Candidiasis

CANDIDIASIS

Candidiasis , is also trmed Moniliasis, is an infection caused by the yeast-like fungus

Acute pseudomembranous candidiasis , also called Thrush, is one of the more common of this deseases

EtiologyCandida albicans is the most

common candidas species to cause oral candidiasis. • Normally present mucocutaneous

body surfaces.• Candida albicans is a member of the

normal oral flora and generally shows weak phatogenicity

Classification1. Primary Candidiasis : pseudomemberanous, erythematous, nodular,

and candida associated lesions (angular cheilitis, median rhomboid glossitis, denture stomatitis)

2. Secondary Candidiasis : Includes chronic mococutaneous and Candida

Endocrinopathy syndrome.3. Systemic Candidiasis : is less common and problem in

immunocompromised

DiagnosisDirect smear microscopicCulture ExaminationBiopsy and Histophatologic

Histology candida

HistoIt appears as an oval cell ( yeast form ) , 4-6

µm in diameter.In gram stain of clumps of multiple budding

cells and branching pseudohyphae grown in sabouraund agar

On the right are large , round, thick-walled, and highl-refractive clamydospres ( indicated by arrow ) on the ends of hyphae grown in corn meal agar

Histopathology CandidaCandidiasis occurs as a result of proleferation of

candida organisms and their penetration of the tissues under certain circumstances

This is an opprtunistic infection and occur more commonly in aged and infants, in presence of local facors such as decreased salivation or echanica rritation from ill fitting denture, and patient with sysemic diseases associated with depressed immunocapacity

Impaired host defense mechanisms – prdispose to candidiasis

Multiple Granulomatous nodules with scattered giant cells are present in lamina propia. Clinically he lesion presented as a raised, nodular mass which could be mstaken for a papilloma or lymphanioma

Tongue , buccal and soft palate mucosa

Multiple granulomatous nodules with scattered giant cells tumors are present in the lamina propia

Pseudohyphae are characteristic

PAS staing of he section above reveals he inclusion pseudohyphae and budding cells within the giant cells of the granuloma

Clinical FeaturesCliinical picture shows mucocutaneous

candidiosis involving he tongue and buccal mucosa

There re numerous white plaques some of which have desquamated leaving small erosions on the buccal surface

The oral mucosa is the most common site of superficial Candidiasis. However, The vagina, glans penis, skin, and nails may also be involved.

Diffierential Diagnosis• Leukoplakia• Hairy Leukoplakia• Lichen planus• Lupus Erythematosus• Mucous patches of secondary syphilis• White Sponge Nevus• Uremic Stomatitis• Cinnamon Contact Stomatitis• Chemical Burns• Traumatic Lesions• Furred tongue

Treatment• Elimination of systemic and/or local

predisposing factors : Itaconazole Capsules 100 mg/day or Fluconazole 100 mg/day for 1 – 2 weeks for acute pseudomembranous candidiasis and associated lesions

• Therapy for 2 – 4 weeks. –erythematous and nodular

• The secondary forms need long-term administration dose of 100 – 200 mg/day for 1 – 3 months

• Ketonazole capsules for 200 mg twice daily for 1 – 4 weeks, topical effect

Itraconazole Oral solution 2,5 – 5 mg/kg per day, for patients of resistence candida species, neutropenic, malignancies, transplants and AIDS

Systemic azoles in patients with severe liver disease and during pregnancy

Tropical treatment• Nystatins oral suspensions four times a day

or miconazole oral gel 5 ml four times a day for 1 – 2 weeks is indicated. Particulary for oral acute pseudomembranous candidiasis in infants or children or for adults

Thee healing of candidiosisMucocutaneous

candidiasis of the tonge undergoing healing with dessquamation of the pseudomembrane