Diagnosis of Thrush
Thrush Diagnosis: Book Excerpts
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Oral Lesions:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Aphthous stomatitis
–Idiopathic
–Recurrent, shallow, painful, spontaneously
resolving oral ulcers -
Herpes stomatitis
–Due to a primary outbreak of HSV-1
–Severe gingivostomatitis with pain, redness,
and erosions around the gum line
–Recurrent oral HSV (“cold sores”) often occur at the lip border
–Stress, sun exposure, and many other factors contribute to flare-ups
-
Self-limited viral disease (e.g., herpangina,
hand-foot-mouth disease)
–Most often seen in children
–Prodrome of malaise and fever followed by
a 5–10 day outbreak of oropharyngeal erosions or vesicles is common
-
Chemotherapy drugs (especially 5-FU and methotrexate)
-
Squamous cell carcinoma should always be considered if a nonhealing ulcer or oral erosion is noted
-
Bullous diseases (e.g., pemphigoid,
pemphigus, lichen planus)
–Recurrent painful oral ulcers and erosions
–Evaluate for other skin rashes suggestive of
these disorders
-
Behçet syndrome
–Uncommon but well-known cause of oral ulcers
–Patients must exhibit other symptoms (e.g., uveitis, CNS problems, GI complaints, genital ulcers) before this diagnosis can be made
-
Allergic contact dermatitis to amalgams in dental work may result in buccal tenderness
-
Erythema multiforme (Stevens-Johnson syndrome)
–Characterized by oral ulcers, ocular involvement, and simultaneous targetoid, erythematous, or bullous skin lesions
–May be triggered by HSV infection, Mycoplasma infection, or drugs (e.g., phenytoin, sulfonamides)
-
Primary syphilis
–Painless chancre
-
Agranulocytosis or leukopenia
-
Histoplasmosis (especially in immunosuppressed patients)
Workup and Diagnosis
-
Detailed history and physical examination
–Associated symptoms (e.g., fever, prodrome)
–Review the patient's past medical history and medication
list
–If ulcers occur in the same location with every episode, oral HSV is likely
–Is the patient sexually active (consider HIV, immunosuppression, or syphilis)
–Perform a thorough skin exam to evaluate for rashes or other mucosal lesions (ocular, urethral, or perianal)
–Lacy white plaques on the tongue or buccal mucosa may suggest lichen planus
–Ocular or anogenital complaints can be suggestive of Behçet syndrome, pemphigus, or pemphigoid
-
Initial evaluation includes a viral swab for culture and/or serum for HSV-1 IgG detection to diagnose HSV, and consider an RPR and CBC to rule out syphilis and leukopenia, respectively
-
Consider a punch biopsy of the edge of an ulcer/erosion to determine if there are viral changes or cytologic atypia; or evidence of an autoimmune bullous disease
-
Recurrent aphthous stomatitis is a diagnosis of exclusion, but is also the most common diagnosis of recurrent painful oral ulcers after HSV
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
Mouth lesions:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed pain, odor, or drainage. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, the frequency of dental examinations, and the date of his most recent dental visit.
Next, perform a complete oral examination, noting lesion sites and character. Examine the patient’s lips for color and texture. Inspect and palpate the buccal mucosa and tongue for color, texture, and contour; note especially painless ulcers on the sides or base of the tongue. Hold the tongue with a piece of gauze, lift it, and examine its underside and the floor of the mouth. Depress the tongue with a tongue blade, and examine the oropharynx. Inspect the teeth and gums, noting missing, broken, or discolored teeth; dental caries; excessive debris; and bleeding, inflamed, swollen, or discolored gums.
Palpate the neck for adenopathy, especially in patients who smoke tobacco or use alcohol excessively.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Candidiasis:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Diagnosis of superficial candidiasis depends on clinical signs and symptoms plus evidence of Candida on a Gram stain of skin, vaginal scrapings, pus, or sputum or on skin scrapings prepared in potassium hydroxide solution. Systemic infections require obtaining a specimen for blood or tissue culture.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Chronic mucocutaneous candidiasis:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Laboratory findings usually show a normal circulating T-cell count, although it may be decreased. Skin tests don’t usually show delayed hypersensitivity to Candida, even during the infectious stage. Migration inhibiting factor that indicates the presence of activated T cells may not respond to Candida.
