DefinitionThis section has been translated automatically.
ClassificationThis section has been translated automatically.
According to Mayser (2018) several clinical manifestations can be distinguished:
- Acute pseudomembranous candidosis (oral thrush)
- Acute erythematous candidosis
- Acute atrophic candidiasis (dental carrier stomatitis)
- Chronic hyperplastic candidiasis (Candida leukoplakia)
- Perlèche (Angulus infectiosus)
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Occurrence/EpidemiologyThis section has been translated automatically.
Increased incidence especially in infants, in patients with chronic bronchial asthma who are permanently treated with inhaled glucocorticoids, in immunosuppression, diabetes mellitus or in old people with poorly fitting and well maintained dentures. Oral candidiasis is the most common opportunistic disease in HIV-infected persons. Predisposing are also erosive diseases of the oral mucosa such as lichen planus erosivus, pemphigus vulgaris and others.
Clinical featuresThis section has been translated automatically.
Acute pseudomembranous candidosis (oral thrush)
Acute pseudomembranous candidiasis is the clinical manifestation of oral candidiasis, which is generally referred to as classic oral thrush. It occurs mainly in newborns and in immunodeficiency.
In this case, whitish deposits are found on flat enanthema, low in symptoms, initially in stippling, later on small areas or confluent large areas. The coatings can be easily removed with a wooden spatula. After stripping off the coatings, there is an underlying, deep red, slightly bleeding mucous membrane. Subjectively, discomfort such as impaired taste and/or furry feeling is expressed. This form of oral candidiasis is often associated with candidiasis of the pharynx, oesophagus or tongue.
Acute erythematous candidiasis
Clinically a swollen, shiny, bright red oral mucosa with elapsed papillae is found. The tongue surface is usually affected. Acute erythematous candidosis usually develops from pre-existing acute pseudomembranous candidosis. It occurs mainly with immunodeficiencies or after long-term antibiotic therapy.
Chronic atrophic candidiasis
This form of oral candidiasis usually occurs with prosthesis wearers (dentition carrier stomatitis) under the contact points of the denture. The lesional mucosa is bright red, atrophically shiny. The changes in the hard palate as well as in the gingival mucosa of the upper and lower jaw correspond to the prosthesis contact points. The subjective sensation is only slightly disturbed.
Until today it is still unclear whether this clinical symptomatology can be described as Candida leukoplakia or as hyperplastic candidiasis. It is also unclear whether the Candida infection is the cause of the leukoplakia or whether it is a superinfection of a pre-existent mucosal change.
Clinically, this clinical picture is characterized by a (cobblestone-like) leukoplakia (in contrast to the classic oral thrush, no easily strippable deposits). The leukoplakic changes are surrounded by an erythema border. The delimitation (or exclusion) of a premalignant leukoplakia is important.
DiagnosisThis section has been translated automatically.
General therapyThis section has been translated automatically.
External therapyThis section has been translated automatically.
Internal therapyThis section has been translated automatically.
In case of severe affection or involvement of the esophagus (thrush esophagitis) systemic therapy with Fluconazole (e.g. Diflucan) 200 mg/day for 10-14 days. Resistances are known, after therapy control with pharyngeal rinsing water or combination therapy with Amphotericin B or liposomal Amphotericin B (AmBisome) and Flucytosin (e.g. Ancotil). S.u. Candida sepsis.
Alternative: Posaconazole day 1:1x200mg p.o.; afterwards 100mg p.o. for 13 days.
Alternative: In therapy-resistant cases Amphotericin B 0.3 mg/kg bw/day i.v. for 5-10 days.
Secondary prevention of recurrent oral thrush (possibly with oral esophagitis): Fluconazole 50 mg/day p.o. or 3 times/week 100 mg/day p.o. Alternatively: Posaconazole: 3x200mg/day.
In immunocompromised patients: Fluconazole initially 200 mg p.o., then 100 mg/day for 5-10 days. In case of non-response double the dose.
AftercareThis section has been translated automatically.
LiteratureThis section has been translated automatically.
- Fukushima C et al (2003) Oral candidiasis associated with inhaled corticosteroid use: comparison of flucasone and beclomathasone. Ann Allergy Asthma Immunol 90: 646-651
Mayer P (2018) Mycoses. In: Braun-Falco`s Dermatology, Venerology Allergology G. Plewig et al. (Hrsg) Springer Verlag S 280-281
Incoming links (18)Acute erythematous candidiasis; Acute erythematous candidosis of the oral mucosa; Acute pseudomembranous candidosis; Acute pseudomembranous candidosis; Amphotericin b; Candida folliculitis; Candida leukoplakia; Candida leukoplakia; Chronic atrophic candidiasis; Chronic mucocutaneous candidiasis; ... Show all
Outgoing links (8)Amphotericin b; Antimycotics; Candida sepsis; Fluconazole; Flucytosine; Nystatin; Perlèche (overview); Posaconazole;
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.