FUNGAL

INFECTIONS OF
THE ORAL CAVITY
Abdulmalik Fadya Nasib
V28/30331/2015

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INTRODUCTION

There are 2 types of fungal infections in the oral region :

1. Candidal infections
2. Non-Candidal infections

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 CANDIDAL INFECTIONS
i) ORAL THRUSH
■ Oral thrush occurs when a yeast infection develops on
the inside of your mouth and on your tongue. This
condition is also known as oropharyngeal candidiasis.
■ It is caused by Candida albicans fungus. A small
amount of this fungus normally lives in your mouth
without causing harm. However, when the fungus
begins to grow uncontrollably, an infection can develop.

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■ Oral thrush is typically a mild infection that rarely causes
complications. However, the condition can be problematic for
those who are immuno compromised

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 CAUSES
■ Oral thrush occurs when the C. albicans fungus begins to grow out of control.
Normally, the immune system uses good microorganisms to keep it under control.
When this balance is disrupted, however, harmful bacteria and fungi begin to multiply.
This causes an infection to develop.
■ Oral thrush can occur when your immune system is weakened by certain medications.
Cancer treatments, including chemotherapy and radiation, can also damage or kill
healthy cells. This makes you more susceptible to oral thrush and other infections.
■ Diseases that attack your immune system, such as HIV, AIDS, and leukemia, also
increase your risk for oral thrush. Diabetes, another illness that affects your immune
system, can contribute to oral thrush as well. If you have uncontrolled diabetes, you
likely have a high level of sugar in your saliva. It’s thought that C. albicans can then
use this extra sugar to fuel its growth in your mouth.

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■ In newborns, oral thrush can be contracted at
birth. The same fungus that causes oral thrush
also causes yeast infections, so pregnant women
with a vaginal yeast infection can pass the
infection on to their baby during delivery

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RISK FACTORS
■ HIV, AIDS, diabetes, or anemia.
■ have an illness that causes dry mouth.
■ take antibiotics or corticosteroids.
■ use chemotherapy, radiation, or drugs to treat cancer.
■ wear dentures.
■ smoke cigarettes.
■ Immunesuppressive therapy for Organ transplant.

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SYMPTOMS
■The following symptoms may occur :
• Creamy white bumps on the tongue, inner cheeks,
gums, or tonsil
• Slight bleeding when the bumps are scraped
• Pain at the site of the bumps
• Dry, cracked skin at the corners of the mouth
• Difficulty swallowing
■In infants, oral thrush may cause:
• Difficulty feeding
• Fussiness
• Irritability
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■ Other oral manifestations of candida infections are :
– Angular chelitis, represents a nonspecific
inflammatory reaction to the corners of the mouth
because of candida.
– Candida leukoplakia, consists of a raised firm white
plaque of the oral mucosa that cannot be removed by
scraping, is usually found on the side of the tongue,
and can affect the cheeks.
– Acute atropic candidiasis, chronic atrophic
candidiasis, denture sore mouth, which is described
as erythematous tongue, or thinning of the mucous
membrane.

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DIAGNOSIS
■  Examining mouth and tongue for the characteristic white
bumps.
■ The dentist may take a biopsy to confirm the diagnosis. A
biopsy involves scraping off a very small portion of a bump in
the mouth. The sample is then sent to a laboratory, where it
will be tested for the presence of C. albicans.

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TREATMENT
■ Treatment for oral thrush varies depending on age and overall health. The
purpose of treatment is to prevent the growth and spread of the fungus.
■ Medical treatment for oral thrush may consist of:
• Fluconazole, which is an oral antifungal medication.
• Clotrimazole lozenge, which is an antifungal medication that
you leave in your mouth until it dissolves.
• Nystatin which is an antifungal mouthwash.
• Itraconazole, which is an oral antifungal medication used for
people who are resistant to initial treatments or who have HIV
or AIDS.
• Amphotericin B, which is a drug used to treat severe
infections.
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MANAGEMENT

■ Brushing your teeth with a soft toothbrush to avoid

scraping the lesions.
■ Replacing your toothbrush every day until the
infection goes away.
■ Maintaining appropriate blood sugar levels if you
have diabetes.
■ Practicing good oral hygiene.

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COMPLICATIONS
■ Oral thrush rarely causes complications in people
with healthy immune systems. People whose immune
systems are weakened by certain diseases or
medical treatments are the most likely to experience
complications. The fungus may enter your
bloodstream and spread throughout your body. This
can eventually cause problems in various body
structures, including the brain, heart, and liver.

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NON-CANDIDAL INFECTIONS
1. ASPERGILLOSIS
– The organisms (Aspergillis spp.) exist as prolific
saprophytes in soil and decaying vegetation. Inhalation of
the organisms allows for their germination and colonization
in the mucosa of the respiratory tract, including the mouth.
Lesions may be established primarily in the oral mucosa,
but they more commonly begin in the mucosa of the
maxillary sinus. They may appear in the oral cavity after
local invasion or destruction of the surrounding structures.

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■ Diagnosis : Computed tomographic scanning of
the sinusee can be used to confirm fungus ball. It
is also helpful in determining the extent of the
infection in invasive disease.
■ Treatment : Voriconazole or Amphotericin B.
– Surgical debridement might be required.

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 2.BLASTOMYCOSIS

– B dermatitidis, which is found in soil and spores, may be

inhaled to produce respiratory tract and sometimes
disseminated disease, for example in diabetes.

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 3.CRYPTOCOCCOSIS
–  Left image shows solitary, destructive lesion resulting in necrosis of
alveolar bone and palatal mucosa; note the superficial
pseudomembranous candidiasis of the palate. Right image shows
nonspecific chronic ulceration of the buccal mucosa due to
cryptococcosis; this is associated with submucosal induration and
regional adenopathy. 

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■ Cryptococcus spp. Can rarely cause gingivitis, sinusitis and
salivary gland enlargement. The oral lesion are craterlike,
nonhealing ulcers that are tender to palpation or are friable
plaques.
■ Diagnosis: Characteristic of C.neoformans is the presence of the
spherical budding yeast and the organism capsule on India ink
stain.
■ Treatment: Fluconazole and Amphotericin B.

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4.HISTOPLASMOSIS

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■ Caused by Histoplasma capsulatum .
■ Acquired by inhalation of mycelial fragments and microconidia
from the soil.
■ Most oral lesions are ulcerative or nodular and can involve the
skin, tongue, palate, or buccal mucosa. They can mimic squamous
oral cancer.
■ Diagnosis requires isolation of the organism from body fluid or
tissue. The antigen detection and PCR analysis assay, which
detects polysacchride antigen in the serum or the urine by
enzyme-linked immunosorbent assay, are the mainstays of the
diagnosis of histoplasmosis.
■ Treatment : Oral itraconazole and intravenous amphotericin B.

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5.ZYGOMYCOSIS

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Mucormycosis
■ Acute rhinocereberal mucormycosis is a well described
fungal infection that typically develops in a rapidly
fulminant manner with fever, headache, lethargy,
mucosal necrosis and opthalmologic findings.
■ Maxillary sinusitis and oral involvement have been
described. Oral lesions are ulcerative with a black
necrotic surface. Massive tissue destruction can occur.
■ Diagnosis : histopathological finding of broad nonseptate
hyphae confirms it.
■ Treatment: Surgical debridement, systemic IV
amphotericin B followed by posaconazole.
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