Candidiasis, Oral is a topic covered in the 5-Minute Emergency Consult.

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Basics

Description

  • 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 60% of the healthy population.
  • 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
  • In immunocompromised patients, more likely to be recurrent and a non-albicans species
  • May represent an early manifestation of AIDS in HIV-infected patients
  • Typically localized
  • Risk factors for systemic infection:
    • AIDS
    • Diabetes
    • Hospitalization
    • Immunosuppressive therapy
    • Malignancy
    • Neutropenia
    • Organ transplantation
    • Prematurity

Etiology

  • Usually overgrowth of C. albicans from alterations in intraoral environment
  • May be medication induced—commonly antimicrobials, inhaled or systemic steroids, chemotherapy, immunosuppressive agents
  • Immunocompromised patients
  • 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 immaturity of their immune system 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

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TY - ELEC T1 - Candidiasis, Oral ID - 307219 Y1 - 2016 PB - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307219/all/Candidiasis__Oral ER -