Infection Fungal

Candidiasis. Candida albicans is a common organism found in the oral cavity flora that causes candidiasis in certain clinical situations. Candida has a capsule and forms true hyphae and pseudohyphae. It adheres to mucosal surfaces and is capable of superficial mucosal invasion. Factors that contribute to oral candida proliferation include uncontrolled diabetes mellitus, antibiotic therapy, and any condition that causes immunosuppression. Clinical features of candidiasis include white, cheesy plaques that can be wiped off with a tongue blade. The tongue and buccal mucosa are frequently infected, but tonsillar and pharyngeal lesions are not uncommon and may extend to the esophagus and larynx. Superficial infections are often painless and self-limiting. Deep infections can cause ulcerative lesions that are painful. Diagnosis is made by epithelial scrapings and KOH preparations demonstrating budding yeast and hyphae under light microscopy. Cultures may be obtained if needed. Treatment of oral candidiasis often begins with correction of underlying causes, such as stopping or changing antibiotics or better blood sugar control when possible. Nystatin suspension rinses and clotrimazole troches are often the first line of therapy for superficial infections. More severe infection should also be treated with oral fluconazole and may require several weeks of therapy for complete resolution.

Other Mycoses. Infection of the tonsils and pharynx with other fungal elements is rare but may occur. Aspergillosis, Histoplasmosis, and Cryptococcus are the most common of these rare infections. Symptoms are similar to those seen with candidiasis. Diagnosis is made by cultures, and treatments are directed at the offending organism. Aggressive oral antimycotics are commonly employed.

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