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16.4 Fungal Infections

Table of Contents

16.4.1 Oral Candidiasis

This is a fungal infection of the oral mucosa caused by Candida infection mainly Candida albicans. Acute oral candidiasis (thrush) is seen most commonly in the malnourished, the severely ill, neonates and HIV-AIDS patients or patients on long term oral corticosteroid use. In chronic oral candidiasis dense white plaques of keratin are formed. Other risks for candidiasis include chronic diseases like diabetes mellitus, prolonged use of antibiotics and ill/poorly fitting dentures.

Diagnostic Criteria

Feature of candidiasis are divided according to the types as follows:

Pseudomembranous

  • White creamy patches/plaque
  • Cover any portion of mouth but more on tongue, palate and buccal mucosa
  • Sometimes may present as erythematous type whereby bright erythematous mucosal lesions with only scattered white patches/plaques

Hyperplastic

  • White patches leukoplakia-like which are not easily rubbed-off.
  • Angular cheilitis (angular stomatitis)
  • Soreness, erythema and fissuring at the angles of the mouth
  • Commonly associated with denture mastitis but may represent a nutritional deficiency or it may be related to orofacial granulomatosis or HIV infection

Pharmacological Treatment

A: Nystatin (suspension) 100,000IU (1 ml) mixture held in the mouth for at least 3minutes before swallowing, 4 times a day (after each feed)

OR

C: Miconazole (PO) gel 25mg/ml 5–10mls in mouth –hold in the mouth for 60 seconds before swallowing. The treatment should be continued for 5 days after cure/clearance.

Where topical application has failed or candida infection has been considered severe use;

A: Fluconazole (PO) 150mg once daily for 7 days

OR

C: Itraconazole (PO) 200mg once daily 7 days

NoteCandidiasis has several risk factors; it is recommended that for HIV/AIDS patients with candidiasis the HIV guidelines should be referred to.

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