Oral candidiasis

Oral candidiasis
Classification and external resources
Oral candidiasis
ICD-10	B37.0
ICD-9	112.0
DiseasesDB	29743
MedlinePlus	000966
eMedicine	derm/68 ped/2245
MeSH	D002180

Oral candidiasis (also known as oral candidosis, (oral) thrush oropharyngeal candidiasis, moniliasis candidal stomatitis) is a common opportunistic mycosis (yeast infection) of Candida species on the mucous membranes of the mouth.

Classification

Being a type of candidiasis, oral candidiasis is a mycosis. Traditionally, oral candidiasis is classified into acute and chronic forms (see table). The fact that rarely, some of the subtupes may present as either acute or chonic creates problems with this system.

Traditional classification of oral candidiasis.
Acute candidiasis: pseudomembranous candidiasis (thrush) atrophic candidiasis Chronic candidiasis: hyperplastic candidiasis atrophic candidiasis hyperplastic candidiasis chronic oral candidiasis (Candida leukoplakia) candidiasis endocrinopathy syndrome chronic localized mucocutaneous candidiasis chronic diffuse candidiasis.
Classification of oral candidiasis.
Primary oral candidiasis (group I) Acute: pseudomembranous, erythematous Chronic: pseudomembranous, erythematous Candida-associated lesions Secondary oral candidiasis (group II) Oral manifestations of systemic mucocutaneous candidiasis (due to diseases such as thymic aplasia and candidiasis endocrinopathy syndrome) Hyperplastic plaque-like, nodular Denture related stomatitis, angular stomatitis, median rhomboid glossitis

A more recently proposed classification distinguishes primary oral candidiasis, where the condition is confined to the mouth and perioral tissues, and secondary oral candidiasis, where there is involvement of other parts of the body in addition to the mouth.

Angular cheilitis

Main article: Angular cheilitis

Angular cheilitis

Angular cheilitis is inflammation at the angles of the mouth, very commonly involving candida infection. Signs and symptoms include soreness, erythema (redness), and fissuring of the angles of the mouth, with edema seen intraorally on the commisures. Angular cheilitis is usually bilateral and commonly occurs in elderly people and is associated with denture related stomatitis.

Median rhomboid glossitis

Main article: Median rhomboid glossitis

Median rhomboid glossitis in a child

This is an elliptical or rhomboid lesion in the center of the dorsal tongue, just anterior (in front) of the circumvallate papillae. The area is depapillated, reddened (or red and white). This condition is rarely painful. There is frequently Candida in the lesion, sometimes mixed with bacterial species.

Denture related stomatitis

Main article: Denture related stomatitis

This is the most common form of oral candidiasis, and refers to a mild inflammation and erythema of the mucosa beneath a denture, usually located underneath an upper denture in elderly edentulous patients. Although this condition is also known as "denture sore mouth", there is rarely any pain. Candida is associated with about 90% of cases of denture related stomatitis.

(Acute) pseudomembranous candidiasis

Oral candidiasis in a child

Oropharyngeal candidiasis, pseudomembranous type

This is a common form of oral candidiasis in which there is a pseudomembrane of white slough which can be wiped away to reveal erythematous and sometimes bleeding mucosa beneath. It is classically an acute condition, appearing in infants (who are yet to develop immunity to Candida species) or in those with immunocompromised state, but sometimes it can be chronic. It is rare in healthy people, and has been termed "a disease of the diseased".

(Chronic) hyperplastic candidiasis

Also termed candidal leukoplakia, these variable white or red and white hyperplastic lesions do not rub off. It can be indistinguishable from other types of leukoplakia, but tissue biopsy shows candidal hyphae invading epithelium. Hyperplastic candidiasis is uncommon, and is usually chronic and found in adults.

Erythematous candidiasis

Erythematous (or atrophic) candidiasis is candidiasis presenting with red lesions. This type of candidal lesion can be found in denture related stomatitis, antibiotic-induced stomatitis, and sometimes in median rhomboid glossitis. It may precede the formation of a pseudomembrane, or be left when the membrane is removed.

