Oral and oropharyngeal candidiasis

Overview and risk factors

Oral candidiasis is usually caused by Candida albicans.

It is common in infants and also occurs in immunocompromised or diabetic patients.

• Risk is increased by oral antibiotics and high-dose inhaled corticosteroids.
• Frequent recurrence or oesophageal symptoms should prompt assessment for HIV or other immune compromise.

Clinical features

• White patches on the tongue and inside the cheeks.
• Patches may spread toward the pharynx.
• Swallowing difficulty or pain suggests more extensive disease.

Treatment

• Apply nystatin suspension or miconazole gel between meals; keep in the mouth for 2 to 3 minutes, then swallow.
• In young children, apply to the tongue and inside each cheek and show the caregiver how to do this safely at home.
• Assess hydration and feeding; provide fluid and nutrition support if mouth pain or swallowing symptoms limit intake.
• In immunocompromised patients or patients with frequent, extensive, or oesophageal disease, assess and manage the underlying condition, especially HIV or diabetes.
• Handover should include age, feeding ability, lesion extent, swallowing pain, diabetes/HIV risk, recent antibiotics or inhaled corticosteroids, medicine chosen, caregiver technique, and review plan.