Candida albicans is a fungal organism, normally part of human upper aerodigestive tract flora. Candida albicans may become pathogenic (creating a disease state) when there is a disturbance in the balance of other normal organisms. Such an imbalance may occur due to use of steroids, either taken by mouth or inhaled, as for asthma. Other causes of candida albicans overgrowth include use of broad-spectrum antibiotics, and/or immunosuppression. The resulting disease state in the upper aerodigestive tract may cause hoarseness or an outbreak of thrush.
Photos:
Candida laryngitis (1 of 4)
Severe laryngeal candidiasis, in a person using inhaled steroids at high dose. Standard light.
Candida laryngitis (2 of 4)
Closer view shows more clearly not only the white areas, but also surrounding inflammation. Standard light.
Candida laryngitis, 15 days after starting treatment (3 of 4)
After 15 days of oral fluconazole. Obvious improvement, but incomplete resolution of tissue changes.
Candida laryngitis (1 of 4)
Candidiasis in patient using inhaled steroids for asthma. Under standard light, the lesions are vague, hazy, and best seen anteriorly on the right cord (left of image).
Candida laryngitis (2 of 4)
Same patient, narrow-band illumination. This not only emphasizes vascularity, but brings out the candida colonies.
Candida laryngitis, after treatment (3 of 4)
After treatment with fluconazole, the colonies have virtually disappeared.
Candida pharyngitis (2 of 2)
An even more dramatic case of candidiasis, in a different patient. Here, the colonies are more obvious and nearly confluent.
Candida laryngitis (1 of 3)
Elderly woman with a history of laryngeal amyloidosis requiring laser sculpting several years earlier. Now using high-dose inhaled steroids, antibiotics, and oral steroids for unrelated pulmonary problem. Marked increase of hoarseness, and whitish discoloration, especially of the left vocal cord (right of image).
Candida laryngitis (2 of 3)
Closer view of hazy white areas and irregular right cord margin (left of image), presumed to be candida overgrowth. Empiric treatment with fluconazole is justified, given history and findings.
Candida colonies (2 of 3)
Candida colonies are routinely surrounded by a zone of erythema (see other photo series). No redness is seen here.
After throat clearing (3 of 3)
After aggressive throat clearing, the pattern of white lesions has changed, and this is of course another indication that we are not dealing with candida colonies here, but simple adherent mucus.
Haziness and redness (1 of 3)
This patient uses inhaled steroids and takes oral steroids as well. She has had prior episodes of documented Candida infection in prior years and has developed new laryngitis. Under standard light, both haziness (Candida) and redness (inflammatory response) are seen.
Leukoplakia (2 of 3)
Narrow band light shows the leukoplakia much more clearly. Candida on the vocal cords is often hazy and diffuse, presumably because the shearing effects of vibration do not allow the discrete, demarcated colonies often seen in other locations.