Home | Business News | Browse by Publication | J | Journal of Respiratory Diseases

Oropharyngeal candidiasis: Diagnostic clues, treatment tips: esophageal involvement is an ominous finding.

Article Excerpt
ABSTRACT: The most common manifestation of oropharyngeal candidiasis (OPC) is pseudomembranous candidiasis, commonly known as "thrush," which appears as a whitish yellow, curdlike discharge on the mucosal surfaces. Other forms of OPC include denture stomatitis, angular cheilitis, and glossitis. Patients with denture stomatitis are usually asymptomatic, but the tissue beneath the denture is typically red and hyperplastic. Patients with angular cheilitis may complain of a burning sensation at the margins of the lips. Candidiasis involving the tongue can be exuberant and is usually associated with complaints of a white tongue, taste alterations, and a burning sensation of the tongue. The diagnosis of OPC can be established by identifying typical fungal elements on potassium hydroxide preparation or Gram stain of scraped material. Treatment options include clotrimazole, fluconazole, itraconazole, and nystatin.

KEY WORDS: Candidiasis, Oral thrush, HIV/AIDS, Antifungal therapy STEPHEN A. KLOTZ, MD, NAND K. GAUR, PhD, and PETER N. LIPKE, PhD

**********

Oropharyngeal candidiasis (OPC) is a common clinical problem caused by fungi of the genus Candida, of which Candida albicans is the most commonly encountered species. OPC refers to disease caused by this fungus in or adjacent to the mouth. Occasionally, OPC is associated with esophageal candidiasis.

The presence of OPC should alert the physician to look for an underlying disease that may predispose the patient to this fungal infection. Two significant underlying problems associated with OPC that are frequently encountered are HIV-1 infection and neutropenia secondary to myelodysplastic disorders or cancer chemotherapy.

In this article, we will describe the common clinical presentations of OPC and review diagnosis and treatment. We also will briefly discuss the pathophysiology of OPC.

THE CAUSATIVE MICROORGANISM

C albicans, the predominant cause of OPC, lives in small numbers on the mucous membranes (the oropharynx, GI tract, and vagina) of humans and other vertebrates. The fungus survives within a dynamic consortium of resident microorganisms. It can be cultured from normal mouth tissue in many adults. (1)

C albicans has several morphologies, all of which can be seen in the lesions of OPC: yeast cells; true hyphae, which are cylindrical; and pseudohyphae, which are chains of elongated spheroidal cells. Another Candida species occasionally associated with OPC, particularly in patients with HIV infection, is Candida dubliniensis. C albicans adheres to mucous epithelia through fungal adhesins that are covalently anchored to the fungal cell walls. These adhesins have...

View this article FREE - Now for a Limited Time, try Goliath Business News
Free for 3 Days!