Oral Candidiasis Thrush

Monilla, or oral candidiasis (thrush), is one of the fungal infections of the pharynx. Extensive white areas cover the entire oropharynx, and are not confined to the tonsil. They are either continuous (Fig. 4.56a) or punctate (Fig. 4.56b). A swab shows Candida albicans and confirms the diagnosis. The condition responds to antifungal mouth washes or lozenges containing nystatin or amphotericin. It is commoner in neonates, and may complicate treatment with broad spectrum antibiotics.

Oral candidiasis is one of the commonest upper respiratory tract manifestations of AIDS; unexplained oral fungal infection should make the possibility of AIDS a diagnostic consideration (Fig. 4.57). Nasal vestibulitis and cervical lymphadenopathy may be associated findings.

Fig. 4.56 Oral candidiasis. a Extensive continuous white areas covering the oropharynx. b Extensive punctate white areas covering the oropharynx.

Oral Thrush
Fig. 4.57 AIDS-related oral candidiasis. This is a common presentation of HIV infection. Oral Candida is treated with topical or systemic antifungal agents, e.g., nystatin, ketoconazole, or fluconazole. If there is dysphagia with oral candida, esophageal involvement should be suspected.
Oral Candida

Fig. 4.58 Hairy leukoplakia. Oral candidiasis is the commonest presentation in the pharynx of AIDS, but hairy leukoplakia (arrows) is a further presentation, along with cervical lymphadenopathy.

Oral hairy leukoplakia differs from oral candida in that it is distributed along the lateral borders of the tongue and cannot be scraped off. It is due to Epstein-Barr virus reactivation. Mouth ulcers also occur with HIV infection and good oral

Fig. 4.58 Hairy leukoplakia. Oral candidiasis is the commonest presentation in the pharynx of AIDS, but hairy leukoplakia (arrows) is a further presentation, along with cervical lymphadenopathy.

Oral hairy leukoplakia differs from oral candida in that it is distributed along the lateral borders of the tongue and cannot be scraped off. It is due to Epstein-Barr virus reactivation. Mouth ulcers also occur with HIV infection and good oral hygiene and dental care are important adjuncts to treatment.

Ulcerative Pharyngitis

Fig. 4.60 Chronic pharyngitis. In this condition there is a generalized hyperemia of the pharyngeal mucous membrane, with hyperemic masses of lymphoid tissue on the posterior wall of the oropharynx. A persistent, slightly sore throat is the main symptom. The cause is usually "irritative" rather than due to chronic infection. Environment, occupation, diet, and tobacco are the common factors.

Sores Uvula

Fig. 4.61 Scleroma with scarring of the soft palate and oropharynx. This is a specific chronic inflammatory disease of the upper respiratory tract mucosa predominantly occurring in Eastern Europe, Asia, and South America. A protracted painless inflammation of the nose (rhinoscleroma), pharynx, or larynx is followed after many years by extensive scarring, which is particularly apparent in the oropharynx. Unlike gummatous ulceration, which is a differential diagnosis, scleroma is not destructive, the uvula is preserved, although it may be retracted by scarring into the nasopharynx, and is seen with the postnasal mirror. The histology of the mucosa in scleroma is characteristic and diagnostic.

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Responses

  • vanessa
    Can candida cause hearing loss?
    4 months ago

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