Oropharyngeal candidiasis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{ | {{Tongue DDX}} | ||
{{DDX oral rashes and lesions}} | |||
==Diagnosis== | ==Diagnosis== | ||
Revision as of 21:16, 26 April 2016
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
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
Diagnosis
- 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