This document discusses Candidiasis, a fungal infection caused by Candida albicans and other Candida species. It is a common opportunistic infection that can affect the oral cavity and other parts of the body. Risk factors include immunosuppression, diabetes, corticosteroid use, and HIV infection. Clinical manifestations vary and include white patches or plaques in the mouth. Diagnosis involves smear examination, culture, or biopsy showing presence of Candida. Treatment involves use of topical or systemic antifungal medications like fluconazole, nystatin, or clotrimazole depending on severity and location of infection.
This document discusses Candidiasis, a fungal infection caused by Candida albicans and other Candida species. It is a common opportunistic infection that can affect the oral cavity and other parts of the body. Risk factors include immunosuppression, diabetes, corticosteroid use, and HIV infection. Clinical manifestations vary and include white patches or plaques in the mouth. Diagnosis involves smear examination, culture, or biopsy showing presence of Candida. Treatment involves use of topical or systemic antifungal medications like fluconazole, nystatin, or clotrimazole depending on severity and location of infection.
This document discusses Candidiasis, a fungal infection caused by Candida albicans and other Candida species. It is a common opportunistic infection that can affect the oral cavity and other parts of the body. Risk factors include immunosuppression, diabetes, corticosteroid use, and HIV infection. Clinical manifestations vary and include white patches or plaques in the mouth. Diagnosis involves smear examination, culture, or biopsy showing presence of Candida. Treatment involves use of topical or systemic antifungal medications like fluconazole, nystatin, or clotrimazole depending on severity and location of infection.
Roll no-77 Final Year • Candidiasis is a disease caused by infection with a yeast like fungus, Candida albicans • It is most common opportunist infection in the world. • Other species are :- C. tropicalis, C.parapsilosis, C.glabrata • Oral candidiasis or thursh usually remains as a localised disease, but on occasion it may show extension to pharynx or even lungs. Predisposing factors:- • Factors that alter immune system of the host • Immunodeficiency disorders like HIV infection • Blood dyscrasias • Radiation therapy • Corticosteriods therapy • Old age or infancy • Pregnancy • Diabetes Mellitus Classification of Candidiasis (Greenberg and Glick, 2003) Pseudomembraneous type Atrophic (erythematous)-antibiotic stomatitis ATROPHIC • Denture sore mouth • Angular cheilitis • Median rhomboid glossitis HYPERTROPHIC/HYPERPLASTIC • Candida leukoplakia • Papillary hyperplasia of palate • Median rhomboid glossitis(nodular) MULTIFOCAL SYNDROME ASSOCIATED • Familial endocrine neoplasia syndrome • Myositis LOCALISED GENERALISED CLINICAL PRESENTATION ACUTE PSEUDOMEMBRANEOUS CANDIASIS • It is the most common form of candiasis. • Common site :- buccal mucosa, dorsum of the tongue, palate. • Usually follows a immuno-suppressive therapy. • Burning sensation usually preceeds the appearance of a soft, creamy white to yellow elevated plaque that are easily wiped off from the affected oral tissues and leave Erythematous, eroded or ulcerated surface • In HIV patients :- Combination of oral and oesophageal candidiasis is prevalently is seen. • Either the entire oral muscosa or relatively localised area is affected. • Prodromal symptoms :- rapid onset of bad taste, loss of taste discrimination. Differential Diagnosis: • Habitual cheek biting • Burns • White sponge nevus CHRONIC HYPERPLASTIC CANDIASIS • Also called as candida leukoplakia • Seen as chronic discrete raised lesion that vary from small, palpable translucent whitsih area to large, dense, opaque plaques, hard and rough to touch. • Common site- Anterior buccal mucosa along the occlusal line, laterodorsal surface of the tongue. • Adherent and do not scrape off. CHRONIC ATROPHIC (ERYTHEMATOUS) CANDIDIASIS • Site- Hard palate under the denture, dorsal tongue or other mucosal surface. • Etiology- poor denture hygiene, continuous denture insertion, immunosuppression, xerostomia, or antibiotic therapy. • Most commomly appears as red patch or velvet textured plaque. • When it appears on the hard palate in association with denture, frequently associated papillary hyperplasia. • Burning sensation • Also reported in AIDS patients Median Rhomboid Glossitis • It is a form of chronic atrophic candidiasis characterized by an asymptomatic, elongated, erythematous patch of atrophic mucosa of the posterior mid dorsal surface of the tongue due to chronic candidal infection • A concurrent ‘kissing lesion’ of the palate is sometimes noted. ANGULAR CHEILITIS(PERLECHE) • Appears as red, eroded, fissured lesions • Occurs bilaterally in the commisures of the lips • Frequently irritating and painful • Etiology – loss of vertical occlusion dimension • May be associated with immunosuppresion CHRONIC MULTIFOCAL ORAL CANDIDIASIS • Seen in multiple oral sites • Seen in combination with angular stomatitis, median rhomboid glossitis and palatal lesions • All lesion have 1 month duration with no predisposing factors • Commonly seen in chronic smokers in their 5th to 6th decade of life ROLE OF CANDIDA IN ORAL CARCINOGENESIS • Candida leukoplakias may develop into carcinomas • The Candida organisms have a higher nitrosation potential than others, which might indicate the possible role of specific type in the transformation of some leukoplakias INVESTIGATIONS Smear examination • Histological examination of intraoral scrapings which have been smeared on microscopic glass slide. • A 10-20% potassium hydroxide preparation is used for identification of yeast cell forms. • Alternatively, the smear can be sprayed with cytologic fixative and stained using PAS stain and other slide with grams stain . • Yeast appears: • Dark blue- Gram staining • Red or Purple- PAS staining Hematologic investigation: • Associated with predisposing factors such as blood dyscrasias, estimation of Hb, white cell counts, blood sugar and serum ferritin. Biopsy • A biopsy may be indicated when candidiasis is suspected in conjunction with some concurrent pathology such as candidial leukoplakia, epithelial dysplasia, SCC or lichen planus. Imprint culture technique: • A sterile plastic foam pad of 2.5x2.5 cm is dipped in Sabouraud’s broth and placed on suspected mucosal surface for 60 seconds. • Then the plastic foam is directly placed on Sabouraud’s agar. • Candida density at each site is determined by Gallenkamp colony counter and expressed as colony-forming units (CFU) per mm2 • Denture wearers= 49CFU cm2 suggest candidiasis Salivary culture technique: 2ml of mixed unstimulated saliva into a sterile universal container The number of candida is expressed in CFU per mm of saliva is estimated by counting the resultant growth on Sabouraud’s agar. Oral rinse technique: Pt. is asked to rinse 10ml of sterile phosphate buffered saline or sterile water for 60 seconds The oral rinse is centrifuged at 1,700g for 10 mins and the deposits are resuspended in 1ml sterile PBS. The concentrated oral rinse is now inoculated in appropriater media to asses CFU/mm of rinse sample using a spiral platter prior to intubation. More advantageous than imprint technique: • Simple to perform • Used for quantitation of other organisms. Treatment Oral candidiasis Systemic candidiasis
Treat the underlying
cause or local factor
Topical Route Parental Route Oral Route
Clotrimaxazole 1% cream or Fluconazole 150mg or 200mg b.i.d for 14
2% gel or 1% solution for 5 days. times/day for 2 weeks. Ketoconazole 200mg o.d for 1-4 weeks. Nystatin 5Lakh Units for 4 Itraconazole 100mg o.d for 14 days. times/day for 14 days. Hamycin 2Lakh Units 2-3 Amphotericin B IV infusions 0.3 mg/kg can be times/day for 7-10days. infused over 4-8 hours. Fluconazole dispersable tablet with water to use as mouthrinse 3 times/day for 14 days. THANK YOU