HEENT 09: Oral Candidiasis Flashcards
What are the causative organisms of oral candidiasis?
generally caused by C. albicans
- less commonly caused by C. glabrata and C. tropicalis
- candida is normal organism in flora – overgrowth can be due to decrease in competitive bacteria secondary to antibiotic use
What are the predisposing factors to oral candidiasis?
- recent antibiotic use
- immunosuppression, malignancy, diabetes, Cushings disease, HIV infection (most common opportunistic infection)
- inhaled corticosteroid use, chemotherapy, radiation therapy
- infants < 1
- dentures
- poor oral hygiene
- chronic dry mouth
- smoking
What are the symptoms of oral candidiasis?
- white, creamy white plaques/patches on lips, buccal mucosa, tongue, palate – can easily be scraped off (might cause mild bleeding), ‘milk curd’ or ‘cottage cheese’
- mild pain if any at all
- loss of taste
What are the differential diagnoses to oral candidiasis?
- milk residue in infants
- aphthous ulcers (canker sores)
- periodontal infection
- leukoplakia – malignant (may require biopsy), mostly see in > 30 year old men, usually on tongue
When is a referral required for oral candidiasis?
- between 1-65 years without predisposing factor – antibiotics in last 2 weeks, inhaled corticosteroids
- dentures
- recent burn to mouth
- receiving chemotherapy or radiation
- recently started new medication (sore mouth ADR)
- lesion present for > 3 weeks
- frequent recurrences
- no improvement in 7 days after treatment started OR not resolved after 14 days
- uncertain diagnosis
What are the 5 different types of oropharyngeal candidiasis?
- pseudomembranous (thrush)
- erythematous (atrophic)
- hyperplastic (candida leukoplakia)
- angular cheilitis
- denture stomatitis
Pseudomembranous (Thrush)
- neonates, HIV or cancer, elderly, broad spectrum antibiotic, steroid inhalers, xerostomia, smokers
- ‘cottage cheese’ plaques over areas of erythema, easily removed by rubbing
Erythematous (Atrophic)
- patients with HIV, broad spectrumb antibiotics, steroid inhalers
- sensitive and painful erythematous mucosa, very few plaques, flat red patches, can be acute or chronic
Hyperplastic (Candida Leukoplakia)
- smokers
- thick white keratotic plaques, not easily scraped off
Angular Cheilitis
- patients with HIV, denture wearers
- red ulcerative lesions at corners of mouth
Denture Stomatitis
- denture wearers with poor oral hygiene
- red, flat lesions beneath denture
What is the treatment for mild oropharyngeal candidiasis?
nystatin 100,000 units/mL suspension
- dose: 4-6 mL orally QID for 7-14 days (minimum for 2 days after symptoms resolve)
- swish and swallow
- as much contact time in mouth as possible
What is the treatment for severe oropharyngeal candidiasis?
fluconazole
- dose: 100-200 mg PO daily x 7-14 days
- prophylaxis: 100 mg 3x/week for high-risk (ie. CD4 counts < 200)
What is the drug of choice in HIV patients?
fluconazole
What drug can be used for dual therapy in breastfeeding patients?
fluconazole
What drug is used when fluconazole fails?
itraconazole
- dose: 100-200 mg PO daily x 14 days – also available as solution
- drug interactions
Posaconazole
- dose: 100 mg PO BID x 1 day, then 100 mg PO daily x 13 days
- increase dose in fluconazole failure or in HIV-infected people
- drug interactions
- expensive
What drug can be prescribed as a minor ailment by pharmacists?
nystatin
What is the treatment for esophageal candidiasis?
fluconazole 200-400 mg PO daily x 14-21 days
- can be given IV if they cannot tolerate oral therapy
- NOT considered minor ailment
What are the efficacy monitoring points for oral candidiasis?
- symptomatic relief in 48-72 hr
- if not resolved after 14 days, refer to physician
What are the safety monitoring points for oral candidiasis?
side effects very rare – only really results in contact dermatitis
