Mouth
Thrush
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Thrush
, Oral Candidiasis, Candida Albicans Pharyngitis
Epidemiology
Common in infants, especially
Breast
fed
Rare in first week of life
Peaks at 4 weeks of age
Risk Factors
Adults with Thrush (
Immunodeficiency
)
Human Immunodeficiency Virus
Corticosteroid
exposure
Prolonged systemic steroids
Inhaled Corticosteroid
s
Dentures
Xerostomia
Leukemia
Malnutrition
Radiation Therapy
Systemic
Chemotherapy
Broad-spectrum antibiotics
Risk Factors
Children with chronic Thrush
Hypoparathyroidism
Addison's Disease
Hypothyroidism
Diabetes Mellitus
Risk Factors
Systemic
Candidiasis
Acquired
Immunodeficiency
Virus
Diabetes Mellitus
Immunosuppressive Therapy
Malignancy
Neutropenia
Organ
Transplantation
Prematurity
Symptoms
Pharyngitis
Oral burning sensation
Mild
Pharyngitis
compared with
Streptococcal Pharyngitis
Dysphagia
Nausea
Vomiting
Signs
Typical erythematous
Candidiasis
White, curd-like or cottony patches or
Plaque
s
Adherent to erythematous mucosa over
Palate
,
Buccal mucosa
,
Tongue
Adherent, but does rub off with scraping to reveal an underlying erythematous base
Signs
Alternative presentations
Median Rhomboid Glossitis
Perleche
(
Angular Cheilitis
)
Differential Diagnosis
See
Pharyngitis Causes
Other opportunistic fungus (e.g.
Aspergillus
) in immunocompromised patients
Leukoplakia
Does not rub off with scraping
Esophageal
Candidiasis
(immunocompromised patients)
Consider if
Dysphagia
or odynophagia
Management
Gene
ral Measures
In HIV patients,
Antiretroviral
therapy is typically used to prevent recurrence
Management
First-Line Agents
Nystatin
Adults
Pastilles: 200,000 u lozenge qid for 14 days
Swish and swallow: 500,000 u qid for 14 days
Tablets: Two 500,000 u tablets tid for 14 days
Children
Suspension (100,000 u/ml): Swab 1 ml on each cheek
Clotrimazole
troche (Mycelex)
Adults
Troche: 10 mg five times daily for 14 days
Vaginal Suppository: 100 mg qd to bid for 14 days
Adverse Effects
May raise
Liver Function Test
s
Gastrointestinal Side effects
Fluconazole
Adults
Initial: 200 mg orally for 1 dose
Later: 100 mg daily for 5-7 days (up to 10-14 days)
Suppression in immunocompromised patients:
Fluconazole
100 mg orally three times weekly
Children
Protocol 1: 5 mg/kg orally daily for 5 days
Protocol 2: 6-12 mg/kg day 1, then 3-6 mg/kg for 10 days
Chetwynd (2002) J Hum Lact 18:168-71 [PubMed]
Management
Alternative Agents
Itraconazole
Indicated in immunocompromised adults with concurrent esophageal involvement (also covers
Aspergillus
)
Adults: 200 mg orally daily for 10-14 days
Amphotericin B Oral Suspension
Adults with HIV: 3-5 ml PO qid
Indicated for refractory oropharyngeal
Candidiasis
Other
Antifungal
agents
Posaconazole
Voriconazole
Capsofungin, Micafungin or Anidulafungin
Miconazole
gel
Not currently available in U.S.
Other treatments used historically
Gentian Violet?
Homemade Recipe
2 drops of dish soap
1/4 tsp baking soda
Glass of warm water
Apply to roof of mouth w/ cotton applicator qid
Reference
Anderson (2019) Crit Dec Emerg Med 33(9): 3-10
Hoppe (1997) Pediatr Infect Dis J 16:885-94 [PubMed]
Pappas (2016) Clin Infect Dis 62(4):409-17 +PMID:26810419 [PubMed]
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