Candidiasis Mucosal

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Text of Candidiasis Mucosal

2011

NotesThis is a compilation of free medical articles and journals This only used as a school paperwork and never for any commercial purpose All of the articles and journals provided in this compilation are copyrights of their own authors Please do not copy, distribute, or use this for commercial purpose To cite, please visit the link provided in each article or journalT.S.K.

TABLE OF CONTENTSIntroduction ......................................................................... iii Table of Contents................................................................. iv Articles 1. Candidiasis Mucosal ..................................................... 1 2. Mucocutaneus Candidiasis ........................................... 22 3. Candidiasis: Oral, Esophageal, and Vulvovaginal .......... 31 4. Candidal Balanitis ......................................................... 40 5. Mucocutaneus Candidiasis and HIV .............................. 43 6. Molecular and Cellular Mechanisms that Lead to Candida Biofilm Formation........................................... 63 7. Successful Treatment of Chronic Mucocutaneous Candidiasis Caused by Azole-Resistant C. albicans with Posaconazole ............................................................... 84 8. Probiotics for Prevention of Recurrent Vulvovaginal Candidiasis: A Review................................................... 91 9. Prospects for Development of a Vaccine to Prevent and Control Vaginal Candidiasis .......................................... 103

CANDIDIASIS MUCOSALSOURCE: http://emedicine.medscape.com/article/1075227-overview AUTHOR: Crispian Scully, MD, PhD, CBE, MDS, MRCS, FDSRCS, FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed(HC), Dr (HC), Professor, Director of Special Projects, Eastman Dental Institute for Oral Health Care Sciences; Professor, Special Needs Dentistry, University College; Professor, Oral Medicine, Pathology and Microbiology, University of London; Visiting Professor Universities of Athens, Bristol, Edinburgh, and Helsinki LAST UPDATED: April 29, 2010

INTRODUCTION Background Candidosis describes a group of yeast like fungal infections involving the skin and mucous membranes. Infection is caused by Candida species, typically, Candida albicans. C albicans is ubiquitous and is found mainly on oral or genital mucosae; it may also be transmissible between consorts.[1] By tradition, the most commonly used divides the infection into 4 types membranous candidosis (thrush), (2) candidosis, (3) chronic hyperplastic atrophic (erythematous) candidosis. classification of oral candidosis including (1) acute pseudoacute atrophic (erythematous) candidosis, and (4) chronic

Chronic hyperplastic candidosis was further subdivided into 4 groups based on localization patterns and endocrine involvement including (1) chronic oral candidosis (candidal leukoplakia), (2) endocrine candidosis syndrome, (3) chronic localized mucocutaneous candidosis, and (4) chronic diffuse candidosis. Thrush (acute pseudomembranous candidiasis) is the term used for the multiple white-fleck appearance of acute candidiasis, which purportedly resembles the appearance of the bird with the same name. Erythematous candidosis is the term used for the red lesions of candidiasis. Pathophysiology

C.albicans is the predominant causal organism of most candidosis. Other species, including Candida krusei, have appeared in persons who are severely immunocompromised. Candida glabrata is an

emerging cause of oropharyngeal candidosis in patients receiving radiation for head and neck cancer.[2] In patients with HIV infection, new species, such as Candida dubliniensis and Candida inconspicua, have been recognized.

