Clinical Appearance of Oral Candida Infection and Therapeutic Strategies

Abstract

Candida species present both as commensals and opportunistic pathogens of the oral cavity. For decades, it has enthralled the clinicians to investigate its pathogenicity and to improvise newer therapeutic regimens based on the updated molecular research. Candida is readily isolated from the oral cavity, but simple carriage does not predictably result in development of an infection. Whether it remains as a commensal, or transmutes into a pathogen, is usually determined by pre-existing or associated variations in the host immune system. The candida infections may range from non-life threatening superficial mucocutaneous disorders to invasive disseminated disease involving multiple organs. In fact, with the increase in number of AIDS cases, there is a resurgence of less common forms of oral candida infections. The treatment after confirmation of the diagnosis should include recognizing and eliminating the underlying causes such as ill-fitting oral appliances, history of medications (antibiotics, corticosteroids, etc.), immunological and endocrine disorders, nutritional deficiency states and prolonged hospitalization. Treatment with appropriate topical antifungal agents such as amphotericin, nystatin, or miconazole usually resolves the symptoms of superficial infection. Occasionally, administration of systemic antifungal agents may be necessary in immunocompromised patients, the selection of which should be based upon history of recent azole exposure, a history of intolerance to an antifungal agent, the dominant Candida species and current susceptibility data.

Keywords: Candida; NCAC species; antifungal therapy; opportunistic infections; oral candidosis.

FIGURE 1

Pseudomembranous candidiasis of the tongue. The copyright of the images is owned by Prof. Anil and a written consent was obtained for the Figures 1–6.

FIGURE 2

Erythematous candidiasis of the palate.

FIGURE 3

Hyperplastic candidiasis at the lateral border of the tongue.

FIGURE 4

Denture stomatitis of the palate.

FIGURE 5

Median Rhomboid glossitis-note the candidal overgrowth.

FIGURE 6

Linear Gingival erythema in an HIV infected patient.

FIGURE 7

Cellular targets of antifungal agents. (The antifungal agents target three cellular components of fungi. Azoles inhibit the synthesis of ergosterol in the endoplasmic reticulum of the fungal cell. Polyenes such as amphotericin B bind to ergosterol in the fungal membrane causing disruption of membrane structure and function. Flucytosine is converted within the fungal cell to 5-fluorouracil which inhibits DNA synthesis.)