Diagnosis and Treatment of Throat Thrush
Yes, a swab taken directly from the lesion is the essential specimen for diagnosing oropharyngeal candidiasis (throat thrush). 1
Diagnostic Approach
Specimen Collection
- A swab taken from the lesion is the essential specimen for detecting oropharyngeal candidiasis and esophagitis 1
- The swab should be obtained directly from visible white patches or lesions on the throat, tongue, palate, or pharyngeal wall 2, 3
- Swabs must be inoculated on selective media to prevent overgrowth by colonizing bacteria 1
When Biopsy May Be Needed
- A biopsy is not mandatory for diagnosis but may help discriminate between infection and colonization in unclear cases 1
- When biopsy is obtained, it should be processed with appropriate histopathology and culture 1
Additional Testing Considerations
- Species identification and susceptibility testing are recommended in recurrent or complicated cases and in patients who have been previously exposed to azole antifungals 1
- PCR-based methods have been evaluated but are not recommended as they have not been validated in clinical settings 1
Clinical Presentation
Throat thrush typically presents with:
- White patches appearing as discrete lesions on the buccal mucosa, throat, tongue, and gum linings that can develop into confluent pseudomembranes resembling milk curds 4
- Hoarseness when the larynx is involved 5
- Local pain and discomfort, loss of taste, and aversion to food 6
- Pain may be present inconsistently, particularly in laryngeal thrush 5
Treatment
First-Line Therapy
- Oral fluconazole is highly effective for treating oropharyngeal candidiasis 6, 5
- All patients with laryngeal thrush responded readily to oral fluconazole 5
Additional Management
- Remove predisposing factors where possible, such as discontinuing or adjusting inhaled steroids, systemic steroids, or broad-spectrum antibiotics 5
- Ensure appropriate oral hygiene 3
- Topical agents may be used in conjunction with systemic medications 3
Important Clinical Pitfalls
- Diagnosis is often delayed—in laryngeal thrush cases, diagnosis was not made until an average of 6 months after symptom onset 5
- Three patients underwent unnecessary surgical procedures that might have been avoided with accurate initial diagnosis 5
- Laryngeal thrush can occur isolated to the vocal folds alone without oral or oropharyngeal manifestations, making it easily missed 5
- Inhaled steroids alone can be the only identifiable causative factor, particularly for vocal fold thrush 5