Fungal Infection Candidadiasis (Candidosis)

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Fungal InfectionCandidadiasis (Candidosis)

• Dent 451
• Lecture 4
• Dr Jumana Karasneh

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Candidal carriage

• 40-60 of the population are Candida carriers
• Candida species albicans, tropicalis, glabrata,
  
• It causes infection when resistance is lowered

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Predisposing factors
Factor Description
Physiological factors Old age, infancy, pregnancy
Local tissue trauma Appliances, poor OH
Antibiotic therapy Broad spectrum (systemic/topical)
Corticosteroid therapy Topical /systemic/ inhaler
Malnutrition Haematinic deficiency
Immune defects AIDS, immune suppression
Endocrine disorders Diabetes, Addison's, hypothyroidism
Malignancies Leukaemia
Salivary gland hypofunction Irradiation, Sjogrens syndrome, xerogenic drug
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Symptoms

• Asymptomatic
• Bad / altered taste
• Nausea
• Soreness burning sensation
• Dysphagia (pharynx / oesophagus involved)
• Hoarseness of voice (Larynx involved)

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Lehner Classification of Oral Candidosis (1960)

• Acute
• Pseudomembranous
• Atrophic
• Chronic
• Atrophic
• hyperplastic

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Clinical classification of Oral Candidosis

• Primary oral candidosis
• Acute
• Pseudomembranous
• Erythematous
• Chronic
• Pseudomembranous
• Erythematous
• Hyperplastic
• Candida-associated lesions
• Denture induced stomatitis
• Angular chelitis
• Median rhomboid glossitis

• Secondary oral candidosis
• Manifestation of systemic mucocutanous candidosis

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Pseudomembranous Thrush

• Not common in healthy individuals disease of
  diseased
• Pseudomembrane is made of necrotic material,
  haphae, desquamated epithelial cells.
• Should be differentiated from other white lesions
• Could extend to pharynx oesophagus

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Erythematous Candidosis

• Could be acute or chronic
• Marked pain and soreness
• Could precede or follow thrush or be isolated
• Most cases predisposed by antibiotic or steroid
• Further inv. if couldn't confirm diagnosis
  clinically
• Treatment

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Hyperplastic Candidosis

• Always chronic
• Predisposing factors
• Smoking
• ?Fe folate
• Defective cell-mediated immunity
• Candidal leukoplakia (always give antifungal
  prior to biopsy)

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Candida-associateddenture induced stomatitis

• Most common
• Usually not painful
• Predisposing factors
• Dental appliance
• Diabetes or ? carbohydrate diet
• Clinical picture
• Newton Classification

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Candida-associateddenture induced stomatitis

• Treatment should include
• OHI / Stop denture night wearing
• Check denture
• Topical antifungal
• Check glucose level

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Candida-associatedangular chelitis

• Soreness, erythema, cracking crusting.
• Treatment
• Candida reservoir should be eliminated
• Correct predisposing factors

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Candida-associatedMedian rhomboid glossitis

• Midline of tongue anterior to sulcus terminalis
• Predisposing factors
• Smoking
• Dental appliance
• Corticosteroid inhalers
• Immunosuppression / HIV infection
• Respond poorly to topical antifungal ?long-term
  topical or systemic
• Patients should undergo blood test and hormonal
  analysis

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Diagnosis

• Clinical
• Oral rinse
• Stained Smear
• Swab culture
• Biopsy
• Heamatological tests

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Diagnosis

• Clinical
• Oral rinse
• Stained Smear
• Swab culture
• Biopsy
• Heamatological tests

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Diagnosis

• Clinical
• Oral rinse
• Stained Smear
• Swab culture
• Biopsy stained with periodic acid Schiff (PAS)
• Other investigations
• Haematologic
• Hormonal

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Management

• Removal of predisposing factors if possible
• Avoid/reduce smoking
• Improve oral hygiene
• Therapy
• Systemic
• Topical

Which one to choose?!
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• Drug interaction with warfarin cyclosporin

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Chronic mucocutaneous candidosis

• Oral cavity
• Skin scalp
• Nails
• Starts as pseudomembranous then develop into
  hyperplastic
• Need referral to dermatologist
• Long-term systemic antifungal with monitoring of
  liver function

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