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Fungal Infection Candidadiasis (Candidosis)

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... alternating with atrophy and a diffuse chronic inflammatory cell infiltrate in the lamina propria. * * Start systemic antifungal (fluconazol) ... – PowerPoint PPT presentation

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Title: Fungal Infection Candidadiasis (Candidosis)


1
Fungal InfectionCandidadiasis (Candidosis)
  • Dent 451
  • Lecture 4
  • Dr Jumana Karasneh

2
Candidal carriage
  • 40-60 of the population are Candida carriers
  • Candida species albicans, tropicalis, glabrata,
  • It causes infection when resistance is lowered

3
Predisposing factors
Factor Description
Physiological factors Old age, infancy, pregnancy
Local tissue trauma Appliances, poor OH
Antibiotic therapy Broad spectrum (systemic/topical)
Corticosteroid therapy Topical /systemic/ inhaler
Malnutrition Haematinic deficiency
Immune defects AIDS, immune suppression
Endocrine disorders Diabetes, Addison's, hypothyroidism
Malignancies Leukaemia
Salivary gland hypofunction Irradiation, Sjogrens syndrome, xerogenic drug
4
Symptoms
  • Asymptomatic
  • Bad / altered taste
  • Nausea
  • Soreness burning sensation
  • Dysphagia (pharynx / oesophagus involved)
  • Hoarseness of voice (Larynx involved)

5
Lehner Classification of Oral Candidosis (1960)
  • Acute
  • Pseudomembranous
  • Atrophic
  • Chronic
  • Atrophic
  • hyperplastic

6
Clinical classification of Oral Candidosis
  • Primary oral candidosis
  • Acute
  • Pseudomembranous
  • Erythematous
  • Chronic
  • Pseudomembranous
  • Erythematous
  • Hyperplastic
  • Candida-associated lesions
  • Denture induced stomatitis
  • Angular chelitis
  • Median rhomboid glossitis
  • Secondary oral candidosis
  • Manifestation of systemic mucocutanous candidosis

7
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

8
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

9
Hyperplastic Candidosis
  • Always chronic
  • Predisposing factors
  • Smoking
  • ?Fe folate
  • Defective cell-mediated immunity
  • Candidal leukoplakia (always give antifungal
    prior to biopsy)

10
Candida-associateddenture induced stomatitis
  • Most common
  • Usually not painful
  • Predisposing factors
  • Dental appliance
  • Diabetes or ? carbohydrate diet
  • Clinical picture
  • Newton Classification

11
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12
Candida-associateddenture induced stomatitis
  • Treatment should include
  • OHI / Stop denture night wearing
  • Check denture
  • Topical antifungal
  • Check glucose level

13
Candida-associatedangular chelitis
  • Soreness, erythema, cracking crusting.
  • Treatment
  • Candida reservoir should be eliminated
  • Correct predisposing factors

14
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

15
Diagnosis
  • Clinical
  • Oral rinse
  • Stained Smear
  • Swab culture
  • Biopsy
  • Heamatological tests

16
Diagnosis
  • Clinical
  • Oral rinse
  • Stained Smear
  • Swab culture
  • Biopsy
  • Heamatological tests

17
Diagnosis
  • Clinical
  • Oral rinse
  • Stained Smear
  • Swab culture
  • Biopsy stained with periodic acid Schiff (PAS)
  • Other investigations
  • Haematologic
  • Hormonal

18
Management
  • Removal of predisposing factors if possible
  • Avoid/reduce smoking
  • Improve oral hygiene
  • Therapy
  • Systemic
  • Topical

Which one to choose?!
19
  • Drug interaction with warfarin cyclosporin

20
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21
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22
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

23
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