欧博娱乐Oropharyngeal candidiasis
Background Risk Factors Clinical Features
Oral thrush
"Acute pseudomembranous candidiasis" is a classic form of oral candidiasis, commonly referred to as thrush.
Pseudomembranous candidiasis in a person with HIV.
View of posterior pharynx showing pseudomembranous oropharyngeal candidiasis in a patient with HIV, with a distribution concerning for esophageal candidiasis (later found on scope).
Oral candidiasis in an infant.
White curd-like (pseudomembraneus) plaques that are difficult to remove and leave behind an erythematous base on the oral mucosa, tongue, palate, or oropharynx
Usually painless
Cotton sensation in mouth
Angular cheilitis
Loss of taste
Differential Diagnosis Tongue diagnoses Oral rashes and lesions EvaluationMost cases are diagnosed clinically and need only one of the treatments listed below
May consider KOH prep of skin scrapings (using a tongue depressor), if available
Consider HIV testing if no other etiology is determined or if risk factors are present
ManagementTreatment 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)
AntifungalsNystatin 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 DosingIf the patient is breast feeding it is important for the mother to treat her nipples before and after feeding
Clotrimazole 10mg PO five times daily for 14 days
reserved for patients > 3 years old
Thrush is typically self-limited and patients may be discharged home unless concomitant symptoms require further work-up
See Also References
Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 62:e1.