Oral Fungal Infections Flashcards
Oral candidiasis is
Opportunistic fungal infection of the oral cavity
Candida
Yeast
Single cell organism
Transformation between different forms increases pathogenecity
Candidal virulence factors
Adherence
Switching mechanisms
Germ tube formation
Extracellular enzymes
Acidic metabolites
Predisposing factors
Disease only happens in pt with predisposing factors
Local factors- mechanical like dentures; smoking, local corticosteroids, xerostomia, topical antimicrobials
Generalised factors- immunosuppression like steroids or HIV, very young/old, endocrine disease like diabetes, nutritional deficiencies like iron, antibiotics
Classic of candidosis
Acute pseudomembranous -sudden local/systemic immunosuppression
Chronic erythematous - longstanding and persistent issue like poor fitting dentures. Can be due to HIV, denture stomatitis, antibiotic stomatitis, median rhomboid glossitis, angular cheilitis
Chronic hyperplastic- speckled (red and white) lesion cannot be wiped off, labial commissure is a common site. has malignancy potential
*Mucocutaneous candidiasis- congenital condition due to keratin defect
Diagnosis of candidiasis
Mainly clinical
Lab test: usually to help with the treatment, they don’t differentiate different types of candida only the quantity; don’t say how virulent canida is
Culture and sensitivity
Smear/microscopy occasionally
Swab, whole saliva/rinse - grown on selective agar to quantify the candida
Oral rinse- pt rinses with 10ml of PBS. It is then inoculated on selective agar plate on a spiral plater. Has the advantage of being “quantitative technique”
Direct microscopy
Germ tube test- fast
Both not used routinely
Biopsy- essential for diagnosis of hyperplastic candidiasis (using PAS stain)
Direct smear- quick results . Can be used for hyperplastic candidiasis but not without biopsy
Management of candidiasis
Correction of predisposing factors: OH, diet, trauma, steroid inhaler hygiene; identifying underlying illnesses
Antifungal agents
Consider co-infection with other microorganisms
Antifungal drugs
Polyenes: Nystatin, amphotericin
Imidazole: miconazole, clotrimazole
Triazoles: fluconazole, itraconazole
All district cell membrane
Treatment type
Topical- safer, for lengthty courses, less chances of side effects and drug interaction
Nystatin, amphotericin, miconazole
Systemic- more effective, short treatment time needed
Fluconazole, itraconazole
Miconazole
Not absorbed systematically
Interactive with warfarin
Available as cream, ointment, patch, gel
Cream/ointment comes with hydrocortisone
Gel should not be used for skin lesions
Effective against staphylococci as well as candida
Systemic antifungals
Fluconazole - 50 mg capsules taken once a day, 14 day course
Itraconazole - 100mg capsules, 14 day course, 100mg twice a day for pseudomembranous candidiasis
Interaction with warfarin and statins.
If nausea happens- stop the treatment
Candida resistant to antifungal agents
C. glabrata
C. kruseii
C. dubliniensis
Not common
