CANDIDIASIS - dental.subharti.org

CANDIDIASIS

Dr Preeti Sharma

Reader

Oral & Maxillofacial Pathology

SDC

Dr. Preeti Sharma, Subharti Dental College, SVSU

Candidiasis

Blastomycosis

Histoplasmosis

Coccidioidomycosis

Cryptococcosis

Phycomycosis

Aspergillosis


CANDIDIASIS Refers to multiplicity of diseases caused by

yeast like fungus Candida albicans

Most common oral fungal infection in humans

Most opportunistic infection in the world

Exists in 3 forms:

Yeast form

Pseudohyphae form

Chlamydospore form


Predisposing Conditions 1. Acute & Chronic diseases

2. Endocrinopathies

3. Immunodeficiency

4. Nutritional deficiencies

5. Prolonged hospitalization

6. Prolonged drug therapy

7. Radiation therapy

8. Use of i.v. tubes, catheters, heart valves & poorly maintained dentures, heavy smoking

9. Old age, infancy, pregnancy


C/F:

May range from mild superficial mucosal involvement to severe, fatal disseminated form seen in Immunocompromised patients


CLASSIFICATION OF ORAL CANDIDIASIS

PRIMARY

I ACUTE FORMS

Pseudomembranous (Thrush)

erythematous

II CHRONIC FORMS Hyperplastic

Nodular

Plaque like

Erythematous

pseudomembranous


Candida-associated lesions

• Denture stomatitis

• Angular cheilitis

• Median rhomboid glossitis

Keratinized primary lesions superinfected with Candida

• Leukoplakia

• Lichen planus

• Lupus erythematosus


Secondary oral candidiasis

• Oral manifestations of systemic mucocutaneous candidiasis as a result of diseases such as a thymic aplasia and candidiasis endocrinopathy syndrome.


Acute Pseudomembranous Candidiasis m/c in debilitated, chr. ill, infants

M/c site – buccal mucosa, tongue. Palate, gingiva, floor of mouth

Symptoms – mild burning sensation, unpleasant taste (salty/bitter), feeling of ‘blisters’

Soft white elevated plaques, “ milk curd” or “Cottage Cheese”


White plaque can usually be wiped away with a gauze, leaving either a relatively normal appearing mucosa or an erythematous area

HISTOLOGICAL FEATURES

• Tangled masses of fungal hyphae with intermingled desquamated epi., keratin, fibrin, necrotic debris, leukocytes, bacteria



Erythematous candidiasis

• Acute atrophic candidiasis/antibiotic sore mouth

• Central papillary atrophy of the tongue

• Chronic multifocal candidiasis

• Angular cheilitis

• Cheilocandidiasis

• Denture stomatitis/ chronic atrophic candidiasis.


Acute Atrophic Candidiasis (Antibiotic Sore Mouth)

Develop as sequelae or de novo

Appears red/ erythematous

Consistently painful, burning sensation

Bald tongue – loss of filliform papillae


Chronic Atrophic Candidiasis (Denture sore mouth)

Denture Stomatitis Erythema & petechial hemorrhage localized to

maxillary denture bearing area


• The process is rarely symptomatic.

• Patient admits to wearing dentures continuously, removing it only periodically to clean it.

• Whether this represents actual infection by C.albicans or is simply a tissue response by the host to the various microorganisms living beneath the denture remains controversial.


• The clinician should also rule out the possibility that this reaction could be caused by improper design of the denture (which could cause unusual pressure on the mucosa), allergy to the denture base, or inadequate curing of the denture acrylic.


• If the palatal mucosa & tissue contacting surface of the denture are swabbed & separately streaked onto a Sabouraud’s agar slant, the denture typically shows much heavier colonization by yeast.


CENTRAL PAPILLARY ATROPHY • A form of erythematous candidiasis which is

asymptomatic and chronic. It is also known as median rhomboid glossitis of the tongue.

• In the past, this was thought to be a developmental defect of the tongue, occuring in 0.01 to 1% of adults.

• The lesion was supposed to have resulted from a failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue.


• Now, a consistent relationship between the lesion and C.albicans has been noted.

• Clinically, central papillary atrophy appears as a well-demarcated erythematous zone that affects the midline, posterior dorsal tongue and often is asymptomatic.

• Erythema is due in part to the loss of filiform papillae in this area.


