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. 2. Patches of creamy white pearl or bluish white 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 & Addisons 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 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)

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 therapyresistant 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,