Antibiotic or steroid-induced stomatitis

This is acute oral candidiasis occurring due to medication with corticosteroids or broad-spectrum antibiotics (e.g. tetracycline). There is generalized mucosal erythema and soreness, sometimes with areas of pseudomembranous candidiasis.

Chronic mucocutaneous candidiasis

Main article: Chronic mucocutaneous candidiasis

This is a group of rare syndromes characterized by chronic candidal lesions on the skin, in the mouth and on other mucous membranes. These include Localized chronic mucocutaneous candidiasis, diffuse mucocutaneous candidiasis (Candida granuloma), candidiasis–endocrinopathy syndrome and candidiasis thymoma syndrome.

Chronic multifocal oral candidiasis

This is an uncommon form of chronic (more than one month in duration) candidial infection involving multiple areas in the mouth. Unusually for candidal infections, there is an absence of predisposing factors such as immunosuppression.

Signs and symptoms

Signs and symptoms are dependent upon the type of oral candidiasis. Often, apart from the appearance of the lesions, there are no other signs or symptoms. Most types of oral candidiasis are painless.

Causes

Risk factors

These include:

• Newborn babies.
• Lupus
• Diabetics with poorly controlled diabetes.
• As a side effect of medication, most commonly antibiotics. Inhaled corticosteroids for treatment of lung conditions (e.g., asthma or COPD) may also result in oral candidiasis: the risk may be reduced by regularly rinsing the mouth with water after taking the medication.
• People with an immune deficiency (e.g. as a result of AIDS/HIV or chemotherapy treatment).
• Women undergoing hormonal changes, like pregnancy or those on birth control pills.
• Denture users.
• Tongue piercing.

It is frequently caused by Candida albicans, or less commonly by Candida glabrata or Candida tropicalis.

Etiopathogenesis

The causative organism is the yeast-like fungus Candida albicans. C. albicans shows dimorphism, namely a yeast form which is thought to be relatively harmless and a hyphal form which is associated with invasion of host tissues. About 50% of humans possess C. albicans as part of their oral microbiota. This candial carrier state is not considered to be a disease since there are no lesions or symptoms. When candida species cause lesions, this is termed candidiasis.

Prevention

Prophylactic use of antifungals is sometimes employed in persons with HIV disease, during radiotherapy, during immunosuppressive or prolonged antibiotic therapy as the development of candidal infection in these groups may be more serious.

Treatment

Oral candidiasis can be treated with topical anti-fungal drugs, such as nystatin, miconazole, Gentian violet or amphotericin B. Topical therapy is given as an oral suspension which is washed around the mouth and then swallowed by the patient.

Patients who are immunocompromised, either with HIV/AIDS or as a result of chemotherapy, may require systemic treatment with oral or intravenous administered anti-fungals.

Since smoking is associated with many of forms of oral candidiasis, cessation may be beneficial. If candidiasis is secondary to corticosteroid or antibiotic use, this may be stopped, although often this is not a feasible option depending on the initial reason the drug was prescribed. Sometimes median rhomboid glossitis is caused by use of a corticosteroid inhaler. In this case, a spacer device to stop the medication contacting the dorsal tongue may be useful. Underlying immunosuppression may be medically manageable once it is identified, and this will help to prevent recurrence of candidal infections.

Epidemiology

Oral candidiasis is by far the most common fungal infection of the mouth which can occur in humans. About 50% of persons in the general population carry C. albicans in their mouths without any candidiasis lesions or symptoms of infection. This candida carrier state is not considered to be candidiasis. As such, candida could be considered a normal variation of the oral microbiota, with lesions only occurring when the environment favors pathogenic behaviour.

Society and culture

Many pseudoscientific claims by proponents of alternative medicine surround the topic of candidiasis. Oral candidiasis is sometimes presented in this manner to be a symptom of a widely prevalent "systemic candidiasis", "candida hypersensitivity syndrome", "yeast allergy", or "gastrointestinal candida overgrowth", which are medically unrecognized conditions. (See: Candidiasis#Society and culture.)

External links

• "Oral Thrush: Symptoms". Mayo Foundation for Medical Education and Research. 20 August 2009. Retrieved 7 June 2011.