Oral candidiasis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 21 Oct 2024

Last updated: 22 Aug 2023

Oral candidiasis is an oral infection resulting from yeasts of the genus Candida, mostly C albicans. The pseudomembranous form is commonly known as 'thrush'.

Superficial local mucosal infection, capable of focal invasion and dissemination.

Seen most frequently in association with local and systemic immunological suppression.

Clinical appearance is important for diagnosis.

Treatment is with topical or systemic antifungals depending on severity of infection.

Definition

Oral candidiasis involves a local infection of oral tissues by yeasts of the genus Candida, mostly C albicans. It is the most common oral fungal infection and is commonly seen in infants and older adults, and also with states of local and systemic immunological suppression. Although Candida are considered normal flora in the gastrointestinal and genitourinary tracts in humans, they are capable of local infection of mucous membranes (oropharyngeal candidiasis, oesophagitis, vulvovaginitis), focal invasion (endophthalmitis, meningitis, endocarditis), and dissemination (candidaemia).

History and exam

Key diagnostic factors

presence of risk factors
creamy white or yellowish plaques, fairly adherent to oral mucosa
burning oral pain
cracks, ulcers, or crusted fissures radiating from angles of the mouth

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Other diagnostic factors

unpleasant taste in the mouth
lesions on any part of the oral mucosa
atrophic, fiery red, flat lesions on the palate
patchy areas of loss of filiform papillae on the dorsum of the tongue
spotty red areas on the buccal mucosa
lesions confined to the outline of a dental prosthesis
dysphagia or odynophagia
rhomboid outline on the dorsal aspect of the tongue
continuous or patchy band of erythema, involving the free gingival margin

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Risk factors

hyposalivation/xerostomia
poor oral hygiene, especially among denture wearers
malabsorption and malnutrition
advanced malignancy
cancer chemotherapy and radiotherapy
HIV infection
endocrine disturbance (e.g., diabetes mellitus, hypoparathyroidism, pregnancy, hypoadrenalism)
immunosuppressive agents (e.g., local or systemic corticosteroid therapy)
current or recent past use of broad-spectrum or multiple narrow-spectrum antibiotics
extremes of age
high carbohydrate diet

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Diagnostic investigations

1st investigations to order

superficial smear of lesion for microscopy

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Investigations to consider

biopsy of lesion
culture of mouth rinse sample
upper GI endoscopy with or without biopsy of lesions
urinalysis, random or fasting blood glucose, or glucose tolerance test to exclude diabetes
HIV antibody test
sialometry
electrolyte panel

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Treatment algorithm

ACUTE