Candidal Laryngitis vs Viral Laryngitis: Symptom Patterns
Fever and runny nose are characteristic of viral upper respiratory infections, not candidal laryngitis. Candidal laryngitis presents primarily with dysphonia (hoarseness) without systemic symptoms like fever or rhinorrhea, whereas viral infections cause the constellation of fever, rhinorrhea, cough, and constitutional symptoms you're describing.
Key Clinical Distinctions
Viral Laryngitis Presentation
- Viral laryngitis is characterized by cough, sneezing, rhinorrhea, sore throat, and nasal congestion 1
- Fever, when present in viral upper respiratory infections, tends to occur early in the illness (first 24-48 hours) along with constitutional symptoms like headache and myalgias 2
- Respiratory symptoms typically peak within 3-6 days and resolve within 7-14 days 2
- Common viral pathogens include parainfluenza viruses, rhinovirus, influenza, and adenovirus 1
Candidal Laryngitis Presentation
- The most common presenting symptom is dysphonia (hoarseness), occurring in 69% of patients 3
- Candidal laryngitis does NOT typically present with fever or rhinorrhea 3, 4
- This is a localized infection of the laryngeal mucosa, not a systemic or upper respiratory tract infection 4
- Patients are usually immunocompetent but have specific risk factors 4
Risk Factor Profile for Candidal Laryngitis
The key distinguishing feature is the presence of predisposing factors rather than viral prodrome:
- Inhaled corticosteroid use is the most common risk factor, present in 89% of cases 3
- Oral prednisone use (7% of cases) 3
- Gastroesophageal reflux disease history 4
- Immunosuppression (HIV infection, malignancy) in select cases 5
- Notably, most patients with laryngeal candidiasis are actually immunocompetent 4, 6
Anatomic and Visual Findings
Candidal laryngitis has distinct laryngoscopic findings:
- Most commonly affects the glottis (vocal cords), with 28% showing isolated glottic involvement 3
- Can involve hypopharynx, supraglottis, and glottis simultaneously (33% of cases) 3
- Presents with leukoplastic (white) lesions on laryngoscopy 4
- Can mimic laryngeal carcinoma or leukoplakia on visual examination 7, 6
Clinical Algorithm
If the patient presents with fever and runny nose:
- This indicates viral upper respiratory infection, not candidal laryngitis 2
- Manage with symptomatic relief: analgesics, hydration, voice rest 1, 8
- Avoid antibiotics, as they are ineffective for viral illness and can actually increase risk of laryngeal candidiasis 1, 8
If the patient presents with isolated dysphonia without fever/rhinorrhea:
- Consider candidal laryngitis, especially if using inhaled steroids 3, 4
- Perform laryngoscopy to identify leukoplastic lesions 4
- 96% of candidal laryngitis cases respond to a single course of oral antifungal therapy 3
Common Pitfall to Avoid
Do not prescribe antibiotics for viral laryngitis, as this contributes to bacterial resistance and paradoxically increases the risk of developing laryngeal candidiasis 1, 8. The misuse of antibiotics is specifically identified as a risk factor for candidal overgrowth in the larynx 8.