Chances are our patient has been on antibiotics and is being treated with either inhaled and/or systemic corticosteroids which may all contribute to yeast overgrowth in the respiratory and GI tracts. Fortunately, in the absence of severe immunocompromised state such as neutropenia, Candida sp. in respiratory specimens (including those obtained by bronchoscopy) is only rarely associated with pneumonia (1,2). So no antifungal therapy seems to be indicated in our patient, unless oral candidiasis (e.g. either thrush or the atrophic variety) is also simultaneously present. Time to examine the mouth!
1. El-Ebiary M, Torres A, Fabregas N, et al. Significance of the isolation of Candida species from respiratory samples in critically ill, non-neutropenic patients. Am J Resp Crit Care Med 1997;156:583-590
2. Rello J, Wsandi ME, Diaz E, et al. The role of Candida sp. isolated from bronchoscopic samples in non-neutropenic patients. Chest 1998;114:146-49
Yes! Although we often associate oral candidiasis with thrush or pseudomembranous white plaques, another common form of oral candidiasis seen in hospitalized patients is “acute atrophic candidiasis” (AAC), also referred to as “antibiotic sore mouth” because of its association with use of broad spectrum antibiotics (1,2).
Despite the absence of thrush, patients with AAC often have erythematous patches on the palate, buccal mucosa and dorsum of the tongue. Common symptoms include burning sensation in the mouth (especially with carbonated drinks in my experience), dry mouth and taste buds “being off” (2).
Aside from antibiotics, other predisposing factors for AAC include corticosteroids, HIV disease, uncontrolled diabetes mellitus, iron deficiency anemia, and vitamin B12 deficiency.
So next time you see a hospitalized patient with new onset sore, burning mouth that wasn’t present on admission, think of antibiotic sore mouth!
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1. Stoopler ET, Sollecito TP. Oral mucosal diseases. Med Clin N Am 2014;98:1323-1352. https://www.ncbi.nlm.nih.gov/pubmed/25443679
2. Millsop JW, Fazel N. Oral candidiasis. Clin Derm 2016;34:487-94. https://www.ncbi.nlm.nih.gov/pubmed/27343964