CANDIDIASIS

By- BHAVESH SIPPY

Roll no-77
Final Year
• Candidiasis is a disease caused by infection with a yeast
like fungus, Candida albicans
• It is most common opportunist infection in the world.
• Other species are :- C. tropicalis, C.parapsilosis,
C.glabrata
• Oral candidiasis or thursh usually remains as a localised
disease, but on occasion it may show extension to
pharynx or even lungs.
 Predisposing factors:-
• Factors that alter immune system of the host
• Immunodeficiency disorders like HIV infection
• Blood dyscrasias
• Radiation therapy
• Corticosteriods therapy
• Old age or infancy
• Pregnancy
• Diabetes Mellitus
 Classification of Candidiasis
(Greenberg and Glick, 2003)
 Pseudomembraneous type
 Atrophic (erythematous)-antibiotic stomatitis
 ATROPHIC
• Denture sore mouth
• Angular cheilitis
• Median rhomboid glossitis
 HYPERTROPHIC/HYPERPLASTIC
• Candida leukoplakia
• Papillary hyperplasia of palate
• Median rhomboid glossitis(nodular)
 MULTIFOCAL
 SYNDROME ASSOCIATED
• Familial endocrine neoplasia syndrome
• Myositis
 LOCALISED
 GENERALISED
 CLINICAL
PRESENTATION
ACUTE PSEUDOMEMBRANEOUS
CANDIASIS
• It is the most common form of candiasis.
• Common site :- buccal mucosa, dorsum of the tongue, palate.
• Usually follows a immuno-suppressive therapy.
• Burning sensation usually preceeds the appearance of a soft,
creamy white to yellow elevated plaque that are easily wiped off
from the affected oral tissues and leave Erythematous, eroded or
ulcerated surface
• In HIV patients :- Combination of oral and oesophageal
candidiasis is prevalently is seen.
• Either the entire oral muscosa or relatively localised area is
affected.
• Prodromal symptoms :- rapid onset of bad taste, loss of taste
discrimination.
Differential Diagnosis:
• Habitual cheek biting
• Burns
• White sponge nevus
 CHRONIC HYPERPLASTIC
CANDIASIS
• Also called as candida leukoplakia
• Seen as chronic discrete raised lesion that vary from
small, palpable translucent whitsih area to large, dense,
opaque plaques, hard and rough to touch.
• Common site- Anterior buccal mucosa along the
occlusal line, laterodorsal surface of the tongue.
• Adherent and do not scrape off.
 CHRONIC ATROPHIC
(ERYTHEMATOUS) CANDIDIASIS
• Site- Hard palate under the denture, dorsal tongue or
other mucosal surface.
• Etiology- poor denture hygiene, continuous denture
insertion, immunosuppression, xerostomia, or antibiotic
therapy.
• Most commomly appears as red patch or velvet textured
plaque.
• When it appears on the hard palate in association with
denture, frequently associated papillary hyperplasia.
• Burning sensation
• Also reported in AIDS patients
 Median Rhomboid Glossitis
• It is a form of chronic atrophic candidiasis
characterized by an asymptomatic, elongated,
erythematous patch of atrophic mucosa of the
posterior mid dorsal surface of the tongue due to
chronic candidal infection
• A concurrent ‘kissing lesion’ of the palate is
sometimes noted.
 ANGULAR
CHEILITIS(PERLECHE)
• Appears as red, eroded, fissured lesions
• Occurs bilaterally in the commisures of the lips
• Frequently irritating and painful
• Etiology – loss of vertical occlusion dimension
• May be associated with immunosuppresion
 CHRONIC MULTIFOCAL
ORAL CANDIDIASIS
• Seen in multiple oral sites
• Seen in combination with angular stomatitis,
median rhomboid glossitis and palatal lesions
• All lesion have 1 month duration with no
predisposing factors
• Commonly seen in chronic smokers in their
5th to 6th decade of life
 ROLE OF CANDIDA IN ORAL
CARCINOGENESIS
• Candida leukoplakias may develop into carcinomas
• The Candida organisms have a higher nitrosation potential than
others, which might indicate the possible role of specific type in
the transformation of some leukoplakias
INVESTIGATIONS
 Smear examination
• Histological examination of intraoral scrapings which have
been smeared on microscopic glass slide.
• A 10-20% potassium hydroxide preparation is used for
identification of yeast cell forms.
• Alternatively, the smear can be sprayed with cytologic fixative
and stained using PAS stain and other slide with grams stain .
• Yeast appears:
• Dark blue- Gram staining
• Red or Purple- PAS staining
 Hematologic investigation:
• Associated with predisposing factors such as blood
dyscrasias, estimation of Hb, white cell counts, blood
sugar and serum ferritin.
 Biopsy
• A biopsy may be indicated when candidiasis is
suspected in conjunction with some concurrent
pathology such as candidial leukoplakia, epithelial
dysplasia, SCC or lichen planus.
 Imprint culture technique:
• A sterile plastic foam pad of 2.5x2.5 cm is dipped in Sabouraud’s
broth and placed on suspected mucosal surface for 60 seconds.
• Then the plastic foam is directly placed on Sabouraud’s agar.
• Candida density at each site is determined by Gallenkamp colony
counter and expressed as colony-forming units (CFU) per mm2
• Denture wearers= 49CFU cm2 suggest candidiasis
 Salivary culture technique:
2ml of mixed unstimulated saliva into a sterile
universal container
The number of candida is expressed in CFU per mm
of saliva is estimated by counting the resultant
growth on Sabouraud’s agar.
 Oral rinse technique:
Pt. is asked to rinse 10ml of sterile phosphate buffered saline or
sterile water for 60 seconds
The oral rinse is centrifuged at 1,700g for 10 mins and the
deposits are resuspended in 1ml sterile PBS.
The concentrated oral rinse is now inoculated in appropriater
media to asses CFU/mm of rinse sample using a spiral platter
prior to intubation.
More advantageous than imprint technique:
• Simple to perform
• Used for quantitation of other organisms.
Treatment
 Oral candidiasis Systemic candidiasis

Treat the underlying

cause or local factor

Topical Route Parental Route Oral Route

Clotrimaxazole 1% cream or Fluconazole 150mg or 200mg b.i.d for 14

2% gel or 1% solution for 5 days.
times/day for 2 weeks. Ketoconazole 200mg o.d for 1-4 weeks.
Nystatin 5Lakh Units for 4 Itraconazole 100mg o.d for 14 days.
times/day for 14 days.
Hamycin 2Lakh Units 2-3 Amphotericin B IV infusions 0.3 mg/kg can be
times/day for 7-10days. infused over 4-8 hours.
Fluconazole dispersable tablet
with water to use as
mouthrinse 3 times/day for 14
days.
THANK YOU