This patient presents with thrush, or oral candidiasis. Of the available choices, the most likely predisposing condition is infection with the HIV virus, a type of retrovirus.
Thrush is caused by an overgrowth of Candida albicans. Up to 60% of adults carry candida species in their normal oral flora. However, certain disorders can permit an overgrowth of candida, leading to thrush. Predisposing conditions include use of dentures, use of inhaled steroids (particularly with improper technique), as well as certain conditions predisposing to decreased immunity, such as HIV, systemic radiation or chemotherapy, or leukemia. Thrush can be distinguished clinically from oral leukoplakia because thrush can be easily scraped off with a tongue depressor, whereas leukoplakia is firmly adherent and will not easily scrape off.
Gonsalves et al. review common oral lesions, including thrush. Thrush is usually a localized infection. However, in some cases thrush may progress to a systemic disease. Risk factors for systemic dissemination include many disorders predisposing to immunosuppression, including AIDS, immunosuppressive therapy, neutropenia, and malignancies, among others.
Singh et al. review the treatment of thrush. Usually oral candidiasis can be treated with topical antifungal medications. Topical medications include clotrimazole troches and nystatin swish and swallow. However, in some cases, particularly in chronic cases in immunocompromised patients, as well as in any case with systemic dissemination, systemic antifungal medications will be required. Systemic therapy can include amphotericin or fluconazole preparations, among other choices.
Figure A demonstrates a common presentation of thrush. For comparison, Illustration A depicts oral hairy leukoplakia. Recall that leukoplakia lesions would not scrape off easily with a tongue depressor.
Answer 1-2: Alcohol and tobacco can predispose to oral leukoplakia, as discussed above this patient has thrush, not oral leukoplakia.
Answers 4-5: Herpes and hepatitis infections do not typically predispose to thrush.
Gonsalves WC, Chi AC, Neville BW. Common oral lesions: Part I. Superficial mucosal lesions. Am Fam Physician. 2007 Feb 15;75(4):501-7.
PMID:17323710 (Link to Abstract)
Singh A, Verma R, Murari A, Agrawal A. Oral candidiasis: An overview. J Oral Maxillofac Pathol. 2014 Sep;18(Suppl 1):S81-5.
PMID:25364186 (Link to Abstract)