Oral Candidiasis

Fadel Muhammad Garishah

Diponegoro Medical SchoolTo be a medical research institution

2012

World Health Organization HIV/AIDS Staging

Introduction

Primary HIV infection has been associated with severe aphthous stomatitis and with oropharyngeal and esophageal candidiasis.

Candida infections of the hard and soft palates, buccal mucosa, tongue, pharynx, and hypopharynx are observed frequently.

Thrush

hard and soft palates

tongue

pharynx, and hypopharynx

buccal mucosa

Microbial pathogen

Fungi kingdom; Opportunistic fungi Candida albicans is the species most

commonly identified, but Candida tropicalis, Candida glabrata, and Candida krusei infections also occur.

Immunological basis of disease Systemic Candida infections due to defects

in phagocyte function and number Mucosal Candida infections result from

impaired cellular immunity. Particularly as CD4+ lymphocyte counts

fall below 200 to 300/omm3. An opportunistic infection, it is

predictive of the disease progression and development of other AIDS-related infections.

Immunological mechanism

Candida albicans induces a T helper 1 (TH1) and TH17 cell-mediated immune response that is essential to clear the fungi.

Clinical manifestation

Generally cottage cheese plaques that can be removed with a tongue blade are seen on the soft palate, tonsils, and buccal mucosa

Atrophic candidiasis: erythematous plaques distrib-uted in the same way as the pseudomembranous form of the disease but without the characteristic white exudate.

Underdiagnosed by clinicians

Hypertrophic candidiasis

Candida can cause a nonscrapeable white plaque similar to that in hairy leukoplakia (hypertrophic candidiasis).

Leukoplakia: corrugated lesions and hairlike projections, candidal lesions are smooth.

Angular chelitis Candidiasis

Candida infection of the lateral lip (angular cheilitis) is another common complication.

Diagnostics

Physical examination, Potassium hydroxide (KOH)

preparation (scraped material from a plaque),

The response to antifungal therapy establish the diagnosis.

Pharmacology therapeutics Wide use of oral triazole antifungal agents -

emergence of disease caused by drug-resistant fungi

Patients treated with HAART, rates of flu- conazole resistance were relatively low, even though many had received several previous courses of fluconazole, suggesting that advanced immunosuppression is the most important risk factor for resistance

Some species, C. krusei and C. glabrata, are frequently less sensitive to fluconazole.