PANCE Blueprint EENT (7%)

3 week old with a black plaque on tongue and diaper rash

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.

Oral candidiasis is a fungal infection of the mouth often called 'thrush' because its white spots resemble the breast of a bird with the same name

• Although candida is present in 50% of the normal flora of healthy mouths, it causes infection (candidiasis) when increased numbers of yeast cells invade the mucosa
• Oropharyngeal candidiasis causes white plaques on oral mucous membranes that may bleed when scraped but do scrape off! (unlike oral leukoplakia which does not scrape off)
  • Remember, oral candidiasis scrapes off
• If a 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

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

• Clotrimazole (Mycelex): oral 10-mg troche; 20 minutes 5 times daily for 7 to 14 days
• Nystatin oral suspension: 100,000 U/mL swish and swallow 400,000 to 600,000 U 4 times per day
  • Treat infants with nystatin oral suspension 100,000 units to each cheek four times daily
• Nystatin pastilles: 200,000 U each, QID daily for 7 to 14 days