• The lesion is usually symmetric.

• Often the mucosal alteration resolves with antifungal therapy.

• Some patients with central papillary atrophy may also exhibit signs of oral mucosal candidal infection at other sites. This presentation of erythematous candidiasis is termed as chronic multifocal candidiasis.


• The junction of the hard and soft palate and the angles of the mouth may be involved.

• Palatal lesion appears as an erythematous area that, when the tongue is at rest, contacts the dorsal tongue lesion, resulting in what is called a “kissing lesion” because of the intimate proximity of the involved areas.


Angular cheilitis, perleche

• Involvement of the angles of the mouth is characterized by erythema, fissuring, and scaling. Sometimes, it is seen as a component of chronic multifocal candidiasis, but it often occurs alone, typically in an older person with reduced vertical dimension of occlusion and accentuated folds at the corners of the mouth.


• Saliva tends to pool in these areas, keeping them moist and thus favouring a yeast infection.

• 60% cases are due to combined infection with C.albicans and staphylococcus aureus.

• The candidal infection may involve the perioral skin causing cheilocandidiasis.


Angular Cheilitis (Perléche)

Old patients with vertical dimension & accentuated folds at corners of mouth

Erythema, fissuring, scaling at corners of mouth

Pooling of saliva


Id Reaction

Hypersensitivity reaction to candidal antigen, which manifests as vesicular & papular rash on skin of patients with chronic candidiasis


Chronic hyperplastic candidiasis

• Also known as candidal leukoplakia.

• In some patients with oral candidiasis, there may be a white patch that cannot be removed by scraping; in such case, the term chronic hyperplastic candidiasis is used.

• Least common and is controversial.

• Some believe that this condition simply represents candidiasis that is superimposed on a preexisting leukoplakic lesion.


• However, the candidal organism alone may be capable of inducing a hyperkeratotic lesion.

• Such lesions are usually located on the anterior buccal mucosa & cannot clinically be distinguished from a routine leukoplakia.

• Often the leukoplakic lesion associated with candidal infection has a fine intermingling of red and white areas, resulting in a speckled leukoplakia.


• Such lesions may have an increased frequency of epithelial dysplasia histopathologically.

• Diagnosis is confirmed by the presence of candidal hyphae associated with the lesion & by complete resolution of the lesion after antifungal therapy.


Histopathological features

• Candida seen in

• exfoliative cytologic prep

• tissue section from biopsy

• Hyphae & pseudohyphae – must for Dx

• Thickness of parakeratin with elongation of rete ridges

• Chronic inflammatory cell infiltrate subjacent to infected epi

• Micro abscess in parakeratin layer & supf spinous layer


Hyphe stained by PAS growing towards epithelium


Chronic Mucocutaneous Candidiasis

Chronic candidal involvement of the skin, scalp, nails and mucous memb.

Oral lesions appear as thick white plaques that don’t rub off

Similar to hyperplastic candidiasis

Familial type is an inherited disorder, autosomal recessive, before age 5


Localized type:

severe form

Seen early in life

No genetic transmission

Widespread skin involvement

Granulomatous & horny masses on face & scalp

↑ incidence of other fungal & bacterial inf.

Primary site for white plaques → Mouth

Nail involvement usually present


Diffuse Type:

Least common form

Late onset, pts. > 50 yrs.

Extensive, raised crusty sheets involving limbs, groin, face, scalp etc.

No family history


Candidiasis Endocrinopathy Syndrome

• Genetically transmitted condition.

• Candidiasis in association with various endocrinal abnormalities.

• E.g. – Hypothyroidism, Hypoparathyroidism, Addison’s disease, Diabetes mellitus.

• Also in association with Fe deficiency anaemia.

• Enamel hypoplasia may be present. Dr. Preeti Sharma, Subharti Dental College, SVSU

Treatment

Antifungal agents

Polyene agents – Nystatin, Amphotericin

B

Imidazole agents

Triazole agents


REFERENCES

• Shafer’s Textbook of Oral Pathology. Eighth Edition.

• Neville, Damm, Allen, Bouquot. Oral & Maxillofacial Pathology. Third edition.

• Regezzi. Oral Pathology: Clinical Pathologic correlations. Seventh Edition.


Documents

CANDIDIASIS - dental.subharti.org