This document provides information on various fungal infections that can affect the oral cavity. It discusses Candidiasis, including pseudomembranous, erythematous, and chronic hyperplastic forms. It also covers Coccidioidomycosis, Rhinosporidiosis, and Mucormycosis - describing their causes, clinical presentations, oral manifestations, treatment and more. Diagnosis involves cytological examination and culture testing. Management includes antifungal medications like nystatin, clotrimazole, amphotericin B depending on the specific infection.

1. DR DAVIS NADAKKAVUKARAN
M.D.S ORAL AND MAXILLOFACIAL SURGERY

2. CONTENTS
 Introduction
 Candidiasis
-pseudomembranous candidiasis
-erythematous candidiasis
-chronic hyperplastic
-mucocutaneous candidiasis
 Coccidioidomycosis
 Rhinosporidosis
 Mucormycosis

3. Candidiasis
 Infection with the yeastlike fungal oranism
candida albicans
 Other organisms like C. stellatoidae,
C. pseudotropicalis, C. purapsillasis,
C. famata, Crugosa,and C.krusei are also
responsible for the infection

4. Candida albicans
 Candida albicans is the most commonest pathogen
of all
candida species and it appears as moist creamy
colonies and on blood agars as dull grey colonies
 Candida in 3 forms namely pseudohyphae, yeast
and chlamydospore forms
 It reproduces by bi asexual budding and optimum
growth temperature is 25-37oC
 Candida species can be identified by the formation
of psuedohyphae or biochemical method
 It is a common inhabitant of oral cavity, GIT and
vagina of normal person
 Mere presence of fungus does not cause the
disease but there must be actual penetration of the

5. P r e d i s p o s i n g f a c t o r s
 Acute and chronic diseases like
tuberculosis, diabetes mellitus and
anaemia
 Myxoedema, hypoparathyroidism and
addison’s disease
 Nutritional deficiencies like iron, vit. A,
vit. B6
 Prolonged use of antibiotics,
corticosteroids and cytotoxic drugs
 Old age, infancy and in pregnancy
 Use of intravenous tubes, catheters,
heavy smoking,etc…
 Immunodeficiency like AIDS

6. Classification
(proposed by samaranayake-1991 and
modified by Axell et al-1997)
 Primary oral candidiasis
 Acute forms
pseudomembraneous
(thrush)
Erythematous
 Chronic forms
Hyperplastic
Nodular
Plaque like
Erythematous
pseudomembranous

7.  Candida –associated lesions
Denture stomatitis
Angular chelitis
Median rhomboid glossitis
 Keratinized primary lesions superinfected
with candida
Leukoplakia
Lichen planus
Lupus erythematous

8.  Secondary oral candidiasis
Oral manifestations of systemic
mucocutaneous candidiasis as a
result of disease such as thymic
aplasia and candidiasis
endocrinopathy syndrome.

9. A c u t e
P s e u d o m e m b r a n e o u s
C a n d i d i a s i s
 Also known as thrush
 Most common candidal infection at any age
 Characterized by the soft, white, slightly elevated
plaques on buccal surface
 This plaques resembles milk curd composed of
tangled masses of hyphae, yeast, desquamated
epithelium, keratin, fibrin, necrotic debris,
leukocytes, etc..
 Common sites are roof of mouth, retromolar area
and mucobuccalfold
 Prodormal symptoms like onset of bad taste will
be occur
 Patient may complain of burning sensations

10.  The white plaques can usually be
wiped away with a gauge, leaving
either a relatively normal appearing
mucosa or an erythematous area
 In severe cases it spread throughout
the oral cavity

11. A c u t e A t r o p h i c
C a n d i d i a s i s
 Also called antibiotic sore mouth
 Lesions in the form of the disease appear
red or erythematous rather than white

12. Clinical features
 occur at any site, usually on tongue
 Burning sensation or vague pain due to
loss of filiform papillae on tongue
 Careful examination reveals a few white
thickened foci that rub off leaving a
painful surface
 Patients with any kinds of xerostomia
have higher chance to cause
erythematous candidiasis

13. C h r o n i c H y p e r p l a s t i c
C a n d i d i a s i s
 Also called candida leukoplakia
 Oral lesion consist of firm, white
persistent plaques
 Most extreme form of candidiasis

14. Clinical features
 Majority of these patients are heavy
smokers
 Occurs in cheek, lips and tongue
 Lesions may persist period of years
 Leukoplakia lesion associated with
candida infection has a fine
interminkling of red and white areas,
resulting in a speckled leukoplakia

