Diagnosing and managing oropharyngeal candidiasis

Oropharyngeal candidiasis (OPC) is often one of the first signs of immunodeficiency. The symptoms may include a sore and painful mouth, a burning tongue, dysgeusia, and dysphagia. However, some patients are asymptomatic despite the presence of clinical signs, such as diffuse erythema and whitish patches on the surfaces of the buccal mucosa, throat, tongue, and gums. The most serious complication of untreated OPC is extension of infection into the esophagus. Although numerous antifungal agents are available, the azoles - both topical (clotrimazole) and systemic (fluconazole, itraconazole, posaconazole) - have replaced older topical antifungals in the management of OPC. Fluconazole has become an integral part of the management of mucosal candidiasis. Itraconazole and posaconazole have clinical response rates similar to those of fluconazole and are effective alternatives.