Thrush

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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250 Thrush

Instruction

Look at this patient’s tongue.

Salient features

History

• Ask the patient about dysphagia (oesophagitis)

• Diabetes mellitus

• Leukaemia, anticancer therapy or immunosuppressive drugs (cause neutropenia)

• Drugs (steroids, broad-spectrum antibiotics and oral contraceptives)

• HIV infection.

Examination

• Superficial white patches or large fluggy membranes that are easily detachable (e.g. by a tongue depressor), leaving underlying erythema (Figs 250.1 and 250.2)

• Erythema, transverse fissuring and maceration may be seen at the angles of the mouth (perleche) as an associated finding.

Fig. 250.1 Pseudomembranous candidiasis of the palate demonstrating multiple areas of Candida colonization.

(With permission from Lerman MA, Laudenbach J, Marty FM. Management of oral infections in cancer patients. Dental Clin North Am 2008;52:129–53.)

Fig. 250.2 Candida albicans.

(With permission from Habif 2009.)

Proceed as follows:

• Look for other sites of candidal infection (eczematoid lesions in moist areas of the skin, such as inframammary folds, inguinal creases, between the fingers and toes).

• Look for id reactions (which are hypersensitivity cutaneous reactions remote from the site of infection).

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