Disease name and synonyms

Oral candidiasis (candidosis), oral thrush, oropharyngeal candidiasis (OPC)

Fungi responsible (links to these)

Candida albicans (>98%)
Rarely C. glabrata and Candida krusei.

Disease description

A painful mouth with loss of taste is the most common symptom. The commonest pattern of OPC is the pseudomembranous form, but an exanthematous type is also found. Occasionally, denture-related candidosis or angular cheilitis (corner of the mouth) are the primary manifestations. In AIDS, the pseudomembranous form predominates.

Frequency and global burden

Oral thrush in HIV/AIDS occurs in ~2.5 million people worldwide based on ~90% of patients not taking but needing anti-retroviral therapy. At least another 1 million are affected who do not have HIV infection.

Underlying problems and at risk patients

It is very common in HIV/AIDS, with declining immunity and leukaemia and stem cell transplantation unless prevented with antifungals)

Common in newborns and patients on head and neck radiotherapy

It is occasional in asthmatics taking inhaled steroids and other immunocompromised patients.

Chronic mucocutaneous candidiasis (rare genetic disorder) caused by either the AIRE mutation or a STAT1 mutation, in most cases.

Diagnostic testing

Inspection of the mouth (including under dentures) showing white plaques or erythematous patches.
Fungal culture and/or microscopy

Treatments

Topical – nystatin, amphotericin B, clotrimazole, chlorhexidine, others

Oral – fluconazole, itraconazole solution, ketoconazole, voriconazole, posaconazole

Rinse mouth out immediately after using steroid inhalers for asthma.

IDSA clinical practice guidelines 2016

Outlook and prognosis

Usually excellent. May be associated with oesophageal candidiasis, which does not resolve with topical therapy. May recur, especially in AIDS, denture wearers and chronic mucocutaneous candidiasis patients. Antifungal resistance a problem if recurrent treatments.