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Oral candidiasis in children with immune suppression: clinical appearance and therapeutic considerations.

Children and adolescents with immune compromise and suppression are particularly susceptible to the development of oral candidiasis. In fact, oral candidiasis is the most common oral manifestation in HIV-infected children. Oral candidiasis has been linked to a depressed immune system, more rapid progression to AIDS, more advanced stage of disease in AIDS, and decreased survival. Several different forms of candidiasis may be recognized clinically. These forms are 1) pseudomembraneous candidiasis; 2) erythematous (atrophic) candidiasis; 3) papillary hyperplasia; 4) chronic hyperplastic candidiasis; 5) angular cheilitis; and 6) median rhomboid glossitis. Diagnosis of candidiasis is primarily based upon clinical appearance; in some cases, however, exfoliative cytology and/or biopsy of the lesion may be necessary. It is also possible to culture the lesion to determine the specific subtype of candidia and to evaluate the susceptibility of the fungus to specific antifungal agents. Both topical and systemic treatment by antifungal medications are readily available.