PANCE Blueprint EENT (7%)

Oral Candidiasis (ReelDx)

VIDEO-CASE-PRESENTATION-REEL-DX

oral thrush

Patient will present as → a 3-week-old infant with decreased appetite and a rash in her mouth. On physical exam, you note white plaques on her tongue that scrape off with a tongue depressor and bleed slightly. Potassium hydroxide (KOH) preparation of the scrapings demonstrates budding yeasts with hyphae.

Alternative presentation → a 33-year-old HIV-positive female presents with her second episode of oral thrush in the past 2 months. Her current CD4 count is 75.

Candidiasis (moniliasis) is skin infection with Candida species, most commonly Candida albicans

  • Erythematous base, bleeds when scraped and scrapes off (unlike oral leukoplakia)
  • If patient has recurrent candidiasis look for underlying disorder: immunocompromised, long term inhaled steroid use.

Scrapes off with a tongue depressor, may bleed

  • Potassium Hydroxide (KOH) prep for diagnosis: budding yeast/hyphae
  • Wet prep or biopsy can be done

ORAL CANDIDIASIS

Treatment is with antifungals, which are available in several forms (i.e., ketoconazole or fluconazole orally, clotrimazole troches, nystatin liquid rinses)

 

Question 1
A young mother brings her 3-week-old daughter for care of a rash in her mouth. The mother indicates the baby was doing fine until 2 days ago when she noticed white spots in the infant's mouth. On examination, they do not come off easily with a tongue blade. She is bottle-feeding the infant without any problem. Which of the following is the most likely diagnosis of this problem?
A
leukoplakia
Hint:
Leukoplakia is a precursor lesion to oral cancer, seen most commonly in oral tobacco users.
B
hand–foot–mouth disease
Hint:
Herpangina and hand–foot–mouth disease are ulcerating lesions of the oral cavity due to viruses and are self-limiting, but can be very painful.
C
herpangina
Hint:
Herpangina and hand–foot–mouth disease are ulcerating lesions of the oral cavity due to viruses and are self-limiting, but can be very painful.
D
oral candidiasis
Question 1 Explanation: 
Oral candidiasis (thrush) is very common in the first few weeks of infancy. The diagnosis is usually done by visual inspection and does not usually require further laboratory testing. On visual examination, white, creamy plaques are found on the buccal mucosa and occasionally the gingival and lingual mucosa. For this age group, direct topical application of nystatin in oral suspension to the lesions should suffice. If the lesions are resistant to treatment or if they occur in older children, consideration should be given to the possibility of the patient being immunocompromised. All sources of candida, such as toys and bottle nipples, should be sterilized daily. Herpangina and hand–foot–mouth disease are ulcerating lesions of the oral cavity due to viruses and are self-limiting, but can be very painful. Leukoplakia is a precursor lesion to oral cancer, seen most commonly in oral tobacco users.
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Aphthous ulcers (ReelDx + Lecture) (Prev Lesson)
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