Makindo Medical Notes

About

• Oral Candidiasis is very overdiagnosed. Unlikely if no pain and only on the tongue. Simply overgrown papillae on tongue.

Risks

• Diabetes mellitus, salivary gland dysfunction, immunosuppression.
• Associated with poor oral hygiene, lack of oral intake, systemic antibiotics.
• Dentures, newborn babies, Sjogren's syndrome (dry mouth), malnutrition.
• Oral inhaled steroids (failing to wash mouth out after use).
• Cytotoxics, malignancy.

Clinical

• Superficial white plaques which when rubbed show an erythematous surface.
• Bleeding raw mucosa when scraped off.
• Can be found on the buccal mucosa or tongue.
• Extensive oral candidiasis should raise the possibility of HIV disease.
• Oesophageal disease can cause odynophagia
• It should raise the possibility of HIV disease.

Investigations

• Where indicated:
  • Blood glucose levels.
  • Full Blood Count (FBC).
  • White Cell Count (WCC).
  • HIV test.
• Biopsy where diagnosis is unclear and fails to respond to initial measures.

Management

• Oral antifungal agents, e.g., nystatin (e.g., Nystan oral suspension).
• Amphotericin (e.g., Fungilin lozenges).
• Miconazole (e.g., Daktarin oral gel).

Conclusion

Oral Candidiasis is often overdiagnosed, particularly in the absence of pain. It is characterized by overgrown papillae on the tongue and can present with superficial white plaques that bleed upon scraping. Risk factors include immunosuppression, diabetes mellitus, poor oral hygiene, and the use of inhaled steroids without proper oral care. Comprehensive clinical assessment and appropriate antifungal therapy are essential for effective management. In cases of extensive oral candidiasis, underlying conditions such as HIV should be considered.

References

• Mayo Clinic. Oral Thrush (Candidiasis). Available at: https://www.mayoclinic.org
• National Health Service (NHS). Oral Candidiasis. Available at: https://www.nhs.uk
• American Academy of Dermatology Association. Oral Candidiasis. Available at: https://www.aad.org
• World Health Organization (WHO). Candida Infections. Available at: https://www.who.int
• Flickinger, J. C., et al. (2017). Oral Candidiasis: Clinical Presentation, Diagnosis, and Management. Journal of Clinical Microbiology.