Candidiasis Mucosa

Fungal infection of the mucous membranes caused by Candida species

Aetiology

  • Candida albicans (most common)
  • Other species: Candida tropicalis, Candida parapsilosis, Candida glabrata

Predisposing Factors

  • Immunosuppression (HIV/AIDS, malignancy, transplant)
  • Diabetes mellitus
  • Broad-spectrum antibiotics
  • Corticosteroid therapy
  • Denture use (especially poor hygiene)
  • Xerostomia
  • Infancy & elderly
  • Pregnancy
  • Inhaled corticosteroids (e.g., asthma therapy) without mouth rinsing
  • Poor oral hygiene

Types & Clinical Presentation

Oropharyngeal Candidiasis (Oral Thrush)

  • White, creamy plaques on tongue, buccal mucosa, palate.
  • Can be scraped off, leaving erythematous base ± bleeding.
  • Symptoms: soreness, dysgeusia, burning sensation, difficulty swallowing.
Forms:
  • Pseudomembranous: classic white plaques
  • Erythematous/atrophic: red painful patches (denture stomatitis)
  • Hyperplastic (chronic): non-removable white patch (rare)
      • Pseudomembranous
      Pseudomembranous

Vulvovaginal Candidiasis

  • Thick curd-like white discharge
  • Vulvar erythema, edema, intense pruritus
  • Dysuria & dyspareunia possible
  • pH normal (≤ 4.5) (distinguishes from BV/trichomoniasis)
Recurrent form: ≥4 episodes per year.

Candida Balanitis (male)

  • Erythematous rash on glans penis
  • Pruritus, burning sensation
  • White exudate may be present, more common in uncircumcised men

Investigations

  • KOH 10% Examination
    • Shows budding yeast cells (blastospora) and pseudohyphae
      • notion image
  • Culture with Sabaroud agar for recurrent/atypical cases
  • Wood’s lamp → usually negative

Management

  • Topical antifungals
    • Nystatin suspension 100.000-400.000 IU/mL 2-3x/day for 3 days
    • Clotrimazole troches
  • Systemic antifungals
    • Fluconazole (first-line if moderate/severe)
    • Itraconazole for resistant cases
        • Duration 7–14 days.