Oral Candidiasis Flashcards
Pathophysiology of oral candidiasis
- AKA thursh, oral candidosis, pseudomembranous candidiasis or moniliasis
- mucocutaneous opportunisic infection caused by Candida species
- Candida organisms = fungi that noramlly live in oral cavity (25-75% peole have it)
- if normal flora compromised, Candida voergrowth and direct tissue invasion can occur
what is most common fungal infection found in immunocompetent and immunocompromised populations
- oral candidiasis
- prevalence is greatest among infants and elderly
what disease states are risk factors for developing oral canidiasis
Addison disease
Anemia (due to iron, folic acid or vitamin B12 deficiency)
Diabetes mellitus
HIV infection and AIDS
Hypothyroidism
Leukemia and head/neck cancer
Psoriasis
Sjogren syndrome
Xerostomia (dry mouth); may be caused by anticholinergic drugs, radiation therapy, dentures or dental appliances
what mediciations are risk factors for Oral candidiasis
Broad-spectrum antibiotics
Cytotoxic chemotherapy
Immunosuppressive drugs
Inhaled corticosteroids
what are risk factors associated with oral candidiasis tht are not diseae states or medications
- infancy/childhood (underveloped immune system)
- local mucosal trauma
- organ and stem cell transplantation
- parenteral nutrition
- poor dental or denture hygiene
- pregnancy
- smoking tobacco
surgery
what candidia species causes more oral candidal ifnections
C. albicans (90% cases)
relationship between HIV and oral candidial ifnection
- HIV pandemic contributed greatly to resurgence of oral candidial infect
- mitigated by effeective antiretroviral therapy
- patients with low CD4 counts and/or AIDS can experience recurrent infections
what are goals of oral candidal infection therapy
- resolve infection or reduce acute candidal overgrowth to level that can be controlled by host defences -> prevent complication
- prevent recurrences by managing underlying risk factors (use of inhaled corticosteroirds, poor dental hygiene, uncontrolled diabetes mellitus)
how to asses patients with oral candidiasis
- based on clinicla recognition of typical lesions, microbiologictests or suspected resistance to antifungal agent
- can be localized (primary oral candidiasis): acute pseudomembraneous (thursh), erythematous or hyperplastic candidiasis
- can also be menifestation of a generalized candidal infection (secondar oral candidiasis)
assessment of Acute pseudomembranous candidiasis
(thrush)
- creamy whitish yellow elevated plaques -> tongue, soft palate and inner cheek
- plaques easily wiped off exposing a raw, erthematous base that is not usually painful
- commonly diagnoses in frist few weeks of infants life, in elderly patients and those with underling HIV infection
- can persits for several months or years esp if taking inhaled or intraoral topical corticosteroids or HIV infected individuals
assessment of Erythematous candidiasis (atrophic candidiasis)
- found on palate and tongue, can cause depapillation and dekeratinization
- lesions vary in size and accompanied by inflammation of surrounding tissues
- develop from pseudomembranous candidiasis as plaques are shed, exposing the underlying erythematosus lesions.
- often follows use of broad spectrum antibiotics or inhaled corticosteroids
- most common varient in HIV infection
assessment of hyperplastic candidases
(candidal leukoplakia)
- chronic discrete lesions that appear as small translucent white plaques or larger opauqe lesions on tongue, palate or inner cheek
- cannoy be wiped off easily like with pseudomembranous variant
*less common, often seen in smokers and males over 30y
what type of oral candidiasis is condeired pre maligant
Hyperplastic candidiasis (candidal leukoplakia)
(biopsy recommended
assessment of Denture stomatitis
Chronic, red, edematous lesions on the denture-bearing mucosa of denture wearers.
Although usually symptomless, some result in mild soreness, burning or tingling beneath the denture.
(approx 50% of complete denture wearers experience denture stomatitis
Assessment of Angular cheilitis
Sore, erythematous fissuring at the angles of the mouth due to a mixed bacterial-fungal infection
commonly associated with denture stomatitis.
- can be sign of vit B12, folic acid or iron deficiency
Non pharmacologic therapy for candidiasis treatment
0 elimiate underlying factors for opportunisitc infection can be sufficient to help flora return to normal
- but usually antifungal agent is required
relationship between inhaled corticosteroids and development of oral candidiasis
- assocaited with use of inhaled corticosteroids
- can reduce the risk by usign a spacer device with metered dose inhalers, rinsing mouth and garlign with water after use, or decreasing dose if appropraite to prevent recurrent episodes of oral candidiasis
relationship with dentures and oral candidiasis
- can cause denture stomatitis or angular cheilitis
- advise patient to:
- remove dentures overnight and store in water
- wear for no longer than 6 hours to allow gums to heal and reduce inflammation
- clear dentures daily with cleaner, soak 30 min daily in proper disinfecting solution,
- celam gums, tongue and affected mucosa area with soft tootherbursh
- review proper fitting of dentures with oral health practiioner
- stop smoking
assocaition of xerostomia and oral candidiasis
Xerostomia = (Dry Mouth)
- dry mouth can be caused by medication, and then lead to candidiasis
- > suggest medication review and assessment: reduce dose or stop offending agent if possible
- keep mouth moist by frequent sips of water, sucking on ice chips or sugar free lozenges
what are the 3 common antifungal categories for treating oral candidiasis
Polyees (nystatin), azoles ((fluconazole, itraconazole, posaconazole) and echinocandins (anidulafungin, caspofungin, micafungin)
what drug is most commonly used to tear mild oral candidiasis/ initial episodes
topical nystatin
- well tolerated, does not interact with toher medications bc not largely absorbed from GI tract when administed orally
*resistance of fungi to polyenes is rare
Why are azoles the second line therapy
- mroe effective but cause mergence of azole resistant Candida strains
- usually will prescribe fluconazole, but if resistant to that then itraconazole or posaconazole
Why is gentian violet no longer used to treat oral candidiasis
- solution was applied locally for treatment
- the 1% concentration caused mucosal irritation, ulceration and staining -> difficult to determine therapeutic progress and decreasing adherence
- has also been linked to carcinogenicity in animal studies so health canadia issues recall advising against do to inc risk of cancer upon exposure
role of probiotoics for prevention of oral candidiasis
-some evidence by decreasing the growth of candida
