CANDIDIASIS

CANDIDIASIS• Caused by Candida Albicans• C. Albican is usually weak pathogens, affected very young,

very old, and very sick• Pathogenesis:

• Predispos factors Candida normal (Saprophytic stage)

• Candida pathogenic organism (Parasitic stage)

• Oral Candidiasis• Primary = restricted to the oral and perioral sites• Secondary = systemic mucocutaneous manifes

• Predisposing factors :

• Epidemiologi• Candida is more frequently isolated from woman• Prevalence increase during the summer• Denture-wearers 50 %

Pseudomembrans Candidiasis (THRUSH)• Predominantly affected medicated antibiotic,

immunosuppressant drugs, disease that suppresses immune• Presents with Loosely attached membranes comprising fungal

organisms and cellular debris• Unique sign :

1. Patches of creamy white pearl or bluish white2. Can be scarped red base, sometimes bleed

• Clinical symptoms: • some discomfort but this is infrequent.

• Chronic form emerge as a result of HIV infections for a long period of time.

Erythematous Candidiasis• referred to as atrophic oral candidiasis • Predisposing factors: use of inhalation steroids, smoking, and

treatment with broad-spectrum antibiotics.• Clinical appearance: • Red (erythematous) lesion with diffuse border • Most common area: in the palate and dorsum of the tongue

• Clinical symptoms: burn sensation and soreness.

• The acute and chronic identical clinical features• Erythematous candidiasis could precede or follow thrush

(pseudomembranous candidiasis)

Chronic Plaque-type and Nodular Candidiasis (Chronic hyperplastic)• Chronic plaque-type candidiasis previously termed as candidal

leukoplakia.• Predisposing factors: smoking• Clinical appearance:• White plaque (may be indistinguishable from oral leukoplakia)

• Most common area: buccal mucosa, lateral borders of the tongue, corner of the mouth

• Clinical symptoms: usually not painful• These lesions are always chronic.

• But the probable role of yeast in oral carcinogenesis remains unclear.

Denture Stomatitis• Characterized by localized chronic erythema of tissues covered

by denture.• Denture stomatitis is classified into three different types:• Type I localized to minor erythematous sites caused by trauma

from the denture• Type II affects major part of the denture-covered mucosa• Type III in addition to type II, it has a granular mucosa in the

central part of the palate• Predisposing factor: dental appliance denture

• Clinical appearance: • Localized erythema of denture-covered tissues • Most common area: palate, upper jaw

• Clinical symptoms: usually not painful

Angular Cheilitis• Predisposing factors: vitamin B12 deficiency, iron deficiency,

loss of vertical dimension (facial wrinkling), dry skin (develop skin fissures)

• Clinical appearance: • Erythematous fissuring at one or both corners of the mouth• 30% of patients with denture stomatitis also have angular cheilitis

Median rhomboid glossitis• It is a chronic erythematous lesion in the center of the

posterior part of the dorsum of tongue resulting from atrophy of the filiform papillae.

• Predisposing factors: smoking, use of denture, use of inhalation steroids

• Clinical appearance:• Erythematous area with oval configuration in the center of the

posterior part of the dorsum of tongue.• Clinical symptoms: - (asymptomatic)

Oral candidiasis associated with HIV

• More than 90% of AIDS patients had oral candidiasis• Most common types of oral candidiasis associated with HIV: • Pseudomembranous candidiasis, erythematous candidiasis,

angular cheilitis, and chronic hyperplastic candidiasis

Clinical Manifestations• Secondary oral candidiasis is accompanied by systemic

mucocutaneous candidiasis & other immune deficiencies.

• Chronic mucocutaneous candidiasis (CMC) can occur as part of endocrine disorders such as hyperparathyroidism & Addison’s disease.

• In addition to oral candidiasis, CMC also affects the skin, typically the nail bed, and other mucosal linings, such as genital mucosa. The face and scalp may be involved.

• Approx. 90% of patients with CMC also present with oral

Diagnosis• Clinical diagnosis by giving antifungal treatment and review

patient’s condition after 1-2 weeks. If the lesion disappears, this confirms our diagnosis. If it doesn’t, then we need a biopsy.

• Biopsy technique:• Smear from infected area • Swab taken by rubbing cotton –tipped • Imprint culture sterile plastic foam • Impression culture alginate impressions • Salivary culture patient expectorates ml saliva into sterile container• Oral rinse Subject rinses for 60 s with PBS at pH 7.2, 0.1The result is expressed as “colony forming units per cubic millimeter” (CFU/mm2)

Oral Candidiasis: Principle of Management• Elimination or reduction of predisposing factors• Improve oral hygiene• Therapy by giving antifungal drugs• The most commonly used drugs group of polyenes or azoles.• Polyenes (ex: nystatin, amphotericin B) first alternatives in

primary oral candidiasis. Polyenes are not absorbed from the gastrointestinal tract and are not associated with development of resistance.

• Topical treatment with azoles (ex: miconazole) is the treatment of choice in angular cheilitis

• If angular cheilitis comprises an erythema surrounding the fissures, a mild steroid ointment may be required to reduce the inflammation.• To prevent recurrences patients must apply a moisturizing

cream to prevent new fissure formation

• Systemic azoles may be used for deeply seated primary oral candidiasis, such as chronic hyperplastic candidiasis, denture stomatitis, median rhomboid glossitis, and for therapy-resistant infections

• The azoles are also used in the treatment of secondary oral candidiasis

• Several disadvantages with azoles:• increasing bleeding propensity• Azoles are fully or partly resorbed from the G.I. tract

Special Consideration for Denture Stomatitis• Educate the patients to improve denture hygiene• Denture should be stored in antimicrobial solutions, ex: alkaline

peroxides, alkaline hypochlorites, acids, disinfectants, enzymes. Chlorhexidine may be used, but can discolor the denture and counteracts the effect of nystatin.

• Recommend the patients for not using denture while sleeping• Type III denture stomatitis may be treated with surgical

excision if it is necesssary,