1. Oral candidiasis (thrush and perleche). Thrush is characterized by creamy white flakes on a red, inflamed mucous membrane. The tongue may be smooth and atrophic, or the papillae may be hypertrophic, as in the condition labeled "hairy tongue." Therapy with Mycostatin pastilles (lozenges) or Mycelex troches is effective. Perleche is seen as cracks or fissures at the corners of the mouth and is usually associated with candidal disease elsewhere and rarely a dietary deficiency (usually B12 deficiency). Thrush is seen commonly in immunosuppressed patients.
A noncandidal, clinically similar condition is commonly seen in elderly persons with ill-fitting dentures in whom the corners of the mouth override. Oral candidiasis is also to be differentiated from allergic conditions, such as those due to toothpaste or mouthwash.
2. Candidal vulvovaginitis. The clinical picture is an oozing, red, sharply bordered skin infection surrounding an inflamed vagina that contains a buttermilk-like discharge. This type of candidal infection is frequently seen in pregnant women, diabetics, and those who have been on antibiotics systemically.
LABORATORY FINDINGS. Skin or mucous-membrane scrapings placed in 20% KOH solution and examined with the high-power microscope lens reveal small, oval, budding, thin-walled, yeast-like cells with occasional mycelia. Culture on Sabouraud's media produces creamy dull-white colonies in 4 to 5 days. Further cultural studies on corn meal agar are necessary to identify the species as C. albicans.
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