Noncandidal Fungal Infections of the Mouth Treatment & Management

Updated: Mar 01, 2018
  • Author: Manuel Valdebran, MD; Chief Editor: William D James, MD  more...
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Treatment

Medical Care

Pharmacologic treatment includes the following agent classes: azoles, polyenes, echinocandins, and pyrimidines (5-fluorocytosine)

For most of the cases, the treatment of choice is an azole, except for those with advanced and extensive disease for which an intravenous drug such as amphotericin B should be used. Treatment variably continues for 6-12 weeks after culture results are negative.

Antifungal prophylaxis is suggested for immunosuppressed patients.

Azoles such as voriconazole or posaconazole may be required in recalcitrant or invasive infections resistant to other antimycotic agents, especially in immunocompromised patients with unusual mycotic infections. [40] Statins may have some antifungal activity. [41]

Cases of Rhodotorula infection are susceptible to 5-fluorocytosine, moderately susceptible to amphotericin B, miconazole, ketoconazole and itraconazole, but resistant to fluconazole. [37]

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Surgical Care

In addition to medical therapy, surgical debridement may be required, especially in aspergillosis and zygomycosis (mucormycosis). Zygomycosis used to be almost uniformly fatal and still has a mortality rate approaching 20%; therefore, control of underlying disease is essential if possible, together with systemic amphotericin or azole therapy (eg, fluconazole, itraconazole, or posaconazole) and surgical debridement and, as some suggest, hyperbaric oxygen. [42]

Surgery may be further indicated in cases of mycoses to correct any defects resulting from fungal destruction of the maxilla, orbit, and/or cranial base.

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Consultations

Consultation with a respiratory medicine, infectious disease, or immunology specialist may be helpful.

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