ORAL

CANDIDIASIS

drg Miftakhul Cahyati, SpPM

 DEFINITION

a common opportunistic infection

caused by an overgrowth of Candida
the commonest being Candida albicans
C albicans is a normal commensal of the mouth and
generally causes no problems in healthy people
The important ones are C albicans
C tropicalis, C glabrata, C pseudotropicalis,
C guillierimondii, C krusei, C lusitaniae, C parapsilosis,

C stellatoidea. C albicans, C glabrata, and Ctropicalis

represent more than 80% of isolates from clinical infection

 Candida Species
Most common fungal
pathogen of humans
Resides as normal part of
the skin, gastrointestinal
and genitourinary
microflora = commensal
organism
Alterations in the microbial
ecology or immunological
status can lead to
candidiasis = opportunistic
infection
 General SS
can lead to local discomfort
an altered taste sensation
dysphagia from oesophageal overgrowth resulting in
poor nutrition, slow recovery and prolonged
hospital stay
In immunocompromised patients can spread
through the bloodstream or upper gastrointestinal
tract leading to severe infection with significant
morbidity and mortality
Systemic candidiasis carries a mortality rate of 71%
to 79%
 INCIDENCE

depending on age and certain predisposing factors

45% in neonates
45%65% of healthy children
30%45% of healthy adults
50%65% of people who wear removable dentures
65%88% in those residing in acute and long term
care facilities
90% of patients with acute leukaemia undergoing
chemotherapy
95% of patients with HIV
 RISK FACTORS

impaired salivary gland function

drugs
dentures
high carbohydrate diet
smoking
diabetes mellitus
Cushings syndrome
malignancies
immunosuppressive conditions
 CLASSIFICATION

Acute pseudomembranous candidiasis

moniliasis, thrush
Acute atrophic candidiasis antibiotic sore tongue
Chronic atrophic candidiasis denture stomatitis
Chronic hyperplastic candidiasis candidal
leukoplakia, median rhomboid glossitis
Angular cheilitis
Chronic mucocutaneous candidiasis
 PAS Stained Candida Albicans
Hyphae Embedded in The Oral Mucosa
 Acute Pseudomembranous Candidiasis
(Thrush)

Etiology:
C.albicans
Appearance:
White slightly elevated plaques that can be wiped
away leaving an erythmatous base.
Direct smear can be fixed and stained using PAS
reagent to reveal the candida hyphea
microscopically.
 Acute Atrophic Candidiasis
(Antibiotic Sore Tongue)

Etiology:
Oral candidiasis secondary to antibiotics or
steroids.
Appearance:
Similar to thrush without overlying
pseudomembrane: erythematous and painful
mucosa.
Differential Diagnosis:
Erosive lichen planus.
Chemical erosion.
 Chronic Atrophic Candidiasis
(Denture Sore Mouth)
Etiology:
most common form of oral candidiasis
candidal infection of denture as well.
treatment should be directed towards mucosa
and denture.
 Chronic Atrophic Candidiasis
(Denture Sore Mouth)
Appearance:
Mucosa beneath denture is erythematous with a
well-demarcated border.
Swabs from the mucosal surface may provide a
prolific growth, but biopsy shows few candida
hyphae in spite of high serum and saliva antibodies
to candida.
Differential Diagnosis:
Inflammatory papillary hyperplasia.
 Chronic Hyperplastic Candidiasis
(Candida Leukoplakia)

Etiology
Oral Candidiasis lesions should be considered
as potentially premalignant. Treatment should
be directed toward mucosa and Leukoplakia.
Appearance
Confluent leukoplakic plaques characterized
by Candida invasion of oral epithelium with
marked atypia.
 Angular Cheilitis
Etiology:
Diminished occlusal vertical dimension
Vitamin B or iron deficiencies

Superimposed candidiasis

Affects approximately 6% of General Population

Appearance:
Wrinkled and sagging skin at the lip commisures.

Desiccation and mucosal cracking.

Differential Diagnosis:
Dry chapped lips.

Basal cell carcinoma.

Squamous cell carcinoma

 Diagnostic Criteria

C.F.U. in Candidiasis can vary from 1,000/ml to

20,000/ml.
As an adjunct to saliva samples, smears stained with
PAS.
Thus clinical manifestations, salivary culture and
stained smears are needed to confirm a diagnosis of
Candidiasis.
 MANAGEMENT
Rx: Nystatin oral suspension
Sig: Swish and swallow 5 ml qid for 5 min.
Rx: Nystatin ointment.
Sig: Apply thin coat to affected areas after each meal and
qhs.
Rx: Clotrimazole trouches 10 mg.
Sig. Let 1 trouch dissolve in mouth 5 times daily.
Stop antibiotic
w/ immunocompromissed antifungal sistemic
(amphoterisin B, ketokonazol atau fluconazol) but
ketokonazol and flukonazol hepatotoksik supresse
hematopoesis
 MANAGEMENT

Rx for Dentures: Improve oral hygiene of appliance.

Keep denture out of mouth for extended periods and
while sleeping.
Soak for 30 min in solutions containing benzoic acid,
0.12% chlorhexidine, or 1% sodium hypochlorite and
thoroughly rinse.