Guide to Oral Mycotic Infections Like Candidiasis (Candidosis
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This document discusses various forms of Candidial infection, including chronic familial, diffuse, and endocrine-related mucocutaneous candidiasis. It describes the clinical features, laboratory diagnosis, and treatment of oral candidiasis. Key points covered include the clinical appearance of different candidiasis types, methods for laboratory diagnosis such as culture and microscopy, and the use of antifungal medications like fluconazole or nystatin to treat oral candidal infections.
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Guide to Oral Mycotic Infections Like Candidiasis (Candidosis
- 1. Oral Mycotic Infections Candidiasis (Candidosis, Moniliasis, Thrush) INDIAN DENTAL ACADEMY Leader in continuing Dental Education www.indiandentalacademy.com
- 2. Learning Objectives • At the end of the lecture the student should describe • Clinical features of Candidiasis • Laboratory diagnosis • Cancerous potential of Candida • Treatment www.indiandentalacademy.com
- 3. Chronic Familial Mucocutaneous Candidiasis • Characterized by chronic candidial involvement of the skin, scalp, nails and mucous membrane. • Pt exhibit varying abnormalities in immune system • Inherited disorder probably an autosomal recessive • Occurs early in life usually before the age of 5 years www.indiandentalacademy.com
- 4. Chronic Localized Mucocutaneous Candidiasis • Severe form occurring early in life – no genetic transmission • Mouth – primary site along with skin involvement www.indiandentalacademy.com
- 5. Chronic Diffuse Mucocutaneous Candidiasis • Least common & is of late onset ( pts. over 55yrs.) • Raised, crusty sheets on face, limbs scalp, shoulders • Oral lesions – Firm, White persistent plaques www.indiandentalacademy.com
- 6. Candidiasis Endocrinopathy Syndrome • Genetically transmitted • Infection of the skin, scalp & mucous memb. in asso. with hypoadrenalism, hypothyroidism, hypoparathyroidism or diabetes mellitus • Oral lesions are seen before the endocrine manifestations in children. www.indiandentalacademy.com
- 7. Clinical type Appearance and symptoms Common sites Associated factors and comments Pseudo- membranous Creamy white plaques, removable, burning sensation, foul taste BM, Tongue, Palate Antibiotic therapy, immunosupression Erythemato us Red macules, burning sensation Post. Hard palate, buccal mucosa, dorsal tongue Antibiotic therapy, xerostomia, immunosupression, idiopathic Clinical features www.indiandentalacademy.com
- 8. Central papillary atrophy Red, atrophic mucosal areas, asymptomatic Midline post. Dorsal tongue Idiopathic, immunosupressi on Angular cheilitis Red, fissured lesions, irritated raw feeling Angles of mouth Idiopathic, immunosupressi on, Loss of vertical dimensions Denture stomatitis Red asymptomatic Confined to palatal denture bearing area Probalbly not true infection www.indiandentalacademy.com
- 9. Hyperplasti c (Candidal leukoplakia) White plaques that are not removable, asymptomatic Anterior buccal mucosa Idiopathic, immunosupression Muco- cutaneous White plaques, some are removable red areas Tongue buccal mucosa palate Rare , inherited or sporadic idiopathic immune dysfunction Endocrine candidiasis syndromes White plaques, most are non- removable red areas Tongue buccal mucosa palate Rare , endocrine disorder develops after candidiasis. www.indiandentalacademy.com
- 10. AIDS related Oral Candidosis • The pseudo membranous and erythematous variants form the most common clinical presentations of mucosal candidiasis associated with HIV-infection • Symptoms may include burning pain, altered taste sensation, and difficulty swallowing liquids and solids www.indiandentalacademy.com
- 11. • Immunodeficiency – T- helper cells predisposes to secondary infections (fungi being fairly common) • C. albicans serotype B is prevalent. • The pseudomembranous form can be easily diagnosed by demonstrating the presence of candidal yeast and pseudohyphae on wet mounts or stained smears of material obtained by swabbing the lesions www.indiandentalacademy.com
- 12. • Confirmed by isolation of Candida species on culture. • In the erythematous form, the sparse presence of Candida at the mucosal surface frequently requires a biopsy and periodic acid-Schiff staining to establish a formal diagnosis. www.indiandentalacademy.com
- 13. • Candidiasis can occur at any time during the course of HIV infection • Oral burdens of C. albicans are augmented in HIV- infected patients even prior to the first episode of Candidiasis and the intensity of carriage increases significantly in the progression from asymptomatic Candida carrier to an episode of Candidiasis www.indiandentalacademy.com
