The image above shows pharyngeal candidiasis. Candidiasis (thrush) in this location suggests that the patient is either suffering from AIDS, or is using an oral corticosteroid inhaler. In this case, note also the redness at the corners of the lips. This is known as angular cheilitis
Angular cheilitis is a yeast infection at the corners of the lips. The combination of pharyngeal and angular Candida infection are strongly indicative of underlying HIV infection. The presence of each of these conditions separately does not infer that the patient is suffering from an HIV infection, but when they occur together, it infers that the patient is suffering from a serious immune deficiency.
Copyright 2006 Martin S. Spiller, D.M.D. courtesy of Dr. Ed Cataldo
Oral Candida infections of the tongue are very frequent in elderly persons who wear dentures. The elderly are often plagued with dry mouth (xerostomia) which is quite conducive to Candida infection.
The above image of an infant shows the most common manifestation of oral Candida infection. In infants it is called Thrush.
Thrush is a yeast infection often found in infants (bottom image). The organism responsible is called Candida albicans. The reason that thrush is found in infants and not in adults is that infants have not yet developed an entirely competent immune system. Oral yeast infections are not often found in healthy adults unless they are suffering from a compromised immune system. The reasons why an adult may have developed a compromised immune system include various chronic diseases and physical or psychological stress.
The most frequent cause of immune compromise leading to oral yeast infections in non elderly adults today is the presence of HIV which has progressed into AIDS. Persons with AIDS often develop pharyngeal (throat) candidiasis (see the top image on this page). In the early history of the AIDS epidemic, it was believed by many clinicians that pharyngeal candidiasis was pathognomonic (found only in) AIDS patients. It did not take very long to discover that a very common cause of pharyngeal candidiasis is the chronic usage of corticosteroid inhalers.
The distinguishing characteristic of an oral candida infection is a series of white plaques which are easily scraped off revealing an underlying erythematous (red) area. This condition is most easily confused with leukoplakia (see image above), which is tough and leathery and not easily scraped off the underlying tissue. The one exception in which Candida cannot easily be scraped off is Hyperplastic candidiasis pictured below.
Hyperplastic candidiasis looks like pseudomembranous candidiasis, however it cannot easily be wiped off with a gauze sponge. It is composed of elevated white plaques, and may easily be confused with leukoplakia. It is found most often on the hard palate or the dorsal surface (top) of the tongue. It looks like any other form of leukoplakik plaque, but it will respond to a therapeutic trial of antifungal antibiotics. It can also be distinguished from other keratotic lesions by cytologic smear or biopsy
Erythematous candidiasis (image above) is characterized by red, inflamed tissue. This form of candidiasis is especially prevalent in people who wear dentures and do not take them out at night. It appears to be the result of decreased tissue resistance because of the constant pressure from the prosthetic appliance. Treatment for this condition is composed of an antifungal antibiotic combined with the strong recommendation for the patient to remove his/her denture at night!