7- Candidiasis - Aphthous Ulcers - Leukoplakia -...
- Be sure not to confuse candidiasis with tonsillitis or bacterial pharyngitisor leukoplakia or aphthous ulcersor 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.
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
- 1° nystatin liquid or fluconazole
- 2°If not better after one day, fluconazole
(See also (bxx004) (bxx005) (bxx006) (bxx007)...)
(bxx010) (bxx018) (bxx019) (bxx021) (bxx033)
Border of tongue, always-same position, no pain, no treatments we have are
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
Treat as chancre on "15-Genital Area"
Stevens Johnson Syndrome and herpes stomatitis
Confusion is easy... see "32-Unable to Eat" and 06-Allergy
Rare in thailand
Addendum Dr Catton afrBXX001 (black patient in Africa) Kaposi Sarcoma - diagnostic of HIV, and difficult to treat.
Ulcer of unknow origin...
Painless or painful...(bxx069...)