- 14. • Pseudomembranous form of OPC and esophageal candidiasis increases dramatically in advanced HIV disease associated with CD4+ cell counts of <200/mm3 , while erythematous candidiasis and angular cheilitis are less strongly associated with late disease www.indiandentalacademy.com
- 15. Cancerous potential of Candida • Non-homogenous leukoplakias are often invaded by yeasts - Candida albicans • N-nitroso-benzylmethylamine (NBMA) is a compound able to induce carcinoma of the esophagus and the oral cavity in the rat www.indiandentalacademy.com
- 16. • The catalytic potential to produce NBMA from the precursors N-benzyl-methylamine and nitrite showed the highest nitrosation potential of C. albicans strains. www.indiandentalacademy.com
- 17. Histopathological features • Microscopically in either in exfoliative cytologic preparation or in tissue sections of biopsy • The PAS staining method the organism are easily identified by the bright magenta color • For diagnosis of candidiasis www.indiandentalacademy.com
- 18. • Hyphae or pseudohyphae (elongated yeast cells), 2um in diameter, vary in length and may show branching, accompanied by variable no. of yeast, Squamous epithelial cells, inflammatory cells. • 10% to 20% potassium hydroxide preparation may be used • The histological pattern of oral candidiasis may vary slightly www.indiandentalacademy.com
- 19. • Increased thickness of parakeratin with elongated epithelial retepegs • Typically chronic inflammatory cell infiltrate in the CT and • small collection of neutrophils in parakeratin layer or superficial spinous layer • The candidal hyphae are embedded in the parakeratin layer www.indiandentalacademy.com
- 20. Lab diagnosis Isolation of yeast from oral samples • Smear • Swab • Imprint culture • Impression culture • Salivary culture • Oral rinse culture • Primary culture media www.indiandentalacademy.com
- 21. • Identification of candidiasis species • Morphological tests • Direct microscopy • water mount /wet film • KOH technique • Germ tube test • Chlamydospore formation www.indiandentalacademy.com
- 22. • Physiological tests – carbon and nitrogen assimilation • carbohydrate fermentation • • Rapid commercial systems • Other methods – strain differentiation • Serotyping • Biotyping • Resistogram typing • Biopsy www.indiandentalacademy.com
- 23. Clinical specimen Sabouraud’s agar CHROM agar incubate 48h,37°C Germ tube test -ve +ve C. albicans Carbohydrate assimilation incubate 24-72h,37°C C. species identified 48h,37°C incubate Colony appearance Green- C. albicans Dark green- C. dubliniensis Blue – C. tropicalis Pale & flat- C.krusei Molecular methods Epidemiologic studies Culture Direct smear www.indiandentalacademy.com
- 24. Treatment • Oral therapy is convenient and very effective as first- line treatment. (azole antifungal drugs are not recommended for use during pregnancy.) – Fluconazole 100 mg OD for 7-14 days • Alternative topical therapy (less expensive, safe for use during pregnancy, and effective for mild to moderate disease). – Clotrimazole troches dissolved in the mouth 5 times/day for 2 weeks www.indiandentalacademy.com
- 25. – Nystatin oral suspension 5 mL "swish and swallow" 4 times daily for 2 weeks • Other alternatives include the following: – Itraconazole oral solution 200 mg once daily for 7- 14 days – Itraconazole capsules and ketoconazole 200 mg once daily for 7-14 days (less effective) www.indiandentalacademy.com
- 26. Patient Education • Patients should maintain good oral hygiene by brushing teeth after each meal. • A soft toothbrush should be used to avoid mouth trauma. • Advise patients to rinse the mouth of all food before using lozenges or liquid medications. • Tell patients to avoid foods or liquids that are very hot in temperature or very spicy. www.indiandentalacademy.com
- 27. • Patients who have candidiasis under a denture or partial denture should remove the prosthesis before using topical agents such as clotrimazole or nystatin. At bedtime, the prosthesis should be placed in a chlorhexidine solution until reinserting it into the mouth. • Pregnant women should avoid azole drugs (eg, fluconazole, itraconazole, voriconazole) because they can cause skeletal and craniofacial abnormalities in infants www.indiandentalacademy.com
- 28. Summary • The clinical appearance of various forms of Candidial infection. • Laboratory diagnosis of Candidiasis. www.indiandentalacademy.com
- 29. BIBLIOGRAPHY Text Book of Microbiology Ananthanarayan R 7th Edition Text book of oral pathology Shafer's, 5 & 6th edition Oral Candiosis, Samarnayak L P Ist edition Color Atlas of Oral Diseases Cawson, R. 2nd edition Oral and Maxillofacial Pathology Neville, Brad W. 2nd Lucas’s Pathology Of Tumor’s of the Oral Tissues Cawson, R. A., Bennie, W. H 5th edition www.indiandentalacademy.com