Oral Candidiasis

An opportunistic oropharyngeal fungal infection caused by candida species

Traditionally divided into acute or chronic types. Now divided into primary vs secondary types depending if other parts of the body are involved.

Clinical Forms

Acute/chronic pseudomembranous
- classic form- aka thrush – white coating that can be wiped away to leave a erythematous(red) base
Acute /chronic erythematous
- atrophic – red lesion on palate/dorsum of tongue(usually causes loss of lingual papillae – leaving a smooth area) – commonly associated with denture-stomatitis, angular-stomatitis, median rhomboid glossitis
Chronic hyperplastic
- aka plaque-like candidiasis or nodular candidiasis
- white plaque that does not rub off, may be rough or nodular
- usually on buccal mucosa
Angular candidiasis
- corners/angles of mouth usually mixed with s.aureus
- sore, red lesions- usually in the elderly or denture wearing patients
Denture candidiasis
- inflammation of mucosa under denture
Median rhomboid glossitis
- rhomboid lesion in the centre of the dorsal tongue – depapillated, red, commonly painless
Linear gingival erythema
- linear red inflamed gingiva, first seen in HIV patients and may cause necrotising ulcerative periodontitis
Chronic multifocal candidiasis
- rare, asssociate with other mucous membranes(secondary oral candidiasis)

Local predisposing factors

Systemic predisposing factors

Treatment

topical antifungals – nystatin, miconazole, gentian violet, amphotericin B, fusidic acid
systemic antifungals – fluconazole
surgery if not responding to antifungals
management of predisposing factors

Prognosis

Usually very good following treatment, but can recur if predisposing factors are not addressed
Can be a marker for underlying diseases e.g. HIV/AIDS or leukemia
Invasive candidiasis can be fatal