This may appear earlier in HIV infection than the more obvious white plaques, which appear later in infection. Angular cheilitis presents with fissuring and redness at either one or both corners of the mouth, and may appear alone or in conjunction with another form of oral candida infection. Organisms may be detected on smear or culture. Do a KOH preparation of a smear collected by the gentle scraping of the affected area with a wooden tongue depressor. Visible hyphae or blastospheres on KOH mount indicate candida infection.
Culture is diagnostic.
Refractory cases of oral candidiasis may be caused by Torulopsis glabrata or C. Krusei , both of which are azole-resistant. Candidiasis which does not respond to therapy should be cultured to check the identity of the fungal species. Swish, retain in mouth as long as possible, then swallow. Recommeded therapy is for two weeks. Note that oral suspension has a high sugar content, which may precipitate caries or xerostomia.