Candidiasis

Candidiasis
A fungal infection commonly caused
by Candida albicans
It usually occurs in the mouth and pharynx, but
may also occur in the esophagus
Candidiasis can become a source of systemic
dissemination, particularly in high-risk persons

Etiology
Candida albicans

is the most common

candidal species to cause oral candidiasis.

More common with immunosuppression from

disease states or treatment regimens
HIV infection, chemotherapy, corticosteroids

Altered oral environment from loss of epithelial

layer, antibiotic therapy, preexisting infections, poor
oral hygiene or nutritional status, wearing dentures

Predisposing factors :

Epidemiology
Candida is more frequently isolated
from women
Prevalence increase during the
summer
Denture-wearers 50 %

CLINICAL MANIFESTATIONS

Clinical manifestations:
Oral discomfort, burning, altered taste, erythema
White, raised, painless plaques, loosely adherent
Possible spread to the esophagus with pain on
swallowing and chest pain
The oral mucosa is the most common site of
superficial Candidiasis. However, The vagina, glans
penis, skin, and nails may also be involved.

Classification
1. Primary Candidiasis :

pseudomemberanous, erythematous, nodular,

Candida associated lesions:
(angular cheilitis, median rhomboid glossitis, denture stomatitis)

2. Secondary Candidiasis :

Includes chronic mococutaneous and Candida

Endocrinopathy syndrome.

3. Systemic Candidiasis :

is less common and problem in immunocompromised

Pseudomembrans Candidiasis (THRUSH)

Presents with Loosely attached membranes
comprising fungal organisms and cellular
debris
Unique sign :

1. Patches of creamy white

pearl or bluish white
2. 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 broadspectrum antibiotics.
Clinical appearance:
Red (erythematous) lesion with diffuse
border
Most common area: in the palate and
dorsum of the tongue
Clinical symptoms: burning 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.

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

Histology
It appears as an oval cell ( yeast

form ) , 4-6 m in diameter.

In gram stain of clumps of
multiple budding cells and
branching pseudohyphae grown
in sabouraund agar
On the right are large , round,
thick-walled, and highl-refractive
clamydospres ( indicated by
arrow ) on the ends of hyphae
grown in corn meal agar

Diagnosis
Clinical diagnosis by giving antifungal treatment and
review patients condition after 1-2 weeks. If the lesion
disappears, this confirms our diagnosis. If it doesnt, 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, 0.1
The result is expressed as colony forming units per cubic
millimeter (CFU/mm2)

Diffierential Diagnosis
Leukoplakia
Hairy Leukoplakia
Lichen planus
Lupus Erythematosus
Mucous patches of secondary syphilis
White Sponge Nevus
Uremic Stomatitis
Cinnamon Contact Stomatitis
Chemical Burns
Traumatic Lesions
Furred tongue

COMPLICATIONS
Candidal infection throughout the GI
tract
Candidal sepsis

MANAGEMENT
Topical antifungal agents in oral rinses,
troches, or creams
clotrimazole (Mycelex)
nystatin

Systemic treatment is indicated if topical

agents fail or for esophageal cases with
fluconazole (Diflucan), ketoconazole (Nizoral),
or amphotericin B (Fungizone)
Analgesics for pain