Management of Acute Pseudomembranous Candidiasis in a Dysphagia Post-Stroke and Hairy Tongue Patient
Abstract
Background. Hairy tongue is a benign condition characterised by the elongation of the filiform papillae. This elongation creates an environment conducive to debris retention and alterations in the oral microflora, thereby increasing the risk of developing candidiasis. In patients with dysphagia, the decrease in mastication and swallowing movements further creates an opportunity for candidiasis to develop. Case report. This present case reports a 67-year-old man with dysphagia following a stroke incident. A thick white pseudomembrane was observed on the dorsum of the tongue and the edentulous ridge, which had otherwise appeared normal to the surrounding mucosa. Treatment consisted of prescribing an oral antiseptic to be used three times daily and regularly using a tongue scraper after brushing. After seven days of treatment, the pseudomembrane had disappeared, except for the central posterior part of the tongue. This remaining pseudomembrane could not be scraped off and was defined as a hairy tongue. Conclusion. Proper management of acute pseudomembranous candidiasis on the hairy tongue lesions can prevent candidemia and further tongue mucosal changes.References
1. Kuo PY, Chen PH, Wu SH. Black hairy tongue treated with traditional Chinese medicine: A case report. Med (United States). 2023;102(43):E34430.
2. Sun KW, Yang ZC. Long-term use of triple antibiotic-induced black hairy tongue: A case report. SAGE Open Med Case Reports. 2023;11:1–4.
3. Burket LW. Burket’s Oral Medicine. Thirteenth. Glick M, Greenberg MS, Lockhart PB, Challacombe SJ, editors. Newyork, USA: Wiley Blackwell; 2021.
4. Burge E, Kogilwaimath S. Hairy tongue. Cmaj. 2021;193(16):E561.
5. Patmah P, Mariana ER, Purwati Ningsih ES. Literature Review Faktor yang Mempengaruhi Pneumonia Aspirasi pada Pasien Stroke dengan Disfagia. J Citra Keperawatan. 2022;10(2):73–80.
6. Schlager E, St. Claire C, Ashack K, Khachemoune A. Black Hairy Tongue: Predisposing Factors, Diagnosis, and Treatment. Am J Clin Dermatol. 2017;18(4):563–9.
7. Kim DY, Park HS, Park SW, Kim JH. The impact of dysphagia on quality of life in stroke patients. Med (United States). 2020;99(34):1–6.
8. Estupiñán Artiles C, Regan J, Donnellan C. Physiological Mechanisms and Associated Pathophysiology of Dysphagia in Older Adults. Gerontol Geriatr Med. 2022;8.
9. Cahyati Y, Ipa M, Rosdiana I. Swallowing Ability in Stroke Patients: A Case Study in Tasikmalaya Hospital, Indonesia. Open Access Maced J Med Sci. 2022;10(G):407–12.
10. Das P, Challacombe SJ. Dry Mouth and Clinical Oral Dryness Scoring Systems. Prim Dent J. 2016;5(1):77–9.
11. Ren J, Zheng Y, Du H, Wang S, Liu L, Duan W, et al. Antibiotic-induced black hairy tongue: two case reports and a review of the literature. J Int Med Res. 2020;48(10).
12. Kannan S, Muthusamy S, Chandrasekaran B, Gopal, Deepika Sidhu P. Black hairy tongue in Older Edentulous Individuals. J Am Geriatr Soc. 2014;62(5):992–4.
13. González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after stroke: an overview. Curr Phys Med Rehabil Reports [Internet]. 2013 Sep 3;1(3):187–96. Available from: http://link.springer.com/10.1007/s40141-013-0017-y
14. Motta APG, Rigobello MCG, Silveira RC de CP, Gimenes FRE. Nasogastric/nasoenteric tube-related adverse events: an integrative review. Rev Lat Am Enfermagem. 2021;29:e3400.
15. Wang DH, Tsai FT, Tu HF, Yang CC, Hsu ML, Huang LJ, et al. Profiles of oral microbiome associated with nasogastric tube feeding. J Oral Microbiol [Internet]. 2023;15(1). Available from: https://doi.org/10.1080/20002297.2023.2200898
16. Wang X, Yang S, Wang Y. Image Gallery: Black hairy tongue in a patient receiving enteral feeding. Br J Dermatol. 2019;181(4):e91.
17. Hoffmann S, Harms H, Ulm L, Nabavi DG, Mackert BM, Schmehl I, et al. Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia – The PREDICT study. J Cereb Blood Flow Metab. 2017;37(12):3671–82.
18. Lyons M, Smith C, Boaden E, Brady MC, Brocklehurst P, Dickinson H, et al. Oral care after stroke: Where are we now? Eur Stroke J. 2018;3(4):347–54.
19. Somayaji S, Gadahad MR, Lakshminarayana S. Antimicrobial efficacy of chlorine dioxide against Candida albicans in stationary and starvation phases in human root canal: An in-vitro study . Sahel Med J. 2014;17(1):1.
20. Zand F, Zahed L, Mansouri P, Dehghanrad F, Bahrani M, Ghorbani M. The effects of oral rinse with 0.2% and 2% chlorhexidine on oropharyngeal colonization and ventilator associated pneumonia in adults’ intensive care units. J Crit Care [Internet]. 2017;40:318–22. Available from: http://dx.doi.org/10.1016/j.jcrc.2017.02.029
21. Rai, A., Misra, S. R., Panda, S., Sokolowski, G., Mishra, L., Das, R., & Lapinska, B. (2022). Nystatin Effectiveness in Oral Candidiasis Treatment: A Systematic Review & Meta-Analysis of Clinical Trials. Life, 12(11), 1677. https://doi.org/10.3390/life12111677
2. Sun KW, Yang ZC. Long-term use of triple antibiotic-induced black hairy tongue: A case report. SAGE Open Med Case Reports. 2023;11:1–4.
