8/18/2019 1-1Candida

1/11

/01/1434 

Introduction

Candida typically colonises

mucocutaneous surfaces but these can

be portals for entry into deeper tissues

when host defences are compromised.

Candida albicans is the only common

cause of oral fungal or yeast infection.

The most dominant oral species, in

decreasing order of frequency, are:

C. albicans

Candida tropicalis .

Candida glabrata

Candida parapsilosis

Candida krusei

other Candida species other which are rare and transient.

Candida carriage is more frequent in: Women

high carbohydrate diets causing acidic saliva

Xerostomia.

8/18/2019 1-1Candida

2/11

/01/1434 

broad-spectrum antimicrobial use (e.g.tetracyclines)

denture wearers

smokers

immunocompromised persons such asthose with HIV disease, malignancy,Down syndrome, malnutrition or diabetes

hospitalised patients.

factors predisposing to oral candidacies

Disturbed oral microbial flora by antibiotics,corticosteroids, xerostomia, dental appliances

Immune defects

Diabetes mellitus 

Malignant and chronic diseases

Severe blood dyscrasias

Radiation to the head and neck

Chemotherapy

Hospitalisation

Heavy smoking 

Malnutrition and dietary factors

Extremes of age 

 immunosuppressant drugs, such ascorticosteroids

T-cell defects, especially HIV infection,leukaemias, lymphomas and cancer

Diabetes

 Anemia.

Management of candidiasis

 Avoid or reduce smoking.

Treat any local predisposing cause such as

xerostomia.

Improve oral hygiene; chlorhexidine has

some anti-candidal activity.

8/18/2019 1-1Candida

3/11

/01/1434 

 Antifungals:

Topical antifungal agents are useful for most

lesions restricted to the oral cavity and are

available as suspensions, tablets and creams.

Oral suspensions are useful for patients with dry

mouth who may have difficulty in dissolving

tablets.

Systemic antifungals are increasingly used,

especially fluconazole, but may interact with

anti-HIV and other medications

Those at greatest need for such

prophylactic antifungals include patients:

with HIV disease

receiving cancer chemotherapy

on immunosuppressive therapy

on prolonged antibiotic therapy

Denture-related stomatitis

IntroductionDenture-related stomatitis (denture sore

mouth; chronic atrophic candidiasis)

consists of mild inflammation and

erythema of the mucosa beneath a

denture, usually a complete upper

denture.

8/18/2019 1-1Candida

4/11

/01/1434 

linical features 

The characteristic presenting features ofdenture-related stomatitis are:

chronic erythema and oedema of themucosa that contacts the fitting surfaceof the denture, usually a complete upperdenture; the mucosa below lowerdentures is rarely involved

erythema restricted to the denture-wearing area

usually no symptoms

uncommon complications, whichinclude: angular stomatitis

papillary hyperplasia of the palate.

lassification 

Denture-related stomatitis has beenclassified into three clinical types(Newton's types), increasing in severity:

Type 1: a localised simple inflammationor a pinpoint hyperaemia.

8/18/2019 1-1Candida

5/11

/01/1434 

Type 2: an erythematous or generalisedsimple type presenting as more diffuseerythema involving a part of, or theentire, denture-covered mucosa.

Type 3: a granular type (inflammatorypapillary hyperplasia) commonlyinvolving the central part of the hardpalate and the alveolar ridge.

Diagnosis 

This is a clinical diagnosis.

Diabetes should be excluded, and a

blood picture, smears for fungal hyphae

and culture or other investigations such

as HIV serology may be indicated if

there is angular stomatitis, or other oral

or systemic lesions.

Thrush

Thrush is the common title for acutepseudomembranous candidiasis

Incidence 

Uncommon in healthy individuals butcommon in immunocompromised

persons.  Age: Can occur at any age.

Sex: It can occur in either sex.

Geographic: Candidiasis is seenworldwide.

Clinical features 

White papules on the surface of the oralmucosa. These can be wiped off withgauze, erythematous and sometimesbleeding base.

Complications, which may sometimes belesions of the mucosa of the upper

respiratory tract and the oesophagus, acombination particularly prevalent in HIV-infected patients.

8/18/2019 1-1Candida

6/11

/01/1434 

Diagnosis 

The diagnosis of thrush is usually

clinical . In immunosuppressed patients,

a Gram-stained smear should be taken

to distinguish it from the thrush-like

plaques produced by opportunistic

bacteria.

Management

Possible predisposing causes should be

looked for and dealt with, if possible.

Topical antifungals such as nystatin or

amphotericin, or imi-dazoles such as

miconazole or fluconazole are oftenindicated.

