Candidiasis

Candidiasis

Cause and presentation

Infections with Candida albicans appear suddenly, on the tongue, lips or other mucosae, in the ‘pseudomem-branous form’ (also called thrush; Fig. 14.47). Small lesions are more common than large ones. About 15% of infants get thrush on the tongue, lips or buccal mucosa, often from an infection acquired while pass-ing through the birth canal. Sometimes candidiasis appears as red sore patches under dentures, or as angular chelitis (perlèche).

Course

If the candidiasis is a complication of systemic anti-biotic therapy, treatment will be curative. Immuno-suppressed and denture-wearing patients often have recurrent disease.

Differential diagnosis

Many tongues are coated with desquamated epithelial cells that create a yellow wet powder on their surface. 

This scapes off easily, and shows no inflammation underneath. Lichen planus, oral hairy leukoplakia and dysplastic leukoplakia may cause confusion.

Investigations

Thrush does not normally occur in healthy adults, in whom the appearance of candidiasis needs more investigation than just a simple diagnosis by appear-ance, KOH examination or culture. Table 13.5 lists some possible underlying causes.

Treatment

Topical and systemic imidazoles are the treatments of choice. Creams and solutions can be used, but suck-ing on a clotrimazole troche  three times daily is better. Some patients are best treated with fluconazole, 150 mg once daily for 1–3 days. If an underlying condition is present, this should be identified and treated. Patients with ‘denture sore mouth’ should scrub their dentures each night with toothpaste and a toothbrush, sleep without dentures, and swish a teaspoonful of nystatin solution around the dentureless mouth three times a day.