Candidasis Flashcards
Organism responsible for candidasis?
Candida Albicans
Candida albicans is a dimorphic fungus with 2 states which are…?
Vegetative state ( healthy person )
Active state
-Fungus in hyphal form, with ability to invade superficial layers of mucosa
What are the general factors that play a role for candida infection to develop
Host immune status
Oral mucosal environment
Strain of C. Albicans
Infection rates are higher in patients with…
diabetes
alcoholism
malnutrution
HIV infection
Candida is classified into 2 categories
Acute
chronic
Acute pseudomembranous candidasis ( thrush ) —> CF
non-adherent plaques on oral mucosa tongue dorsum and palate
soft, friable
looks like cottage cheese
easily scraped off
diffuse underlying red mucosa
Acute erythematous candidasis CF
More common than pseudomembranous candidasis
Whitish component not a prominent feature
Focal/diffuse loss of papillae on tongue
DIffuse erythema of oral mucosa
Painful
Shortly after gving broad spectrum ABS
Xerostomia
How can the prescription of broad spectrum antibiotics result in acute erythematous candidasis?
Antibiotics suppress normal competing commensal organisms in mouth resulting in fungal overgrowth
DDx erythematous candidiasis
Vitamin B/folate deficiency
iron deficiency anemia
syphilitis glossitis
Symptoms acute pseudomembranous candidasis
Asymptomatic
Burning sensation of the mucosa
Bitter taste
General differences between chronic and acute candidasis lesions
Acute occurs more rapidly and associated with antibiotics
while chronic is long standing ( immunosuppresion related )
Difference between acute and chronic pseudomembranous candidiasis
Acute is rapid and occurs within a short duration
Usually due to broad spectrum candidasis
Chronic has a slow onset, long standing and usually is due to immunologic issues
Chronic erythematous candidasis may present as ?
Angular cheilitis
- skin folds at commissures
- erythema, erosion /fissuring
- crusting
associated with older patients with non-functional dentures, loss of vertical dimension of occlusion
saliva accumulates in skin folds
areas kept moist
secondary colonization by C. Albicans
Denture stomatitis
Cheilocandidiasis
more extensive than angular
Median rhomboid glossitis
chronic multifocal candidasis
CF of chronic erythematous candidiasis — Median Rhomboid Glossitis
Central papillary atrophy of tongue
anterior to circumvallate papillae
smooth lobulated and painless
Congenital lack of langerhans cells in particular area
Chronic hyperplastic candidasis CF
Often found on anterior buccal mucosa
Tongue dorsum
Adherent rough white plaque
cannot rub off
usually middle aged men who smoke
DDx of chronic hyperplastic candidiasis
leukoplakia
Diagnosis of Chronic hyperplastic candidasis
Incisional biopsy ,even if we see lesion with candida organisms in superficial layer it can still be leukoplakia
Treatment chronic hyperplastic candidasis
Antifungal treatment
Chronic Mucocutaneous candidiasis importance in dentistry
It may present as endocrine-candidiasis syndrome
Auto-immune polyendocrinopathy candidiasis ectodermal dystrophy syndrome
Auto-immune polyendocrinopathy syndrome type 1
Chronic mucocutaneous candidiasis is associated with which endocrinopathies
DM
Hypoparathyroidism
Hypoadrenocorticism
Hypothyroidism
Treatment Chronic mucocutaneous candidiasis
Controlled with continuous systemic antifungals
Diagnosis of angular chielitis, cheilocandidiasi, gingival erythema,denture stomatitis, MRG?
They are all clinical diagnosis
Diagnosis of angular chielitis, cheilocandidiasi, gingival erythema,denture stomatitis, MRG?
They are all clinical diagnosis
Diagnosis pseudomembranous candidiasis
Smear biopsy for a PAS stain , a clincal diagnosis can be made as well
Diagnosis hyperplastic candidasis
incisional biopsy indicated, even if hyphae present, the candidiasis may super impose the underlying leukoplakia. patient should be treated with anti fungals. If lesions disappears —> no leukoplakia
What types of smear biopsys are indicated for candidiasis
Histo chemical stains like PAS ( periodic acid schiff ) or GMS ( Grocott Gomori Methenamine silver )
Management of candidiasis
Diagnosis
Removal load of fungal components
- Good OH ( tongue brushing/scraping )
- Good denture hygiene
Appropriate anti-fungal
Address predisposing factors
Prevent reoccurences
Appropriate Anti-Fungals for Candidiasis
Nystatin - polyene agent
nystatin suspension 1:100 000
4ml 4x a day for 10-14 days
Hold in mouth as long as possible
Dont rinse/eat for 60 minutes
Miconazole ( angular cheilitis )
Imidazole agent 20 mg
4x
Clotrimazole ( angular cheilitis )
Imidazole agent
10mg lozenges
5x
Amphotericin B
10mg lozenges
dissolve in mouth
4x
Chlorhexidine
complementary mouth wash
rinse 10ml for 2min
2x
not within 30minutes of tooth brushing or anti-fungal agent