Nonimmunologic abnormalities resulting from endocrinopathy may include hypocalcemia, abnormal hepatic function studies, hyperglycemia, iron deficiency, and abnormal vitamin B12 absorption (pernicious anemia). Diagnosis must rule out other immunodeficiency disorders associated with chronic Candida infection, especially DiGeorge syndrome, ataxia-telangiectasia, and severe combined immunodeficiency disease, all of which produce severe immunologic defects. After diagnosis, the patient needs evaluation of adrenal, pituitary, thyroid, gonadal, pancreatic, and parathyroid function as well as careful follow-up. The disease is progressive, and most patients eventually develop endocrinopathy.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Mouth lesions:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed any pain, odor, or drainage. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially any malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, frequency of dental examinations, and the date of his most recent dental visit.
Next, perform a complete oral examination, noting lesion sites and character. Examine the patient’s lips for color and texture. Inspect and palpate the buccal mucosa and tongue for color, texture, and contour; note especially any painless ulcers on the sides or base of the tongue. Hold the tongue with a piece of gauze, lift it, and examine its underside and the floor of the mouth. Depress the tongue with a tongue blade, and examine the oropharynx. Inspect the teeth and gums, noting missing, broken, or discolored teeth; dental caries; excessive debris; and bleeding, inflamed, swollen, or discolored gums.
Palpate the neck for adenopathy, especially in patients who smoke tobacco or use alcohol excessively.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Oral Lesions:
Differential Overview
(Field Guide to Bedside Diagnosis)
Ulceration
❑ Aphthous ulcers
❑ Angular cheilitis
❑ Herpes simplex
❑ Traumatic ulcers
❑ Impetigo
❑ Erythema multiforme
❑ Mucositis
❑ Lichen planus
❑ Squamous cell cancer
❑ Syphilis
❑ Coxsackievirus A
❑ Herpes zoster
❑ Primary HIV
❑ Crohn disease
❑ Behçet syndrome
❑ Acute leukemia
❑ Pemphigoid
Glossitis
❑ Vitamin B12 deficiency
❑ Folate deficiency
❑ Niacin deficiency
❑ Riboflavin deficiency
❑ Leukoplakia
❑ Candida
❑ Geographic tongue
❑ Black hairy tongue
❑ Scarlet fever
❑ Kwashiorkor
❑ Polyarteritis nodosa
Macroglossia
❑ Myxedema
❑ Angioedema
❑ Acromegaly
❑ Amyloidosis
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Candidiasis:
Diagnosis
(Handbook of Diseases)
Identification of superficial candidiasis depends on evidence of Candida on a Gram stain of skin, vaginal scrapings, pus, or sputum or on skin scrapings. For systemic infections, a sample must be obtained for blood or tissue culture.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Mouth lesions:
History
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed any pain, odor, or drainage. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially any malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, frequency of dental examinations, and the date of his most recent dental visit.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Mouth lesions:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin your evaluation with a thorough history. Ask the patient when the lesions appeared and whether he has noticed odor or drainage or experienced pain. Also ask about associated complaints, particularly skin lesions. Obtain a complete drug history, including drug allergies and antibiotic use, and a complete medical history. Note especially malignancy, sexually transmitted disease, I.V. drug use, recent infection, or trauma. Ask about his dental history, including oral hygiene habits, the frequency of dental examinations, and the date of his most recent dental visit.
Next, perform a complete oral examination, noting lesion sites and character. Examine the patient's lips for color and texture. Inspect and palpate the buccal mucosa and tongue for color, texture, and contour; note especially painless ulcers on the sides or base of the tongue. Hold the tongue with a piece of gauze, lift it, and examine its underside and the floor of the mouth. Depress the tongue with a tongue blade, and examine the oropharynx. Inspect the teeth and gums, noting missing, broken, or discolored teeth; dental caries; excessive debris; and bleeding, inflamed, swollen, or discolored gums. Note any odor.
Palpate the neck for adenopathy, especially in patients who use tobacco or ingest alcohol excessively.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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