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Introduction
It is a common opportunistic infection that develops in the presence of one of predisposing conditions. It is fungal infection which can be extremely uncomfortable. The yeast like organisms are normal inhabitants of the mouth and once the normal balance of the body is disrupted for reasons such as stress, hormonal imbalances or any other cause that kills the bacteria the fungal infection becomes excess in the body. | |
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Clinical Features
The most common form is the oral thrush. Young infants and the elderly are commonly affected. The estimates of the disease frequency range up to 5 % of neonates, 5 % of cancer patients and 10% of institutionalised, debilitated elderly patients. The infection is very common in patients treated with radiation, chemotherapy for leukaemia and solid tumours.
The infection seen in the mouth is characteristically seen as soft, white patches. These patches are composed of fungal organisms, inflammatory cells, bacteria. Wiping away the white plaque like patches leaves behind painful ulcerated surface. The sites where they most appear are the lining of the cheek, the sides of the tongue and the throat.
In very severe conditions patients may complain of tenderness, burning sensation and difficulty in swallowing.
The different kinds of candidiasis are
Antibiotic stomatitis: If the fungal infection persists for a long time then it presents itself as acute erythematous candidiasis, on the tongue surface, there are patches of denudation of the skin making it appear red. It is commonly associated with antibiotics.
Chronic erythematous candidiasis: Chronic form of the fungal infection is seen in old patients who wear complete dentures.The clinical appearance is that of a velvety to pebbly surface.
Angular cheilitis: It is the chronic form of candidiasis seen in the case of denture bearers. This condition is mainly seen in ill fitting dentures that do not adequately have lip support. It also occurs in individuals with severe lip licking habits. The lesions appear as painful with a crusty surface.
Median Rhomboid Glossitis: It is generally asymptomatic and discovered in the routine examination. It is oval in nature. It may have smooth, fissured surface and may range from the colour white to red colour.
Mucocutaneous candidiasis: It is a rather diverse group of conditions. The localized form is characterized by persistent infection of the mouth. This form is resistant to treatment with only temporary remission following the use of antifungal therapy. | |
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Causes
It is caused by a fungus called Candida albicans and less commonly by other species of fungus such as Candida parapsilosis, C.Tropicalsi, C glabrata, C.krusei, C pseudotropicalis and C guilliermondi. It is mainly seen in the infants and the elderly. Some of the factors that make the condition favourable for the fungus to transform into disease causing organism are
- Antibiotics which when administered may kill natural bacteria and allowing the other fungus to grow unhampered.
- Prolonged administration of steroids can suppress the immune system causing a favourable environment for the fungus to multiply.
- Severe immune suppression in diseases such as diabetes, leukaemia, AIDS etc.
The infection of this organism is usually superficial only affecting the outer aspects of the involved areas of the mouth. Only in very severe cases the infection can extend into the food and wind tract. In mild forms it is seen in short term use of antibiotic drugs. | |
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Treatment
Majority of the infections are simply treated with topical application of Nystatin or clotrimazole. The cream is often effective when applied directly to the denture bearing surface. In both circumstances prolonged contact time with the lesion proves to be an effective strategy. Antifungal tablets can be administered either locally or in oral form.
In severe long standing conditions medicines such as ketoconazole, flucanazole, or itraconazole may be required. All these are available in oral form. | |
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Prognosis
The prognosis for acute and most other forms is excellent. | |
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