Antimicrobials as a contributory factor in oral candidosis--a brief overview.

The advent of the human immunodeficiency virus infection and the increasing prevalence of compromised individuals in the community due to modern therapeutic advances have resulted in a resurgence of opportunistic infections, including oral candidosis, which is by far the most common oral fungal infection in man. Broad-spectrum antibiotics used in the treatment of a wide range of disease conditions have also been attributed as a predisposing factor of oral candidosis. In this mini review we discuss the research findings on the relationship between antibiotics and oral candidosis and possible mechanisms of pathogenicity following such therapy.     

Oral candidosis in non-Hodgkin's lymphoma: a case report

Though oral candidosis is an opportunistic fungal infection that commonly affects immunocompromised patients, little is known of its occurrence as a complication of Non-Hodgkin's lymphoma. This paper reports a case of oral candidosis in a 20-year-old Indonesian woman with this lymphoproliferative disease. She presented with acute pseudomembranous candidosis on the dorsum and lateral borders of the tongue, bilateral angular cheilitis and cheilocandidosis. The latter is a rare clinical variant of oral candidosis, and the lesions affecting the vermilion borders presented as an admixture of superficial erosions, ulcers and white plaques. Clinical findings were confirmed with oral smears and swabs that demonstrated the presence of hyphae, pseudohyphae and blastospores, and colonies identified as Candida albicans. A culture from a saline rinse was also positive for multiple candidal colonies. Lip and oral lesions were managed with Nystatin. The lesions regressed with subsequent crusting on the lips, and overall reduction in oral thrush. As Non-Hodgkin's lymphoma is a neoplastic disease that produces a chronic immunosuppressive state, management of its oral complications, including those due to oral candidosis, is considered a long-term indication.     

Diagnosis and treatment of oral candidosis.

Oral candidosis is a common opportunistic infection that manifests in a variety of forms. It is also recognized as one of the earliest manifestations of human immunodeficiency virus (HIV) infection. Although a number of antifungal agents are available for the treatment of this condition, a newly introduced triazole group of drugs appears to be highly effective in treating oral candidosis. This article reviews the clinical presentation and management of oral candidosis, particularly with reference to the latter group of drugs and HIV-induced disease.     

The impact of cigarette/tobacco smoking on oral candidosis: an overview

Smoking is associated with a variety of changes in the oral cavity. Cigarette smoke has effects on saliva, oral commensal bacteria and fungi, mainly Candida, which causes oral candidosis, the most common opportunistic fungal infection in man. How cigarette smoke affects oral Candida is still controversial. This brief overview is an attempt to address the clinical findings on the relationship between smoking and oral candidosis and possible mechanisms of pathogenicity.     

Experimental oral infection of mice with a pathogenic and a non-pathogenic strain of the yeast Candida albicans

Oral infection by Candida albicans is thought to be related more to host susceptibility than to virulence of the organism. Using a mouse model of oral candidosis, differences in colonization and infection between two strains of C. albicans were demonstrated.     

Epithelioid angiomatosis affecting the oral cavity as a first sign of HIV infection.

Oral lesions are frequently the first manifestation of HIV infection and accurate diagnosis may be important in determining the management of individual patients. Lesions may be relatively common but non-specific, such as candidosis, or may be indicative of AIDS, such as Kaposi's sarcoma. Epithelioid angiomatosis is a recently described vascular lesion which may be clinically and histologically similar to Kaposi's sarcoma, but which is infective in origin. Usually it is a manifestation of AIDS and presents as multiple cutaneous lesions but has rarely been reported in the mouth. In this report a patient presented with lesions of epithelioid angiomatosis which were confined to the oral mucosa and which were associated with HIV infection, but not with AIDS. Differentiation from Kaposi's sarcoma is important, since epithelioid angiomatosis may be treated with antibiotics and a mistaken diagnosis of Kaposi's sarcoma may wrongly categorise an individual as having AIDS.     

Oral candidosis in the elderly in long term hospital care

A total of 137 patients in long term hospital care were interviewed and examined to determine the prevalence, nature and most important causes of oral candidosis in the hospitalized elderly. Oral candidal infection as determined by the imprint culture technique was present in 47% of patients with a further 31% being carriers of Candida. The prevalence of chronic atrophic candidosis in denture wearers was 38%, while 26% of all patients had angular cheilitis, 67% of which had an infective etiology. Microbiologic examination strongly indicated the upper denture as the major source of infection in those with dentures despite the existence of a ward policy which should have encouraged good oral and denture hygiene.     

Superficial oral fungal infections.

