Candidiasis, Oral
Basics
Description
Description
- Candida is a fungus
- Candidiasis is an opportunistic infection
- Infection of oral mucosa with any species of Candida
- Up to 80% of isolates are Candida albicans (most common), Candida glabrata, and Candida tropicalis
- Candida normally present as oral flora in 30–50% of the healthy population
- Rates of carriage increase with age
- Variations include:
- Pseudomembranous (thrush)
- Chronic and acute atrophic candidiasis
- Angular cheilitis
- Hyperplastic candidiasis
- More common in neonates, elderly, and immunosuppressed individuals
- Usually benign course in healthy patients
- More likely to be recurrent and a non-albicans species in immunocompromised patients
- May represent an early manifestation of AIDS in HIV-infected patients
- Typically localized
- Risk factors for systemic infection:
- HIV—most common oral manifestation
- Diabetes
- Hospitalization
- Immunosuppressive therapy
- Malignancy
- Neutropenia
- Organ transplantation
- Prematurity
Etiology
Etiology
- Usually overgrowth of C. albicans from alterations in intraoral environment
- May be medication induced—commonly antimicrobials, inhaled or systemic steroids, chemotherapy, immunosuppressive agents
- Alterations or impairment of salivary flow:
- Anticholinergic or psychotropic medications
- Sjögren disease
- Head or neck radiation
- Presence of dentures or other orthodontics:
- Occurs in up to 50–65% of denture wearers
- Common etiology for chronic atrophic candidiasis
- Interruption of epithelial barrier (cheek biting)
- Endocrinopathies (diabetes, hypothyroidism)
Pediatric Considerations
- Acute pseudomembranous candidiasis (thrush) is common in infancy likely because of immune system immaturity and lack of mature oral flora
- Initial presentation may be feeding difficulty secondary to dysphagia
- May have concurrent Candida diaper rash
- Consider maternal treatment if breastfeeding:
- Maternal breast colonization may be cause for persistent thrush
- Query maternal nipple pain, burning, itching, or cracked skin
Geriatric Considerations
- Candida organisms are normally present as oral flora from 65–88% of elderly or those in long-term care facilities
- Dentures can lead to Candida overgrowth
- Angular cheilitis more common in the elderly secondary to facial wrinkling
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Citation
Schaider, Jeffrey J., et al., editors. "Candidiasis, Oral." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307219/0.1/Candidiasis_Oral.
Candidiasis, Oral. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307219/0.1/Candidiasis_Oral. Accessed December 3, 2024.
Candidiasis, Oral. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307219/0.1/Candidiasis_Oral
Candidiasis, Oral [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 03]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307219/0.1/Candidiasis_Oral.
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