Candidiasis

Question 1

Define Candidiasis

Answer 1

Local infection of oral tissues by yeasts of the genus candida, mostly C. albicans

Question 2

What are the different types of Candidiasis

Answer 2

• Pseudomembranous (thrush): opportunistic fungal invasion
• Erythematous
• Denture stomatitis
• Angular cheilitis

Question 3

Aetiology of Candidiasis

Answer 3

Most cases are due to Candida Albicans (Dimorphoid fungus that is capable of penetrating epithelial tissues )

Other causes: C. glabrata | C. tropicalis | C. parapsilosis | C. guiliermondii | C. krusei | C. dubliniesis | C auris

Question 4

Risk factors for candidiasis

Answer 4

Hyposalivation/zerostomia
Poor oral hygiene, especially among denture wearers
Malabsorption and malnutrition
Advance malignancy, Cancer chemotherapy and radiotherapy
HIV infection
Endocrine disturbance e.g. DM, hypoparathyroidism, pregnancy, hypoadrenalism
Immunosuppressive agents e.g. systemic corticosteroid therapy
Current or recent past use of broad-spectrum or multiple narrow-spectrum antibiotics
Age >60 | female | inhaled corticosteroids

Question 5

Symptoms of candidiasis

Answer 5

Pseudomembranous/thrush: cream white or yellowish plaques that are fairly adherent to the oral mucosa, removal may reveal erythematous or bleeding base

Erythematous: tenderness, burning and dysphagia

Dermatitis stomatitis:asymptomatic but may have a burning sensation

Angular cheilitis: Moderately painful lesions at the corners of the mouth

Question 6

Signs of Candidiasis

Answer 6

Pseudomembranous/thrush: cream white or yellowish plaques that are fairly adherent to the oral mucosa, removal may reveal erythematous or bleeding base

Erythematous: Atrophic, fiery red flat lesions on the palate, patchy areas of loss of filiform papillae on the dorsum of the tongue, or spotty red areas on the buccal mucosa.

Dermatitis stomatitis: Seen under removable prostheses.
The appearance of the lesion may be smooth and velvety or nodular

Angular cheilitis: Consists of cracks, ulcers, or crusted fissures radiating from angles of the mouth.

Question 7

Investigations for Candidasis

Answer 7

Superficial smear of lesions for microscopy: positive for candida hyphae

Culture of mouth rinse sample (not usually indicated)
Sialometery: reduced salivary flow

Random or fasting glucose: exclude diabetes
HIV serology: exclude HIV

Upper GI endoscopy: candida (for those with dysphagia, odynophagia)

Biopsy of lesion: Candida hyphae