Mucosal Candidiasis

Oral candidiasis occurs in up to 15% of patients with HIV infection, with a wide range of CD4 cells being affected. The incidence rises as the CD4 count falls. Oral candidiasis is generally asymptomatic.

Thrush candidiasis (pseudomembranous candidiasis) is characterized by white or creamy plaques on the oral mucosa which can be scraped off, often revealing a bleeding surface.

Erythematous candidiasis appears as a flat red lesion, which may be found on the hard or soft palate, dorsal tongue, or on other mucosal locations.

Candidiasis, Candida, Thrush

Oral candidiasis may be diagnosed by potassium hydroxide suspension showing hyphae and blastospores.

Treatment of Mucosal Candidiasis

In early HIV disease (CD4 >300), topical therapy is usually sufficient for mucosal Candidiasis. As the CD4 count approaches 100 or less, systemic therapy is often necessary.

Clotrimazole (Mycelex) troches 10 mg, dissolved slowly in mouth 5 times/d for 1-2 weeks.

Fluconazole (Diflucan), 100-200 mg po qd for 1-2 weeks.

Ketoconazole (Nizoral), 400 mg po qd for 1-2 weeks.

Resistant Candida species often develop in patients with advanced disease (CD4 <25).

Treatment of resistant Candida involves switching to an alternative agent (from fluconazole to itraconazole). In difficult to treat cases, systemic amphotericin B is usually effective.

Candida esophagitis generally occurs at CD4 counts below 200 cells/無.

Symptoms most frequently include odynophagia, nausea, mid-epigastric abdominal pain, and fever. Occasionally, symptoms of gastroesophageal reflux are present. The only prominent physical findings are fever and the