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7- Candidiasis - Aphthous Ulcers - Leukoplakia -...

• Be sure not to confuse candidiasis with tonsillitis or bacterial pharyngitis or leukoplakia or aphthous ulcers or herpetic stomatitis or oral chancre, or "Koplick's spots"; a "white mouth" is not always candidiasis!
• If patient has candidiasis, often CD4 counts are already under 200.  He should have Bactrim 1tab 1x/day for the rest of his life for prevention of PCP (dapsone 1tab 1x/day if allergic to Bactrim).  (See "25-Prophylaxis")
• A patient who has never had candidiasis is probably not a priority admission to a ward for dying destitutes.

Candidiasis (bxx024)(bxx043) (bxx051)

Oral thrush only

• Clotrimazole 1tab 4x/day
• If not better after 2 days: fluconazole 100 1-2 tabs 1-2x/day

Presumed esophageal candidiasis (Oral thrush + dysphagia)

• 1° nystatin liquid or fluconazole liquid
• 2°If not better after one day, fluconazole 200mg 2x/day

(See also (bxx004) (bxx005) (bxx006) (bxx007)...)

(Hairy)  Leukoplakia (bxx010) (bxx018) (bxx019) (bxx021) (bxx033)

Border of tongue, always-same position, no pain, no treatments we have are effective...

Aphthous/herpes Ulcers (bxx001) (bxx002) (bxx022) (bxx025) (bxx026) (bxx027) (bxx029) (bxx030) (bxx071...)

For HIV patient, "aphthous ulcer" often means large painful wounds with pink borders.

Herpes & aphthous can give similar lesions.  If you are sure it is aphthous ulcers and not herpetic stomatitis/glossitis, treat with local corticoids and if severe dysphagia, add high dose dexa for a few days (3cc morning +2cc midday for 4 days).  But if the lesions get worse (unusual), stop corticoids and give acyclovir 800mg 5x/day)

Oral chancre (bxx023) (bxx041...)

Treat as chancre on "15-Genital Area"

Stevens Johnson Syndrome and herpes stomatitis

Confusion is easy... see "32-Unable to Eat"

"Koplick's spots" (bxx009)

Ulcer of unknow origin... Painless or painful...(bxx069...) (bxx068...)

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