Chronic hyperplastic candidiasis

8/18/2019 1-1Candida

7/11

/01/1434 

Chronic hyperplastic candidiasis, or candidal

leukoplakia is a persistent white lesion,

characterised histologically by parakeratosis

and chronic intraepithelial inflammation with

fungal hyphae invading the superficial layers

of the epithelium.

Incidence: It is uncommon.

 Age : It is found in adults.

Sex: It can occur in either sex.

Geographic: It can be found worldwide.

linical features 

Candidal leukoplakias are chronic,discrete raised lesions that vary fromsmall, palpable, translucent, whitishareas to large, dense, opaque plaques,hard and rough to the touch (plaque-likelesions). Homogeneous areas orspeckled areas can be seen, which donot rub off (nodular lesions).

Candidal leukoplakias are non-homogeneous 'speckled' leukoplakias inup to 50%.

Candidal leukoplakias usually occur onthe buccal mucosa on one or both sides,mainly just inside the commissure, lessoften on the tongue.

8/18/2019 1-1Candida

8/11

/01/1434 

Diagnosis 

Candidal leukoplakias can be

indistinguishable from other leukoplakias

except by biopsy when Candida hyphae

can be seen after staining with periodic

acid Schiff (PAS). Candidal leukoplakia

should therefore be biopsied both to:

distinguish it from other non-candidal

lesions

examine for possible dysplasia.

Management 

From 9% to 40% of candidal leukoplakiasmay develop into carcinomas.

Factors influencing the prognosis mayinclude:

risk factors, such as tobacco and alcoholuse

whether the lesion is speckled (moredangerous) or homogeneous

the presence (more dangerous) anddegree of epithelial dysplasia

Chronic mucocutaneous candidiasis

8/18/2019 1-1Candida

9/11

/01/1434 

Chronic mucocutaneous candidiasis (CMC)

is the term given to the group of rare

syndromes in which there is persistent

mucocutaneous candidiasis that responds

poorly to topical treatment.

Erythematous candidiasis 

Erythematous or atrophic candidiasis iscandidiasis presenting as red lesions.

Red lesions may be seen in denture-related stomatitis, antibiotic-inducedstomatitis, sometimes in median rhomboidglossitis and, in HIV infection, maypreceede pseudomembranous candidiasis,or may arise as a consequence ofpersistent acute pseudomembranouscandidiasis.

Median rhomboid glossitis 

Median rhomboid glossitis (MRG), orglossal central papillary atrophy, is adepapillated rhomboidal area in thecentre line of the dorsum of the tongue.

Incidence It is uncommon.

 Age : It can occur at any age.

Sex : It can occur in either sex.

Geographic : It has no knowngeographic incidence.

linical features 

MRG is only rarely sore, but is moreusually detected incidentally by the patientor dentist. It is characterised by:

 An area of papillary atrophy which isusually reddish or red and white, oroccasionally white. It is elliptical orrhomboidal in shape, symmetrically placed

centrally at the midline of the tongue, justanterior to the circumvallate papillae.

8/18/2019 1-1Candida

10/11

/01/1434 

Diagnosis 

MRG is usually a clinical diagnosis.

Biopsy is rarely indicated; histology

shows irregular epithelial hyperplasia,

which resembles, but is not, a

carcinoma (because of the

pseudoepitheliomatous hyperplasia).

Rarely, there is a need for blood picture,

smears for fungal hyphae or culture.

Management 

Tobacco habits should be stopped.

 Antifungals are indicated. However, the

lesions may prove poorly responsive to the

antifungal drugs, and some cases respond

only to systemic fluconazole.

Erythematous candidiasis in HIV

disease 

Incidence: It is uncommon.

 Age : It can occur at any age.

Sex : It can occur in either sex.

Geographic : It has no known geographic

incidence.

Predisposing factors

The immunological defect.

Smoking.

Corticosteroid therapy.

Broad-spectrum antibiotic therapy.

Xerostomia (from HIV-salivary gland

disease, or some antiretroviral agents

which also have this effect).

8/18/2019 1-1Candida

11/11

/01/1434 

linical features 

The clinical presentation is of irregularerythematous macules and/or patches,generally on the dorsum of the tongue,palate or buccal mucosa.

Lesions are often seen in the central palateand sometimes termed 'thumbprint lesions'.

Lesions on the dorsum of the tonguepresent as glossitis or depapillated areas.

There can be an associated angularstomatitis.

Diagnosis 

This is a clinical diagnosis; biopsy is only

rarely indicated. Occasionally there is a

need for smears or culture.

Management

Tobacco habits should be stopped.

 Antiretroviral treatment.

Since the lesions in HIV disease may

prove poorly responsive to the antifungal

drugs, systemic fluconazole is usually

indicated.

Thank you...