Candidosis

Question 1

How does fungi compare to that of a bacterial biofilm?

Answer 1

Fungi is 50-100x larger than bacteria as they occupy high physical volume

Fungi provides a physical scaffold for bacteria to form (mycofilm)

Question 2

What are the four types of candidiasis?

Answer 2

Pseudomembranous - thrush

Erythematous - atrophic or denture related

Hyperplastic - candidal leukoplakia

Angular chelitis

Question 3

What is pseudomembranous candidosis?

Answer 3

Thrush

Spotted lesions on the soft tissue - like a thrush’s chest (bird)

Question 4

What is chronic hyperplastic candida? What tests should be done?

Answer 4

Candida leukoplakia

• candida is not on the surface but within the skin
• cannot be scrubbed off

Test for pre malignancy with a biopsy and treat with anti fungal agents

Question 5

What is angular chelitis? How treat?

Answer 5

Typically candida at the angles of the mouth

Treat with miconazole (topical), rub onto angle of mouth

Question 6

What is erythematous candida?

Answer 6

Candida adheres and co-aggregates on acrylic surfaces to form biofilm

Signs and symptoms include
- inflamed mucosa
- burning sensation
- discomfort
- foul taste
- patient often unaware

Question 7

What are the main species of candida that form issues?

Answer 7

Candida albicans

Candida glabrata

Question 8

How would you treat pseudomembranous candida?

Answer 8

Always start with chlorhexadine (3ml rinse for 7 days) and good oral hygiene instruction

If this does not work then try fluconazole (50mg daily 7 days)

If this doesn’t work try nystatin oral (1ml 4 x daily)

Question 9

How would you treat erythematous candida?

Answer 9

If steroid related - use a spacer device or rinse mouth with mouthwash after using inhaler

If denture related - promote good denture hygiene, remove denture at night and soak in water

Use of chlorhexadine mouthwash 3ml for 7 days

If drug treatment needed then topical miconazole - pea sized amount to fitting surface of denture after food 4x daily

Fluconazole 50mg for 7 days

Question 10

How would you treat hyperplastic candida?

Answer 10

Confirm diagnosis through biopsy and histopathology

Fluconazole 50mg 7 days

Iron, folate or b12 may be needed if patient is deficient

Question 11

How treat angular chelitis?

Answer 11

3ml chlorhexadine for 7 days

Topical miconazole 2% apply to angle of mouth twice per day and continue for 10 days after lesion healed

Question 12

What is an azole? How does it work? Any contra indications?

Answer 12

A type of anti fungal medication - fungostatic

Acts by inhibiting the pathway reactions that produce ergosterol, which is required for fungal cell membrane structure and function

Do not give miconazole to anyone of warfarin or statins

Question 13

What is azole resistance?

Answer 13

C.glabrata naturally resistant to fluconazole. This why important to carry out sensitivity testing or candida sub typing to ensure you know which type of candida is causing the infection?

Question 14

What are polyenes?

Answer 14

Nystatin - fungicidal

Binds directly with ergosterol to form pores in the cell membrane of the candida leading to leaking i of cytoplasmic contents and thus cell lysis and death

Question 15

Give some risk factors of oral candida?

Answer 15

• immunosuppression such as HIV / chemotherapy
• antibiotics - alter oral flora
• corticosteroids without spacer device
• poor denture hygiene, leaving it in overnight
• poorly controlled diabetes, elevated salivary sugar
• xerostomia
• poor oral hygiene in general