Superinfections with Candida sp. can occur in association with all, but especially broad-spectrum antibacterial agents.38,39,61,70,73 Acute pseudomembranous oral candidiasis appears as white, raised, or cottage cheese-like that can be scraped off, leaving a red, sometimes hemorrhagic base. Patients may also present with hairy tongue and complain of burning, itching, or a metallic taste. Candidiasis occurring in a patient with a dry mouth may present as areas of patchy erythema with little or no evidence of cottage cheese-like curds. Candida sp. may spread to the esophagus or lungs via swallowing or droplet aspiration; or systemically via the blood stream, especially in immunosuppressed patients.