Oral candidiasis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]
Overview
Oral candidiasis of the mouth and throat is a fungal infection that occurs when there is an overgrowth of candida. Candida yeasts normally live on the skin or mucous membranes in small amounts. However, if the environment inside the mouth or throat becomes imbalanced, the yeasts can multiply and cause symptoms. Candida overgrowth can also develop in the esophagus, and cause esophageal candidiasis.
Historical prespective
In 1839, B. Lagenbeck from Germany described a yeast-like fungus for the first time in the human oral infection thrush and its ability to cause it.
Pathophysiology
Candida species are normal inhabitants of the mouth, throat, and the rest of the gastrointestinal tract. Usually, candida yeasts live in and on the body in small amounts and do not cause any harm. However, the use of certain medications or immunosuppression can cause Candida to multiply, which may cause symptoms of infection.
Causes
Oral candidiasis is an infection of yeast fungus, Candida albicans, (or, less commonly, Candida glabrata or Candida tropicalis or C. parapsilosis or C. krusei or other candida species) in the mucous membranes of the mouth.
Differentiating oral candidiasis from other diseases
Oropharyngeal candidiasis must be differentiated from its different kinds and from various other diseases that can cause stomatitis or glossitisز
Epidemiology and Demographics
Oral candidiasis is not common among the general population but is frequently diagnosed in the immunocompromised patients.
Risk Factors
People who have diabetes and had high blood sugar levels are more likely to get thrush in the mouth (oral thrush) because the extra sugar in saliva acts as a substrate for Candida. High doses of antibiotics or extended use of antibiotics also increases the risk of oral thrush. Antibiotics kill some of the healthy bacteria that help keep Candida from growing too much. People with poorly fitting dentures are also more likely to get thrush.
Natural History, Complications and Prognosis
There are no sequelae with appropriate antifungal therapy. In contrast, among immunocompromised patients with disseminated infections, the mortality rate is almost 50%. Thrush in infants may be painful but is rarely serious. Because of discomfort, it can interfere with eating. If it does not resolve on its own within 2 weeks, a pediatrician should be notified. In adults, thrush that occurs in the mouth can be cured. However, the long-term outlook is dependent on immune status and the cause of the immune deficit.
In patients with a weakened immune system (for example, HIV-positive or receiving chemotherapy), Candida can spread throughout body, causing infection in esophagus (esophagitis), brain (meningitis), heart (endocarditis), joints (arthritis), or eyes (endophthalmitis).
Diagnosis
History and Symptoms
Adults may experience discomfort or burning in the mouth. Symptoms of candidiasis in the esophagus may include pain and dysphagia (difficult swallowing). Candida infections of the mouth and throat can manifest in a variety of ways. The most common symptom of oral thrush is white patches or plaques on the tongue and other oral mucous membranes.
Physical Examination
Oral infections of candida usually appear as thick white or cream color deposits. Underlying the deposits the mucosa of the mouth may appear inflamed (red and possibly slightly raised). Oral lesions are painless, white patches in the mouth.
Laboratory Findings
A healthcare provider diagnoses the infection based on symptoms, and by taking a scraping of affected areas to examine under a microscope. A culture may also be performed; however, because Candida organisms are normal inhabitants of the human mouth, a positive culture by itself does not make the diagnosis.
Treatment
Medical Therapy
Oral candidiasis can be treated with topical anti-fungal drugs, such as nystatin (Mycostatin), miconazole or amphotericin B. Patients who are immunocompromised, either with HIV/AIDS or as a result of chemotherapy, may require systemic treatment with oral or intravenous administered antifungals.
Primary Prevention
Good oral hygiene practices may help to prevent oral thrush in people with weakened immune systems. Some studies have shown that chlorhexidine (CHX) mouthwash can help to prevent oral candidiasis in people undergoing cancer treatment. People who use inhaled corticosteroids may be able to reduce the risk of developing thrush by washing out the mouth with water or mouthwash after using an inhaler.
Secondary prevention
Candida is usually a self-limiting disease unless concurrent immunosuppression is present.