on killing the overgrown yeast with anti-fungal medications.- Nystatin - This medicine must come into contact with the yeast in order to kill it. Nystatin comes in a suspension, or liquid, and in a lozenge, also called a troche. The suspension is swished around the mouth and then swallowed. The lozenge dissolves in the mouth. Both the suspension and the lozenges are used several times a day until the lesions are completely gone.
- Amphotericin B suspension - The suspension is swished and swallowed several times a day until complete resolution of the lesions.
- Clotrimazole lozenge - The lozenge is dissolved in the mouth several times a day until the lesions have disappeared entirely.
- Fluconazole pill - This medication is swallowed once daily for 5-10 days.
References
Bolognia, Jean L., ed. Dermatology, pp.837, 1095, 1096, 1185. New York: Mosby, 2003.
Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed, pp. 2013. New York: McGraw-Hill, 2003.
Oral candidiasis - Oral Mucosal Lesion
See also in: Overview