15. Diagnosis
 The diagnosis of candidiasis is usually
established by the clinical signs in
conjunction with exfoliate cytological
examination
 The cytological findings should demonstrate
the hyphal phase of the organism and then
antifungal therapy can be instituted
 The definite identification of the organism can
be made by means of culture
 A specimen of culture is obtained by a sterile
cotton swab over the lesion and the streaking
the swab on the surface of sabourand’s agent
slant
 C. albicans will grow as creamy, smooth
surface colonies after 2-3 days of incubation

17. Management
 Suspension of nystatin ,held in
contact with the oral lesion,havebeen
sucessfully used in even chronic and
severe cases of the disease
 Clotrimazole
 Amphotericin B and miconazole

19. Coccidioidomycosis
 Valley fever,san joaquin valley fever
 Caused by Coccidioidies immitis
 The disease appear to be transmitted
to man and animals by inhalation of
dust contaminated by spores of the
organism

20. Clinical features
 Two basic forms of the disease;
primary nondisseminated
progressive disseminated
-primary coccidioidomycosis
Cough,pleural pain,headache and anorexia
20%patient develops skin lesions –either
erythema nodosum or erythema multiforme
-it is self limiting and runs its course within 10-
14 days
-in small percentage of cases,pulmonary
cavitation,calcified nodules or pulmonary
fibrosis may remain

21. Disseminated Form
 Occur in 1% of cases
 50%mortality rate
 Dissemination extends from lung to
various viscera,bones,joints,skin and
to the CNS
 and Meningitis is the most frequent
cause of death.

22. Oral manifestations
 Proliferative granulomatous and
ulcerated lesions that are nonspecific
in their clinical appearance.
 Marked chronicity is often a feature
 Lytic lesion of jaws also may occur

23. Treatment
 Amphotericin B

24. Rhinosporidosis
 Chronic granulomatous disease
caused by Rhinosporidium seeberi
 Affects chiefly the oropharynx and
nasopharynx as well as the
larynx,skin,eyes,and geniital mucosa.
 The mode of infection is not known
 Common in India and srilanka

25. Clinical features
 Nasal mucosa is the most common
site involved
 Lesion appear as small verrucae or
warts ,which ultimately become
pedunculated.

26. Oral manifestations
 Oronasopharyngeal lesions ae often
accompanied by a mucoid discharge
 Appear as soft red polypoid growths
of a tumour like nature,which sread to
the pharynx and larynx.
 The lesions are vascular and bleed
readily.
 Soft palate is the most frequent site

27. Treatment
 Surgical removal of the growth is
recommended as treatment of choice.

28. Mucormycosis
 Zygomycosis,phycomycosis
 The term mucormycosis refers to a distinctive
group of disease caused by
ubiquitous,saprophytic fungi of the order
Mucorales
 Infection arises by inhalation of spores that
are deposited in pulmonary alveoli
 Other mode of infection include
contamination of traumatized tissues and
direct inoculation.
 The fungus preferentialy erode arteries
,resulting in thrombosis with subsequent
necrosis of the surrounding tissues.

29. Commonly seen associated with HIV
infection and AIDS
 Other predisposing conditions are
blood dyscrasis,malignant
disease,hepatitis,burns,malnutrition,
irradiation,TB and the administration
of corticosteroids and
immunosuppressive drugs
 Acidosis due to diabetes.

30. Oral considerations
 Symptoms involving the
oral,cranial,and facial structures
accounts for about 60% of all cases.
 Oral ulcerations and sinusitis andor
facial cellulitis havebeen described
in mucormycosis.
 The mortality from mucormycosis is
50 to 100%
 Necrotic ulceration or sloughing of the
maxillary or palatal mucosa.

31.  Other important symptoms include
blood-tinged nasal discharge ,unilaeral
facial pain or numbness.

32. Management
 Detection of acidosis or other
predisposing factors
 Antifungal therapy using amphoericin
B
 Surgical debridement

33. ANTIFUNGAL AGENTS
 Classification:
1. Antibiotics
a) Polyenes – amphotericin B, nystatin, hamycin,
natamycin
b) Heterocyclic benzofuran – griseofulvin
2. Antimetabolites- flucytosine
3. Azoles
a) Imidazole : clotrimazole, miconazole, econazle
(topical) ; ketoconazole(systemic)
b) triazole : fluconazole, itraconazole, (systemic)
4. Allylamine – terbinafine
5. Other topical agents : tolnaftate, benzoic
acid, sodium thiosulphate, ciclopirox olamine

34. References
 Shafer’s textbook of oral pathology
 Burket’s oral medicine-
GreenBerg,Glick,Ship
 Essentials of pharmacology – K D
Tripathi

35. Thank you!