Thrush

250 Thrush



Instruction


Look at this patient’s tongue.



Salient features



History




• Ask the patient about dysphagia (oesophagitis)


• Diabetes mellitus


• Leukaemia, anticancer therapy or immunosuppressive drugs (cause neutropenia)


• Drugs (steroids, broad-spectrum antibiotics and oral contraceptives)


• HIV infection.



Examination




• Superficial white patches or large fluggy membranes that are easily detachable (e.g. by a tongue depressor), leaving underlying erythema (Figs 250.1 and 250.2)


• Erythema, transverse fissuring and maceration may be seen at the angles of the mouth (perleche) as an associated finding.


image

Fig. 250.1 Pseudomembranous candidiasis of the palate demonstrating multiple areas of Candida colonization.


(With permission from Lerman MA, Laudenbach J, Marty FM. Management of oral infections in cancer patients. Dental Clin North Am 2008;52:129–53.)


image

Fig. 250.2 Candida albicans.


(With permission from Habif 2009.)


Proceed as follows:



• Look for other sites of candidal infection (eczematoid lesions in moist areas of the skin, such as inframammary folds, inguinal creases, between the fingers and toes).


• Look for id reactions (which are hypersensitivity cutaneous reactions remote from the site of infection).


• Ask the patient about dysphagia (oesophagitis).


• Tell the examiner that you would like to investigate for underlying:


• diabetes mellitus

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Thrush

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