A 29-year-old female comes into practice and complains of burning tongue and development of circumscribed whitish deposits on the tongue and on the mucous membrane of the posterior pharynx. A history of the patient reports about the inhalation of steroid derivatives because of their asthma and the additional short-term use of antibiotics due to a respiratory infection.
Diagnosis and Etiology:
The anamnestic notes with inhaled steroids and the additional use of antibiotics indicate a thrush. This manifests itself in typical form as pseudomembranous coverings consisting of Candida, desquamated epithelial cells, leukocytes, bacteria, keratin, necrotic tissue and food residues. The diagnosis is confirmed by clinical inspection and by Gram staining of scraped coating as microscopic hyphae abundant, pseudohyphae and yeast forms are detectable. A simple culture is not necessarily the diagnosis because Candida is to count in a low bacterial count to normal oral flora.
Since the introduction of inhaled steroids in the treatment of asthma have been reported increasingly on the development of oral thrush. In particular in case of improper application by an Inhalationsspacers and lack of mechanical Rinse the mouth after inhalation it is not uncommon to develop such oropharyngeal candida colonization. The additional intake of antibiotics selected Candida in the normal body flora and predisposed to such oral thrush. As far as possible, an interruption of the inhaled corticosteroid therapy should be carried out and the Candida colonization is locally with Nystatin (NYSTADERM), miconazole (DAKTAR Mundgel) or amphotericin B (eg AMPHOMORONAL) treated as lozenges or suspension using a pipette over a longer period. If a more pronounced immunodeficiency is present (eg, cancer patients, AIDS, transplant patients) should be a systemic treatment with fluconazole orally (Diflucan) at a dose of once daily lines to 50 - 200 mg over 10 - carried out 14 days. In recurrent oral thrush (eg AIDS), an effective prophylaxis with 50 - 100mg fluconazole are made daily.
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