Fungal infections in humans are provoked and exacerbated by defects in the cellular immune system. Hence, the emergence of novel clinical variants of oral candidoses and rare mycoses with the pandemic spread of human immunodeficiency virus infection is not surprising. The new clinical entities of oral candidoses that have been described in the past few years have had a significant impact on the classification of these diseases. Classification of oral candidoses is an issue addressed in some detail here. Angular cheilitis is a disease commonly associated with Candida infection. In the West, it is frequently seen in the elderly, but a report from Asia indicates that the disease may be prevalent in the young age groups due to factors such as anemia, despite the similarity of the infective agents. A novel cofactor implicated in infectious states has been the host blood group secretor status, and data from three studies suggest that the latter may play an intriguing role in the pathogenesis of oral candidosis. Finally, a new mouse model has been described as a substitute for the rat model in investigating the host-parasite interactions in oral candidosis, and its pros and cons are reviewed.     

Miconazole chewing gum for treatment of chronic oral candidosis

A chewing gum containing the antifungal drug miconazole may be convenient for topical treatment of oral candidosis. Therefore a trial was performed to examine the effect and tolerance of miconazole chewing gum in comparison with miconazole gel in the treatment of oral candidosis. The study group consisted of 32 patients with oral candidosis harboring yeasts, predominantly Candida spp. Half of the patients chewed one piece of chewing gum (dose: 3.6 mg of miconazole) four times daily; the other half dispersed a 2% gel (dose: 50 mg of miconazole) in the oral cavity four times daily. After 6 wk of treatment, there was no clinical evidence of yeast infection in either of the two groups. No significant differences between the two groups were found in clinical, mycologic, and cytologic investigations conducted after 3 and 6 wk of treatment or at the follow-up examination 4 wk after termination of the treatment. The results indicate that miconazole released from chewing gum is as effective as miconazole gel. The chewing gum reduced the dosage of miconazole for treatment of oral candidosis, and the patients approved the chewing gum as a pleasant medicament.     

口腔念珠菌混合带菌及感染的研究

目的 调查不同人群口腔念珠菌混合带菌及感染状况；研究不同菌株对氟康唑的敏感性。方法 收集222例正常人及84例口腔念珠菌病患者的混合唾液，用Sabouraud和CHROMagar两种培养基进行念珠菌培养，根据菌落形态和生化反应鉴定菌株，并对部分菌株进行体外药敏试验。结果 正常个体中带念珠菌者71例(32％)，其中混合带菌8例(11．3％)；口腔念珠菌感染者中混合念殊菌感染20例(23．8％)。从其中8例混合感染患者中分离出16株念珠菌，1／16(6．3％)菌株对氟康唑耐药。结论 本研究表明正常人群和感染患者口腔均有不同程度的念珠菌混合带菌或感染；感染患者中有耐药菌株出现，提示必要时需要对部分菌株进行药敏实验。     

Classification and clinical manifestations of oral yeast infections

By tradition oral candidosis has been classified into acute pseudomembranous (thrush), acute atrophic, chronic atrophic, and chronic hyperplastic types. However, pseudomembranous candidosis is not always acute but may last for many months. Furthermore, the value of using the term atrophic to describe an erythematous area is limited. Moreover, some of the various types have been associated with other clinical entities, which appear to have a combined bacterial/mycologic etiology. A revision of the classification should be based on the use of clinical terms, and in a previous study of multifocal oral candidosis, erythematous, plaque-like, and nodular forms were identified. A revised classification of oral candidosis which considers these aspects could be as follows: acute types: pseudomembranous and erythematous; chronic types: pseudomembranous, erythematous, plaque-like, and nodular; and Candida-associated lesions: denture stomatitis, angular cheilitis, and median rhomboid glossitis.     

Australian Dental Research Fund Trebitsch Scholarship* Efficacy of antifungal prophylaxis in bone marrow transplantation

Oral candidal infection is a common problem in bone marrow transplantation. This prospective study compared the effectiveness of antifungal prophylaxis with topical antifungals (nystatin and amphotericin B suspensions) versus oral fluconazole in 196 patients undergoing bone marrow transplantation. Oral candidosis occurred frequently in the group receiving topical antifungals (61/113, 54%), but was rare in the group receiving fluconazole (6/83, 7%). The difference in efficacy between the two groups was highly significant (p<0.00001). There was no difference in the incidence of suspected systemic fungal infection between the two groups. While nausea was a problem with antifungal suspensions, no significant adverse reactions to fluconazole occurred. Because of greater efficacy in preventing oral candidosis and better patient tolerance, oral fluconazole is preferred to antifungal suspensions for prophylactic use in patients undergoing bone marrow transplantation.     

Oral candidosis.

Oral candidosis is the most common opportunistic fungal infection encountered in dentistry. Normally a benign inhabitant of mucous membranes, the fungal organism, Candida albicans, may present serious, even life-threatening infection in specific patient populations. As an opportunistic organism, Candida albicans is extremely responsive to any process resulting in immunosuppression. The clinical manifestations of oral candidosis are variable, occasionally complicating the clinical diagnosis and management. Treatment is often initially rendered based on a provisional clinical diagnosis and supplemented with adjunctive laboratory tests. Specific therapeutic intervention should be tailored to the individual patient, based on the current health status of the patient and the clinical presentation and severity of the infection.     

Oral colonization by Candida species in AIDS pediatric patients

The aim of this study was to assess the prevalence of factors associated with oral colonization by Candida spp. in pediatric patients with AIDS. The sample comprised of 117 children. Clinical status, medicines in use, and laboratory findings were obtained from hospital records; sociodemographic data were given by relatives. A dental examination assessed the prevalence of dental caries. The prevalence of oral colonization by Candida was 62%. Only seven children presented clinical manifestation of oral candidosis despite their high viral load index and low-for-age CD4 count. Candida colonization was directly associated with frequent use of antibiotics (prevalence ratio [PR] = 1.44), sulfa drugs (PR = 1.23), alteration in the oral mucosa (PR = 1.55), and untreated dental caries (PR = 1.93). It was inversely associated with the use of antiretroviral therapies (PR = 0.65). Candida albicans was the most frequently detected species (80%); phenotypic tests did not detect C. dubliniensis strains. This study observed a low prevalence of Candida-related oral lesions in these patients, which is compatible with the hypothesis that antiretroviral medicines may have contributed to reducing oral manifestations from Candida infection. The high prevalence of Candida colonization in HIV+/AIDS children with untreated dental caries reinforces the importance of oral health care in interdisciplinary health units that assist these patients.     

Etiology, pathogenesis, therapy, and prophylaxis of oral yeast infections

Etiologic factors in oral candidosis are immature antimicrobial host defenses, acquired suppression of immune defense mechanisms (AIDS, immunosuppressive or radiation therapy), or changes of the environmental conditions of the oral cavity (antibiotics, dentures, epithelial changes). After colonization and adhesion of Candida to the epithelial surface the subsequent mucosal lesion is due to tissue destruction by potent proteolytic enzymes or toxins and an inflammatory response to Candida antigens. Topical antimycotic treatment with nystatin, amphotericin B, or miconazole is important especially to prevent spread of the infection. Chronic Candida infections require long-term antifungal therapy, and patient compliance may be difficult to obtain. In denture stomatitis colonization of the fitting denture surface by Candida should be controlled by, for example, using a chlorhexidine solution as a denture disinfectant. However, recurrences are frequent if the local or the systemic predisposing conditions are not corrected. Fluconazole, a new bis-triazole, may be important for long-term treatment of immunocompromised patients.     

Experimental oral candidosis in the mouse: microbiologic and histologic aspects

A model of oral candidosis was developed in order to investigate histologic and microbiologic aspects of this host-parasite interaction under controlled experimental conditions. Normal adult CD-1 mice were inoculated by the topical application of 10(8) Candida albicans blastospores, and oral colonization was monitored by the quantitative culturing of saliva samples and of digested oral mucosa. Tissue sections of the mucosa were examined in a kinetic study ranging from 2 h to 13 days postinoculation. We report here that oral colonization by C. albicans can be induced in normal adult mice without the use of any compromising agent and that the animals recover from this mucosal infection following a reproducible pattern. Temporal analysis of the oral histopathology showed that distinct patterns of inflammation are associated with particular stages in the development of the infectious foci. This experimental model offers a means of further investigating the host-parasite interactions involved in the onset and development of oral candidosis.     

Inhalational and topical steroids, and oral candidosis: a mini review

Candidosis is by far the commonest oral fungal infection in man and could manifest as an adverse effect of drug therapy such as inhaled or topically applied corticosteroids. Due to the anti-inflammatory and immunosuppressive effect steroids are used in the management of bronchial asthma and oral mucosal diseases. In this mini review we discuss the clinical and laboratory findings on the relationship between steroid inhalers, other topical steroids and oral candidosis, possible mechanisms of pathogenicity following such therapy as well as the precautions that could be taken to minimize this adverse side effect.     

Factors predisposing to oral yeast infections

The discussion of factors predisposing to oral yeast infections is very important, and we can ask: what is primary and what is secondary? Without predisposing factors it is difficult to have oral yeast infection, and a yeast infection may also be the first sign of a developing basic illness. As long as the predisposing factors cannot be eliminated, recurrences of oral yeast infections are to be expected. We can say that local and systemic factors permit this micro-organism to cause disease and that it is extremely rare to find a case of oral candidosis in which one or more of these factors cannot be identified. There are many kinds of lists in the textbooks and some review articles in the literature, but more research is needed for better understanding of factors predisposing to oral yeast infections.