3. Burket LW. Burket’s Oral Medicine. Thirteenth. Glick M, Greenberg MS, Lockhart PB, Challacombe SJ, editors. Newyork, USA: Wiley Blackwell; 2021.
4. Burge E, Kogilwaimath S. Hairy tongue. Cmaj. 2021;193(16):E561.
5. Patmah P, Mariana ER, Purwati Ningsih ES. Literature Review Faktor yang Mempengaruhi Pneumonia Aspirasi pada Pasien Stroke dengan Disfagia. J Citra Keperawatan. 2022;10(2):73–80.
6. Schlager E, St. Claire C, Ashack K, Khachemoune A. Black Hairy Tongue: Predisposing Factors, Diagnosis, and Treatment. Am J Clin Dermatol. 2017;18(4):563–9.
7. Kim DY, Park HS, Park SW, Kim JH. The impact of dysphagia on quality of life in stroke patients. Med (United States). 2020;99(34):1–6.
8. Estupiñán Artiles C, Regan J, Donnellan C. Physiological Mechanisms and Associated Pathophysiology of Dysphagia in Older Adults. Gerontol Geriatr Med. 2022;8.
9. Cahyati Y, Ipa M, Rosdiana I. Swallowing Ability in Stroke Patients: A Case Study in Tasikmalaya Hospital, Indonesia. Open Access Maced J Med Sci. 2022;10(G):407–12.
10. Das P, Challacombe SJ. Dry Mouth and Clinical Oral Dryness Scoring Systems. Prim Dent J. 2016;5(1):77–9.
11. Ren J, Zheng Y, Du H, Wang S, Liu L, Duan W, et al. Antibiotic-induced black hairy tongue: two case reports and a review of the literature. J Int Med Res. 2020;48(10).
12. Kannan S, Muthusamy S, Chandrasekaran B, Gopal, Deepika Sidhu P. Black hairy tongue in Older Edentulous Individuals. J Am Geriatr Soc. 2014;62(5):992–4.
13. González-Fernández M, Ottenstein L, Atanelov L, Christian AB. Dysphagia after stroke: an overview. Curr Phys Med Rehabil Reports [Internet]. 2013 Sep 3;1(3):187–96. Available from: http://link.springer.com/10.1007/s40141-013-0017-y
14. Motta APG, Rigobello MCG, Silveira RC de CP, Gimenes FRE. Nasogastric/nasoenteric tube-related adverse events: an integrative review. Rev Lat Am Enfermagem. 2021;29:e3400.
15. Wang DH, Tsai FT, Tu HF, Yang CC, Hsu ML, Huang LJ, et al. Profiles of oral microbiome associated with nasogastric tube feeding. J Oral Microbiol [Internet]. 2023;15(1). Available from: https://doi.org/10.1080/20002297.2023.2200898
16. Wang X, Yang S, Wang Y. Image Gallery: Black hairy tongue in a patient receiving enteral feeding. Br J Dermatol. 2019;181(4):e91.
17. Hoffmann S, Harms H, Ulm L, Nabavi DG, Mackert BM, Schmehl I, et al. Stroke-induced immunodepression and dysphagia independently predict stroke-associated pneumonia – The PREDICT study. J Cereb Blood Flow Metab. 2017;37(12):3671–82.
18. Lyons M, Smith C, Boaden E, Brady MC, Brocklehurst P, Dickinson H, et al. Oral care after stroke: Where are we now? Eur Stroke J. 2018;3(4):347–54.
19. Somayaji S, Gadahad MR, Lakshminarayana S. Antimicrobial efficacy of chlorine dioxide against Candida albicans in stationary and starvation phases in human root canal: An in-vitro study . Sahel Med J. 2014;17(1):1.
20. Zand F, Zahed L, Mansouri P, Dehghanrad F, Bahrani M, Ghorbani M. The effects of oral rinse with 0.2% and 2% chlorhexidine on oropharyngeal colonization and ventilator associated pneumonia in adults’ intensive care units. J Crit Care [Internet]. 2017;40:318–22. Available from: http://dx.doi.org/10.1016/j.jcrc.2017.02.029
21. Rai, A., Misra, S. R., Panda, S., Sokolowski, G., Mishra, L., Das, R., & Lapinska, B. (2022). Nystatin Effectiveness in Oral Candidiasis Treatment: A Systematic Review & Meta-Analysis of Clinical Trials. Life, 12(11), 1677. https://doi.org/10.3390/life12111677
Published
2025-07-24
How to Cite
RAHMAN, Kurnia Hayati et al.
Management of Acute Pseudomembranous Candidiasis in a Dysphagia Post-Stroke and Hairy Tongue Patient.
Journal of Indonesian Oral Medicine Society, [S.l.], v. 2, n. 3, p. 8-12, july 2025.
ISSN 3026-6688.
Available at: <http://jurnal.pdgi.or.id/index.php/jioms/article/view/1371>. Date accessed: 24 aug. 2025.
doi: https://doi.org/10.32793/jioms.v2i3.1371.
Section
Case Reports
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
