Oral disease processes page 1 Fungal infections-DoctorSpiller.com

Disease Processes 12345

Fungal Infections (Candidiasis)

Oral Candidiasis, also called Candidosis is caused by a form of fungus called Candida albicans. As many as 60 percent of healthy individuals may unknowingly harbor this organism as a part of their normal oral floral pattern. In healthy individuals, competing bacteria keep the fungus from overgrowing and causing the infections that you will read about on this page.

The illnesses most commonly associated with the development of canidiasis are systemic steroid therapy, and endocrine disturbances associated with pregnancy, hypothyroidism, and diabetes. It is also associated with dry mouth syndrome, Sjorgren’s syndrome, cancer chemotherapy, chronic tissue irritation (esp under dentures), smoking, antibiotic therapy and immunosuppression disorders such as AIDS.

There are four forms of candidiasis

1. Pseudomembranous Candidiasis

CandidiasisTonguePseudomembranous candidiasis is characterized by the presence of a white curd-like plaques that can easily be scraped off with a wooden tongue depressor blade or wiped away with a 2 x 2 gauze sponge. The white curd consists of the fungal organisms, including spores and mycelia. It happens in healthy adults only rarely, and usually is an indication of a lowered immune response.  Often it is due to illnesses such as general viral infections or stress related fatigue.

The term Thrush is a term for pseudomembranous candidiasis in infants. It is a common problem for infants since their immune systems are not yet fully developed.

CandidiasisThrush

2. Erythematous candidiasis

ErythematousCandidiasis-7Erythematous candidiasis is characterized by red, inflamed tissue. This form of candidiasis is especially prevalent in people who wear dentures and do not take them out at night. It appears to be the result of decreased tissue resistance because of the constant pressure from the prosthetic appliance. Treatment for this condition is composed of an antifungal antibiotic combined with the strong recommendation for the patient to remove his/her denture at night!

In fact, pseudomembranous candidiasis, when scraped off the tissue reveals red, inflamed tissues underneath.

CandidiasisPharyngialThus erythematous candidiasis is probably better characterized as the condition of the mucosa from which the white plaque has been removed. The image above shows pharyngeal candidiasis in an AIDS patient, and it demonstrates both pseudomembranous and erythematous varieties of candidiasis, as well as antular cheilitis at the corners of the lips.

3. Angular Cheilitis

angularcheilitisAngular cheilosis is associated with chronic vitamin B deficiency, and ill fitting dentures. Angular cheilits is not contagious.Angular cheilitis is a very common infection of the corners of the lips.  It happens all the time to healthy people who tend to have moist lips, especially in the cold winter months.  This condition is caused by a persistent mixed fungal/bacterial infection, and left untreated, may remain active for many months.  It generally looks like a reddened,  dry area at the corners of the lips.    It is easily treated with Nystatin cream or nystatin/ triamcinolone ointment. Nystatin is simply an antibiotic that kills the fungus.  Triamcinolone is a light steroid useful for reducing inflammatory responses to the fungus.(Mycolog®–nystatin and triamcinolone, or Vytone®–iodoquinol and hydrocortisone) will work better to relieve the condition than an antifungal antibiotic alone.

4. Hyperplastic candidiasis

HyperplasticCandidiasis
Hyperplastic candidiasis looks like pseudomembranous candidiasis, however it cannot easily be wiped off with a gauze sponge. It is composed of elevated white plaques, and may easily be confused with leukoplakia. It is found most often on the hard palate or the dorsal surface (top) of the tongue. It looks like any other form of leukoplakik plaque, but it will respond to a therapeutic trial of anti-fungal antibiotics. It can also be distinguished fron other keratotic lesions by cytologic smear or biopsy.

Treatment of oral Candidiasis

1. Nystatin Ointment

Disp: 30 gm tube
Sig: Apply three times a day after meals or apply thin coat to inner surface of denture three times a day after meals.

Safe: high compliance: inexpensive

2. Clortrimazole troches

Disp: #70
Sig: Disolve slowly five times a day until gone. do not chew

Safe: High compliance: pleasant tasting: High sugar (bad for teeth) There may be side effects due to the large dose of medication.

3. Amphotericin oral suspension

Disp: 48 ml
Sig: Swish with 1 ml four times per day, and swallow until gone

Expensive: must remove dentures before using: there may be side effects.

4. Nystatin/triamcinolone ointment (Mycostatin®) (For angular cheilitis)

Disp: 15 gm tube
Sig: Apply to corners of lips four times a day, after meals and before bedtime

Safe, inexpensive, high compliance

5. Ketaconazole 200 mg

disp: 14 tabs
Sig: One tab daily with meals

Used in cases which are refractory to treatment with topical antifgungal infections. High compliance: Inexpensive: But there is a potential for liver toxicity.

6. Fluconazole 100 mg (Diflucan®)

Disp: 15 tabs
Sig: take 2 tabs first day, then one tab every day til all are used.

Good compliance: expensive: There is a potential for liver toxicity.

Oral Bacterial Infections==>>

Disease Processes 12345