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C albicans is a harmless commensal organism inhabiting the mouths ofalmost 50% of the population (carriers); persister cells are clinically relevant, and antimicrobial therapy selects for high-persister strains in vivo.[3] Under certain circumstances, C albicans can become an opportunistic pathogen. Such a suitable circumstance for it to become an opportunist may be a disturbance in the oral flora or a decrease in immune defenses. Acute pseudomembranous candidosis (thrush) Thrush may be observed in healthy neonates or in persons in whom antibiotics, corticosteroids, or xerostomia disturb the oral microflora. Oropharyngeal thrush occasionally complicates the use of corticosteroid inhalers. Immune defects, especially HIV infection, immunosuppressive treatment, leukemias, lymphomas, cancer, and diabetes, may predispose patients to candidal infection. Erythematous candidosis Erythematous candidosis may cause a sore red mouth, especially of the tongue, in patients taking broad-spectrum antimicrobials. It also may be a feature of HIV disease. Median rhomboid glossitis is a red patch occurring in the middle of the dorsum in the posterior area of the anterior two thirds of the tongue and especially is observed in smokers and in those with HIV disease. Chronic mucocutaneous candidosis Chronic mucocutaneous candidosis (CMC) describes a group of rare syndromes, which sometimes include a definable immune defect, in which persistent mucocutaneous candidosis responds poorly to topical treatment. Generally, the more severe the candidosis, the greater the likelihood that immunologic defects (particularly of cell-mediated immunity) can be identified. Recent studies suggest a defect in cytokine (interleukin 2 and interferon-g) production in response to candidal and some bacterial antigens, with reduced TH1 lymphocyte function and enhanced TH2 activity (and increased interleukin 6), and reduced serum levels of immunoglobulin G2 and immunoglobulin G4. Frequency United States Candidosis is common in groups at risk, such as patients who are immunocompromised. Frequency of infection is rising, primarily because of HIV infection and both the increase in candidal species other than C albicans and the resistance to antifungals.

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International Candidosis is common in groups at risk, such as patients who are immunocompromised.

Mortality/Morbidity Candidosis may predispose individuals to esophageal spread. Sex Candidosis is reported equally in males and females worldwide, except in areas where males with HIV infection outnumber females. Age Candidosis predominantly occurs in middle-aged or older persons; however, in those with HIV infection, candidal infection primarily occurs in the third and fourth decades.

CLINICAL History Thrush White patches on the surface of the oral mucosa, tongue, or other parts of the body characterize thrush. Lesions develop into confluent plaques that resemble milk curds and can be wiped off to reveal a raw erythematous and sometimes bleeding base. Note the image below.

Pseudomembranous candidosis

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Erythematous candidosis Erythematous areas found generally on the dorsum of the tongue, palate, or buccal mucosa are characteristic. Lesions on the dorsum of the tongue present as depapillated areas. Red areas often are seen on the palate of individuals with HIV infection. An associated angular stomatitis may be present. Note the image below.

Erythematous candidosis in HIV/AIDS

Chronic hyperplastic candidosis (candidal leukoplakia)[4] A chronic, discrete, raised lesion that may vary from a small, palpable, translucent, or whitish area to a large, dense, opaque plaque that is hard and rough to the touch (plaquelike lesion) is observed. Homogeneous or speckled areas, which do not rub off (nodular lesions), can be seen. Speckled leukoplakia accounts for 3-50% of candidal leukoplakias. Candidal leukoplakias usually occur on the inside surface of one or both cheeks; they occur less commonly on the tongue.

Chronic multifocal oral candidosis In a minority of individuals, chronic candidal infection may be seen in multiple oral sites with various combinations including (1) angular stomatitis, which is unilateral or bilateral and is encountered mostly in denture wearers; (2) retrocommissural leukoplakia, which is the most constant component of the tetrad; (3) median rhomboid glossitis; and (4) palatal lesions. Additional criteria include (1) lesions of more than 1-month duration; (2) absence of predisposing medical conditions; (3) exclusion of individuals undergoing radiotherapy or administration of the following types of drugs: anti-inflammatory, immunesuppressive, cytotoxic, or psychotropic agents or antibiotics.

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This type is most common in male tobacco smokers in their fifth or sixth decade. Antifungal therapy clears the infection and produces clinical improvement; however, recurrence is common, unless smoking can be reduced. Denture-related stomatitis (denture-induced stomatitis, denture sore mouth, chronic atrophic candidosis)[5] Chronic erythema and edema of the mucosa that contacts the fitting surface of the denture are characteristic. The mucosa below the lower denture rarely is involved. Occasional slight soreness is experienced; however, the patient typically is asymptomatic. The typical presenting complaint is angular stomatitis. Note the image below.

Denture-related stomatitis; a common form of oral candidiasis. From Scully C, Flint SF, Bagan JV, Porter SR, Moos K. Atlas of Oral and Maxillofacial Diseases. 2010. Informa, London.

Denture-related stomatitis is classified into 3 clinical types as follows: Localized simple inflammation or a pinpoint hyperemia Erythematous or generalized simple type presenting as more diffuse erythema involving a part of, or the entire, denture-covered mucosa Granular type (inflammatory papillary hyperplasia) commonly involving the central part of the hard palate and the