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Infections, continued
Oral Candidiasis (“pseudomembranous candidiasis” or “thrush”)
 
White plaques or pseudomembranes are noted on the surface of the tongue or the buccal, labial, and gingival mucosa. Removal of the plaques shows underlying raw, red, bleeding mucosa. Oral surfaces may become painful, which can interfere with feeding.
 
Fungal infection from C albicans.
 
Common in infants, but triggers for all age groups include systemic antibiotic use, inhaled steroids, diabetes,
Xerostomia: Abnormal dryness of the mouth due to insufficient saliva production.
xerostomia, and poor oral hygiene.
 
Consider immunocompromise (eg, HIV or primary immunodeficiency) in children older than 6 months of age who have persistent or frequently recurring candidal infections in the absence of antibiotic therapy, especially if this pattern persists into the second year
of life.
 
Treatment: Topical antifungal agents (eg, Nystatin or Clotrimazole).
 
If symptoms persist or recur shortly after discontinuation of the antifungal agent, consider re-infection (eg, pacifiers, bottles, breastfeeding with maternal breast colonization) or antifungal medication resistance.
 
Candida also causes angular cheilitis (Chapter 11: Oral Findings > Angular Cheilitis), median rhomboid glossitis, and atrophic candidiasis (erythematous patches without a pseudomembrane).

Strawberry Tongue
 
Refers to an inflamed tongue, which can either present as a diffusely erythematous tongue with prominent
Fungiform Papilla: Any of numerous papillae on the upper surface of the tongue that are flat-topped and noticeably red from the richly vascular stroma and usually contain taste buds .
fungiform papillae or covered by a white membrane except for the prominent fungiform papillae that appear red.
 
Often the white membrane is seen first and peels off, leaving the erythematous base.
 
Associated with 2 common conditions:
   
1.
Group A Beta Hemolytic Strep. Causes erythematous and enlarged tonsils with white exudates, anterior cervical lymphadenopathy, and fever.
   
2.
Kawasaki syndrome. Clinical presentation of 5 days of fever associated with other clinical criteria, one of which is oral mucosal findings, including a strawberry tongue.
 
 
The major morbidity of primary HSV infection is dehydration.
 
Treatment for viral infections with oral manifestations is generally only supportive care.
 
Consider immunodeficiency in a child who has frequent or persistent candidal infections after 1 year of age.
 
A strawberry tongue is commonly seen with GABHS infections and Kawasaki Syndrome.
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