Oral candidiasis

Oral candidiasis (Acute pseudomembranous candidiasis), also known as oral thrush, This candidal carriage state is not considered a disease, but when Candida species become pathogenic and invade host tissues, oral candidiasis can occur. This change usually constitutes an opportunistic infection by normally harmless micro-organisms because of local (i.e., mucosal) or systemic factors altering host immunity.

Classification

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! Traditional classification of oral candidiasis. Where it is associated with inhalation steroids (often used for treatment of asthma), erythematous candidiasis commonly appears on the palate or the dorsum of the tongue. Indeed, it can be clinically indistinguishable from true leukoplakia, but tissue biopsy shows candidal hyphae invading the epithelium. Some sources use this term to describe leukoplakia lesions that become colonized secondarily by Candida species, thereby distinguishing it from hyperplastic candidiasis. It is known that Candida resides more readily in mucosa that is altered, such as may occur with dysplasia and hyperkeratosis in an area of leukoplakia.

Associated lesions

Candida-associated lesions are primary oral candidiases (confined to the mouth), where the causes are thought to be multiple. Candida organisms alone are responsible for about 20% of cases, or "Candida-associated denture-induced stomatitis" (CADIS), Although this condition is also known as "denture sore mouth",

Others

Chronic multifocal oral candidiasis

This is an uncommon form of chronic (more than one month in duration) candidal infection involving multiple areas in the mouth, without signs of candidiasis on other mucosal or cutaneous sites. The lesions are variably red and/or white. Unusually for candidal infections, there is an absence of predisposing factors such as immunosuppression, and it occurs in apparently healthy individuals, normally elderly males. Smoking is a known risk factor. C. albicans accounts for about 50% of oral candidiasis cases, This adhesion involves adhesins (e.g., hyphal wall protein 1), and extracellular polymeric materials (e.g., mannoprotein).

Several Candida species are polymorphogenic,

thumbnail|left|Oral candidiasis in an infant. At very young ages, the immune system is yet to develop fully.

Immunodeficiency

Immunodeficiency is a state of reduced function of the immune system, which can be caused by medical conditions or treatments.

Acute pseudomembranous candidiasis occurs in about 5% of newborn infants. active cancer and treatment, chemotherapy or radiotherapy.

Corticosteroid medications may contribute to the appearance of oral candidiasis, Where inhaled steroids are the cause, the candidal lesions are usually of the erythematous variety. Candidal lesions on both sites are sometimes termed "kissing lesions" These conditions all favor the growth of C. albicans. Sometimes dentures become very worn, or they have been constructed to allow insufficient lower facial height (occlusal vertical dimension), leading to over-closure of the mouth (an appearance sometimes described as "collapse of the jaws"). This causes deepening of the skin folds at the corners of the mouth (nasolabial crease), in effect creating intertriginous areas where another form of candidiasis, angular cheilitis, can develop. Candida species are capable of adhering to the surface of dentures, most of which are made from polymethylacrylate.<!--

Antibiotics

Broad-spectrum antibiotics (e.g. tetracycline) eliminate the competing bacteria and disrupt the normally balanced ecology of oral microorganisms, and/or the presence of certain other mucosal lesions, especially those that cause hyperkeratosis and/or dysplasia (e.g. lichen planus). Such changes in the mucosa predispose it to secondary infection with candidiasis. tongue piercing, atopy, Smears are collected by gentle scraping of the lesion with a spatula or tongue blade and the resulting debris directly applied to a glass slide. Oral swabs are taken if culture is required. Some recommend that swabs be taken from 3 different oral sites.

Sometimes an underlying medical condition is sought, and this may include blood tests for full blood count and hematinics.

If a biopsy is taken, the histopathologic appearance can be variable depending upon the clinical type of candidiasis. Pseudomembranous candidiasis shows hyperplastic epithelium with a superficial parakeratotic desquamating (i.e., separating) layer. Hyphae penetrate to the depth of the stratum spinosum,

Underlying immunosuppression may be medically manageable once it is identified, and this helps prevent recurrence of candidal infections.

Patients who are immunocompromised, either with HIV/AIDS or as a result of chemotherapy, may require systemic prevention or treatment with oral or intravenous administered anti-fungals. However, there is strong evidence that drugs that are absorbed or partially absorbed from the GI tract can prevent candidiasis more effectively than drugs that are not absorbed in the same way.

If candidiasis is secondary to corticosteroid or antibiotic use, then use may be stopped, although this is not always a feasible option. Candidiasis secondary to the use of inhaled steroids may be treated by rinsing out the mouth with water after taking the steroid. Microwave sterilization is only suitable if no metal components are present in the denture. Antifungal medication can also be applied to the fitting surface of the denture before it is put back in the mouth. Other problems with the dentures, such as inadequate occlusal vertical dimension may also need to be corrected in the case of angular cheilitis.

Prognosis

The severity of oral candidiasis is subject to great variability from one person to another and in the same person from one occasion to the next.

The role of thrush in the hospital and ventilated patients is not entirely clear, however, there is a theoretical risk of positive interaction of candida with topical bacteria.

Epidemiology

In humans, oral candidiasis is the most common form of candidiasis, and it also represents the most common opportunistic oral infection in humans with lesions only occurring when the environment favors pathogenic behavior.

Oropharyngeal candidiasis is common during cancer care,

The incidence of all forms of candidiasis have increased in recent decades.<!-- The first description of this condition is thought to have occurred in the 4th century B.C. in "Epidemics" (a treatise that is part of the hippocratic corpus), where descriptions of what sounds like oral candidiasis are stated to occur with severe underlying disease.

The colloquial term "thrush" is of unknown origin but may stem from an unrecorded Old English word <i>*þrusc</i> or from a Scandinavian root. The term is not related to the bird of the same name.

Society and culture

Many pseudoscientific claims by proponents of alternative medicine surround the topic of candidiasis. Oral candidiasis is sometimes presented in this manner as a symptom of a widely prevalent systemic candidiasis, candida hypersensitivity syndrome, yeast allergy, or gastrointestinal candida overgrowth, which are medically unrecognized conditions. (See: Alternative medicine in Candidiasis)