Dear Dr. Reznik let me start by telling you how very much I appreciate your time and dedication to this most worthy cause. I have a brother who is positive and we have found this site to be very informative. I am personally involved with a nightmare. Fifteen months ago I developed a white coating on the back of my tongue. Though it has never been painful nor has it worsened it is none the less irritating. I do not have problems eating, swallowing nor does hot/cold food/drinks irritate this coating. I can only describe it as a thick pasty like coating with stringy saliva at times. It never changes except when I brush my tongue. When I do this it seems to look and feel better for awhile then it returns. Initially I was told by three Doctors that this was Thrush and caused by a compromised immune system most likely related to Aids. I am a 35 year old male who smokes. In fear and trembling I tested and my results were NONREACTIVE. Prior to testing I was given a round of Mycelex Troche 4-5 times a day, and gintin violet, for two weeks with no changes in my tongue, then I was prescribed Diflucan for what ended up being about 18 days with NO CHANGES except major headaches. I have had sinus problems for several years and more recently a dry mouth. I take antihypertension medication (atenolol) and anti-anxiety medication (xanax) for an anxiety disorder which was much improved. I suspect I sleep with my mouth open at night. I have long since suspected the medication was the culprit for the dry mouth. I have been tested for kidney problems, liver, diabetes and have had a CBC, all of which have indicated no problems. My Doctor now wants me to see a specialist in the Gastro Intestinal area for further testing. I have no other symptoms. I AM SICK and TIRED of dealing with this mess and Doctors who do not seem to understand that there might be other things that may cause this. I do not know what it is but I am certain it is not Thrush. I know you can't diagnose me without seeing me. But based on the information I have provided do you believe there is still the possibility I could have Thrush? I understand there are new strains of candida, please explain these, in comparison to the others. I went to the first Doctor within 3 days of realizing this problem and treatment began immediately but to no avail. I appreciate your focus on the HIV population but please share your thoughts on this subject. I am sure there are countless people who have and will endure this nightmare if we don't help them. I live in a small town and educating these people is hard. What kind of physician would you recommend I see to get a straight answer about this condition? I mean what kind of Doctor would be trained and knowledgeable about this type of problem? Your help is most needed as I am in need of reassurance. Thank you again for all you do.

Paul

Dear Paul:

As you realize, it is impossible for me to give an accurate diagnosis of your condition without having the ability to perform a complete examination, but the following observations may prove helpful.

What you have described sounds a great deal like coated tongue. You have several risk factors for the development of coated tongue such as smoking, dry mouth, mouth-breathing and stress. Coated tongue, which is nothing more than an overgrowth of the normal tongue papillae, would not respond to antifungal agents, such as the ones you mentioned you have been on. To determine if you have coated tongue or not, I would suggest you visit a dentist.

Your question concerning new species or strains of Candida is a good one, but probably not related to the issues you face. To give a relatively simple explanation, in the early 1990s approximately 93% of all cases of oropharyngeal candidiasis were due to Candida albicans. Our latest epidemiological research project has shown that in our HIV population this number is now 76%. What this means is that in immunocompromised patients we are seeing an increase in the non-albicans species such as Candida glabrata, C. tropicalis and C. krusei. The problem most associated with these non-albicans species is that for the most part they are intrinsically resistant to the available oral antifungal medications. There are several different strains of Candida albicans, some of which are also intrinsically resistant to available medications.

This is a complicated topic and I hope my answer sheds some light on the situation. My advice: visit a dentist to rule out coated tongue which would be the simplest and most likely explanation for the difficulties you have described.

Thank you for your kind comments and best of luck!

DR