Oropharyngeal Candidiasis (Thrush)

Often asymptomatic but can cause oral pain (orodynia) and painful swalling (orodynophagia), as well as a strange, “cottony” feeling (oral dysesthesia) and a loss of taste (ageusia). Pseudomembranous (exudative) creamy-white-plaques overlying an erythematous tongue (as shown here) is a common manifestation. To confirm the diagnosis, we'll use a tongue blade to scrape off the lesions and assess with potassium hydroxide (KOH) preparation, which should reveal budding yeasts with or without hyphae in cases of candidiasis. Be aware that there is a high rate of candida colonization in the normal population, so the patient must be symptomatic for this test to be useful. From UpToDate "Oropharyngeal Candidiasis in Adults"

• Clotrimazole troches (one 10 mg troche dissolved in the mouth five times daily)
• Miconazole mucoadhesive buccal tablets (50 mg once daily applied to the mucosal surface over the canine fossa)
• Nystatin swish and swallow (400,000 to 600,000 units four times daily)

Oral candidiasis KOH Prep Test