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.
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
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
- 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
1st investigations to order
- superficial smear of lesion for microscopy
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
- electrolyte panel
severely immunocompromised: prophylactic-therapy
- Chemical burns
- Reactive keratosis
- Hairy leukoplakia
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
- Guidelines for the prevention and treatment of opportunistic infections in children with and exposed to HIV
Oral thrush: what is it?
Oral thrush: what treatments work?More Patient leaflets
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer