Candidiasis, Oral

Description

• Candida is a fungus
• Candidiasis is an opportunistic infection
• Infection of oral mucosa with any species of Candida
• Up to 80% of isolates are Candida albicans (most common), Candida glabrata, and Candida tropicalis
• Candida normally present as oral flora in 30–50% of the healthy population
• Rates of carriage increase with age
• Variations include:
  • Pseudomembranous (thrush)
  • Chronic and acute atrophic candidiasis
  • Angular cheilitis
  • Hyperplastic candidiasis
• More common in neonates, elderly, and immunosuppressed individuals
• Usually benign course in healthy patients
• More likely to be recurrent and a non-albicans species in immunocompromised patients
• May represent an early manifestation of AIDS in HIV-infected patients
• Typically localized
• Risk factors for systemic infection:
  • HIV—most common oral manifestation
  • Diabetes
  • Hospitalization
  • Immunosuppressive therapy
  • Malignancy
  • Neutropenia
  • Organ transplantation
  • Prematurity

Etiology

• Usually overgrowth of C. albicans from alterations in intraoral environment
• May be medication induced—commonly antimicrobials, inhaled or systemic steroids, chemotherapy, immunosuppressive agents
• Alterations or impairment of salivary flow:
  • Anticholinergic or psychotropic medications
  • Sjögren disease
  • Head or neck radiation
• Presence of dentures or other orthodontics:
  • Occurs in up to 50–65% of denture wearers
  • Common etiology for chronic atrophic candidiasis
• Interruption of epithelial barrier (cheek biting)
• Endocrinopathies (diabetes, hypothyroidism)

• Acute pseudomembranous candidiasis (thrush) is common in infancy likely because of immune system immaturity and lack of mature oral flora
• Initial presentation may be feeding difficulty secondary to dysphagia
• May have concurrent Candida diaper rash
• Consider maternal treatment if breastfeeding:
  • Maternal breast colonization may be cause for persistent thrush
  • Query maternal nipple pain, burning, itching, or cracked skin

• Candida organisms are normally present as oral flora from 65–88% of elderly or those in long-term care facilities
• Dentures can lead to Candida overgrowth
• Angular cheilitis more common in the elderly secondary to facial wrinkling