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Candidiasis, Oral

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

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  • 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


  • 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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Rosen, Peter, et al., editors. "Candidiasis, Oral." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307219/all/Candidiasis__Oral.
Candidiasis, Oral. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307219/all/Candidiasis__Oral. Accessed April 26, 2019.
Candidiasis, Oral. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307219/all/Candidiasis__Oral
Candidiasis, Oral [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307219/all/Candidiasis__Oral.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Candidiasis, Oral ID - 307219 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307219/all/Candidiasis__Oral PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -