candidal infections Flashcards
what is the definition of oral candidiasis?
> Infection of the oral/perioral tissue with candida species
- Commonest oral fungal infection in human
- Many species, most common is C. albicans
- Present as commensal organism in up to 50% of general population
- Opportunistic pathogen
what is the general features of oral candidosis?
> Very common clinical problem
- Wide variety of clinical patterns
- Often multifactorial aetiologies
- May indicate serious systemic disease
what is the microbiology of oral candidosis?
> Dimorphic yeast-like fungus
- Blastospore
- Hyphae
what local factors are predisposing to oral candidosis?
> Epithelial changes
> Xerostomia
> High carbohydrate diet
> Smoking
> Broad spectrum antimicrobials
> Corticosteroids
> Dental appliances
> Head and neck irradiation
what systemic factors are predisposing to oral candidosis?
> Physiological
> Malnutrition
> Endocrine
> Malignancy
> Primary immunodeficiency
> Secondary immunodeficiency
what is the HPC of oral candidosis?
> HPC can be varied case by case, some include -
- asymptomatic
- xerostomia
- taste disturbance “yeast”
- abnormal sensation “slimy”
- burning sensation
what are the clinical features of oral candidosis?
> clinical features vary case by case
> mucosa may be white, red or both
> may be evidence of predisposing factors
what is oral candidosis classifications?
- Primary oral candidosis - which is confirmed to oral and perioral tissues
- candida associated lesions
- secondary oral candidosis which is distributed in other parts of the body as well as the oral cavity
what is pseudomembranous candidosis also referred to as?
Thrush
what is the age and sex demographic of pseudomembranous candidosis?
> neonates and adults
> M=F
what is the clinical presentation of pseudomembranous candidosis?
> semi adherent white/creamy drop like or confluent patches
> Wiped off to reveal an erythematous base
> tend to Recur
what is the difference between acute and chronic pseudomembranous candidosis?
> acute appears on - palate, dorsum of
tongue, buccal mucosa
> chronic appears on - palate, OROPHARYNX, tongue dorsum
what causes erythematous candidosis?
> corticosteroid use
> antibiotic therapy
> HIV
where are the common sites of erythematous candidosis?
> dorsum of the tongue
> and the opposing palate
> erythematous stands for red patch - inflamed areas of mucosa
what is chronic hyperplastic candidosis also referred to as?
> candida leukoplakia
what is the age and sex demographic of chronic hyperplastic candidosis?
> middle aged
> M=F
what is the clinical features and key sites of chronic hyperplastic candidosis?
> adherent plaques
white speckled lesions
> commissures of mouth
buccal mucosa
palate
tongue
what classification does angular cheilitis fall into?
candida associated lesions
what is angular cheilitis?
> inflammation, fissuring and pain of the skin at commissure
mixed infection
how many people does angular cheilitis effect? and what is its sex demographic?
> 2% of adults
> M=F
what classification does median rhomboid glossitis fall into?
> candida associated lesions
describe median rhomboid glossitis?
> Papillary atrophy, occasionally hyperplastic or exophytic (growth outwards)
> Midline of tongue
> Elliptical or rhomboid in shape
> Asymptomatic
> linked to predisposing factors
what is the age and sex demographic of median rhomboid glossitis?
> middle aged and older
> M>F
what classification does denture associated erythematous candidosis fall into?
> candida associated lesions
describe denture associated erythematous candidosis?
> asymptomatic
> erythema and oedema of the oral mucosa in contact with a dental prosthesis
what is the age and sex demographic?
> F>M
> older patients
what classification does chronic mucocutaneous candidosis fall into?
> secondary oral candidosis
what is chronic mucocutaneaous candidosis?
> Rare, heterogeneous group of syndromes
> presents with a = Persistent, severe, and diffuse mucocutaneous candidal infections affecting skin, nails and mucous membranes
> possibly Due to impaired cell-mediated immunity against Candida species.
> complex classification
when does chronic mucocutaneous candidosis usually present?
> usually presents in infancy
> delayed or adult onset of the disease may also occur
what is chronic mucocutaneous candidosis usually in combination with?
> endocrine disorders
> Candidosis endocrinopathy syndrome (CES)
Autoimmune polyendocrinopathy candidosis ectodermal dysplasia (APECED)
what is the diagnosis pathway for chronic mucocutaneous candidosis?
> Combination of history and clinical examination
> Predisposing factors - Often multi-factorial
> Special Investigation
what investigation do you carry out for oral candidosis?
> microbiological
> smear
> tissue biopsy
> blood tests
describe the 2 microbiological tests -
- swabs = high rate of false -ve, sent to lab promptly, inoculated onto agar and growth checked in 24hrs
- Oral rinse - more sensitive than swab, patient rinses in mouth with 10ml sterile water for 60s and then spits into container, semi quantitative assessment
describe the smear test -
> Obtained from lesional tissue with (moistened) cotton roll
> Transfer scraping to glass microscope slide
> Stain Periodic Acid – Schiff or Gram’s
> Visualise hyphae or blastospores
describe a tissue biopsy for oral candidosis -
> Epithelium may be thicker (white lesion) or thinner (red lesions) than normal
> Neutrophil infiltration in epithelium often forming micro abscesses
> Varying degrees of vasodilation and inflammatory cell infiltrate in connective tissues
> Fungal hyphae seen in superficial layers.
what blood tests are carried out for oral candidosis?
> FBC
Iron
B12
Red cell folate * Glucose
what is the management of oral candidosis?
- control predisposing factors -
- local factors = dentures, diet, oral mucosal disease eg LP
- systemic factors - poor control of DM, anaemia
- smoking cessation
- inhaled corticosteroids advice - rinse mouth out with water after use and spit out, use spacing device
- anti fungal therapy
what are the two classification of antifungal therapy?
- topical = nystatin, chlorhexidine
- systemic = fluconazole, miconazole
describe chlorhexidine as an anti Fungal treatment -
> Gel, mouth rinse or spray
> Biguanide antiseptic and disinfectant
> Effective in management of oral candidosis
Describe Nystatin oral suspension as an anti fungal treatment -
> Polyene
> Topical effect
> Effective against C. albicans and other fungi
> Inhibits ergosterol formation in fungal cell membrane
> No known drug interactions
> 100 000 units qds 1-2 weeks
describe azole anti fungal drugs? -
> Topically & systemic
> Risk of significant drug interactions even when used topically
> Examples include Miconazole and Fluconazole
> Inhibit fungal cytochrome P450 dependant enzyme 14α demethylase:
Inhibits synthesis of ergosterol
Results in:
* Depletion of ergosterol in cell wall
* Accumulation of toxic intermediate sterols
* Membrane permeability and inhibited fungal growth
describe micocanzole gel as an anti fungal treatment -
> Antimicrobial properties
> 24mg/ml (80g tube)
5ml applied to mouth QDS for 7 days after lesion resolves
> After food, Dentures out, Do not eat or drink for 1 hour afterwards
> Resistance can develop
Risk of significant drug interactions
describe fluconazole as an anti fungal treatment -
> 50mg capsules
50mg/5ml suspension
> 50mg OD for 1-2 weeks:
- After food
- Dentures out – if suspension
- Do not eat or drink for 1 hour afterwards – if suspension
> Risk of significant drug interactions
describe fluconazole as an anti fungal treatment -
> 50mg capsules
50mg/5ml suspension
> 50mg OD for 1-2 weeks:
- After food
- Dentures out – if suspension
- Do not eat or drink for 1 hour afterwards – if suspension
> Risk of significant drug interactions
