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Fungal Infection Candidadiasis (Candidosis). Dent 451 Lecture 4 Dr Jumana Karasneh. Candidal carriage. 40-60% of the population are “ Candida carriers” Candida species: albicans, tropicalis, glabrata, … It causes infection when resistance is lowered. Predisposing factors. Symptoms.
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Fungal InfectionCandidadiasis (Candidosis) Dent 451 Lecture 4 Dr Jumana Karasneh
Candidal carriage • 40-60% of the population are “Candida carriers” • Candida species: albicans, tropicalis, glabrata, … • It causes infection when resistance is lowered
Symptoms • Asymptomatic • Bad / altered taste • Nausea • Soreness & burning sensation • Dysphagia (pharynx / oesophagus involved) • Hoarseness of voice (Larynx involved)
Lehner Classification of Oral Candidosis (1960) • Acute • Pseudomembranous • Atrophic • Chronic • Atrophic • hyperplastic
Primary oral candidosis Acute Pseudomembranous Erythematous Chronic Pseudomembranous Erythematous Hyperplastic Candida-associated lesions Denture induced stomatitis Angular chelitis Median rhomboidglossitis Secondary oral candidosis Manifestation of systemic mucocutanous candidosis Clinical classification of Oral Candidosis
Pseudomembranous “Thrush” • Not common in healthy individuals “disease of diseased” • Pseudomembrane is made of necrotic material, haphae, desquamated epithelial cells. • Should be differentiated from other white lesions • Could extend to pharynx & oesophagus
Erythematous Candidosis • Could be acute or chronic • Marked pain and soreness • Could precede or follow thrush or be isolated • Most cases predisposed by antibiotic or steroid • Further inv. if couldn't confirm diagnosis clinically • Treatment
Hyperplastic Candidosis • Always chronic • Predisposing factors: • Smoking • Fe & folate • Defective cell-mediated immunity • Candidal leukoplakia (always give antifungal prior to biopsy)
Candida-associateddenture induced stomatitis • Most common • Usually not painful • Predisposing factors • Dental appliance • Diabetes or carbohydrate diet • Clinical picture • Newton Classification
Candida-associateddenture induced stomatitis • Treatment should include: • OHI / Stop denture night wearing • Check denture • Topical antifungal • Check glucose level
Candida-associatedangular chelitis • Soreness, erythema, cracking & crusting. • Treatment • Candida reservoir should be eliminated • Correct predisposing factors
Candida-associatedMedian rhomboid glossitis • Midline of tongue anterior to sulcus terminalis • Predisposing factors • Smoking • Dental appliance • Corticosteroid inhalers • Immunosuppression / HIV infection • Respond poorly to topical antifungal long-term topical or systemic • Patients should undergo blood test and hormonal analysis
Diagnosis • Clinical • Oral rinse • Stained Smear • Swab & culture • Biopsy • Heamatological tests
Diagnosis • Clinical • Oral rinse • Stained Smear • Swab & culture • Biopsy • Heamatological tests
Diagnosis • Clinical • Oral rinse • Stained Smear • Swab & culture • Biopsy stained with periodic acid Schiff (PAS) • Other investigations: • Haematologic • Hormonal
Management • Removal of predisposing factors if possible • Avoid/reduce smoking • Improve oral hygiene • Therapy • Systemic • Topical Which one to choose?!
Chronic mucocutaneous candidosis • Oral cavity • Skin & scalp • Nails • Starts as pseudomembranous then develop into hyperplastic • Need referral to dermatologist • Long-term systemic antifungal with monitoring of liver function
