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Oral candidiasis - Oral Mucosal Lesion
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Oral candidiasis - Oral Mucosal Lesion

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Contributors: Kiasha Govender MBChB, MMed, FCDerm, Anisa Mosam MBChB, MMed, FCDerm, PhD, Ncoza C. Dlova MBChB, FCDerm, PhD, Susan Burgin MD
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Synopsis

Oral candidiasis, also known as moniliasis or thrush, is a common yeast infection of the oral mucosal membranes typically caused by Candida albicans. Oral candidiasis frequently affects otherwise healthy individuals, although it is seen with greater frequency in immunocompromised individuals. Oral Candida carriage rates are higher in human immunodeficiency virus (HIV)-infected individuals, intravenous drug abusers, and denture wearers.

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

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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.

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.

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References

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Last Reviewed: 10/23/2017
Last Updated: 10/23/2017
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Oral candidiasis - Oral Mucosal Lesion
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Oral candidiasis (Adult/Child Presentation) : Oral white plaque, Dysphagia, Oral burning sensation, Altered taste
Clinical image of Oral candidiasis
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