Candidiasis—Mucocutaneous Infections
Candidiasis (most common opportunistic fungal infection)
General—ranges from localized mucocutaneous infection to life-threatening disseminated infection
Etiology
Candida albicans is the most common.
Other common culpable candida species include glabrata, parapsilosis, and tropicalis.
Mechanism
C. albicans is a normal commensal organism of the oral cavity.
Candidiasis develops when the host is impaired and Candida is able to overgrow.
Risk factors
Impaired salivary gland function from medical problems, medications, or radiotherapy
Inhaled/PO steroids (and Cushing’s) that may suppress cellular immunity and phagocytosis
Broad-spectrum antibiotics that change the local flora
Antineoplastic agents and those with neutropenia
Diabetes, high-carbohydrate diet
Smoking
Dentures (which produce an environment conducive to Candida‘s growth)
Nutritional deficiencies
Extremes of life
Classification of oral candidiasis (most common human fungal infection)
Acute candidiasis
Acute pseudomembranous candidiasis (thrush)
Clinical—white patches throughout oral cavity (mucosa, palate, tongue) which can typically be scraped off to reveal erythematous, nonulcerated mucosa.
Differential diagnosis—lichen planus, squamous cell carcinoma, leukoplakia
Acute atrophic candidiasis
Clinical—burning sensation in the mouth; may have glossitis
Chronic candidiasis
Chronic hyperplastic candidiasis (candidal leukoplakia)
Clinical—buccal mucosa or lateral aspect of the tongue with white lesions
Risk factors—smoking; complete resolution is dependent on smoking cessation
Chronic atrophic candidiasis (denture stomatitis)
Clinical—localized chronic erythema of those tissues covered by dentures
Risk factors—dentures
Median rhomboid glossitis
Clinical—affects symmetric area anterior to circumvallate papillae of tongue
Risk factors—smoking, inhaled steroids
Angular cheilitis (stomatitis)
Clinical—painful, red fissuring at one or two corners of the mouth
Treatment—antifungal steroid creams/ointments
Management of oral candidiasis
Pharmacologic
Topical
