Oral candidiasis pathophysiology
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Candida is a normal commensal of the skin and mucous membranes. The balance between the virulence of the fungus and the host immune defense is responsible avoiding opportunistic infection of candida. Deficiency of cell-mediated immunity or poor general status are the main risk factors for having opportunistic candidiasis. Candidiasis is usually localized to skin and mucous membranes. In rare cases, candidiasis can spread causing candidemia and distant infection. These cases are usually associated with deficient immunity . C. albicans is the main species causing infection in humans more than any other candida species.
Candida Virulence factors
- Secreting molecules that mediate adherence into host cells
- Production of hydrolases which has a lytic effect on tissues and facilitate the invasion by the fungus.
- Polymorphism: Candida has the ability to grow either as pseudohyphae (elongated ellipsoid form) or in a yeast form (rounded to oval budding form. While the role of polymorphism is not clearly understood in the virulence of Candida, it’s noted that the species that are capable of producing the most severe form of the disease has this ability.
- Biofilm production: which means the ability to form a thick layer of the organism on the mucosal surfaces or even on catheters and dentures.
Any condition that compromises cell-mediated immunity, worsens the general status of the patient or provide a favorable medium for Candida to form biofilms put the patient at increased risk for having candidiasis.
Chronic hyperplastic candidiasis (Candidal leukoplakia):
Persistent tough, adherent, white lesions that are indistinguishable from other leukoplakia except through biopsy. Seen more in smokers, patients with iron deficiency anemia or deficient cell-mediated immunity.
Chronic mucocutaneous candidiasis (CMCC):
- CMCC is a syndrome characterized by chronic or recurrent superficial candida infection in the skin and mucous membranes in association with endocrinal and autoimmune diseases.
- Characterized by the inability of T cells to react to candidal antigens.
- Presents with recurrent or chronic candidal infections. Infection is usually superficial though invasive candidiasis is encountered especially in immunocompromised patients.
- Endocrinopathies as hypoparathyroidism and adrenal insufficiency may accompany chronic candidiasis.
Oral manifestations of HIV infection and AIDS. Chronic oral candidiasis in patient with AIDS. Image courtesy of Professor Peter Anderson DVM PhD and published with permission. © PEIR, University of Alabama at Birmingham, Department of Pathology
Soft palate showing extensive oral candidiasis in patient with AIDS. Image courtesy of Professor Peter Anderson DVM PhD and published with permission. © PEIR, University of Alabama at Birmingham, Department of Pathology
- Microscopic examination of the wet mount with 10% KOH or saline demonstrates hyphae, pseudohyphae, and blastospores.
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- "Public Health Image Library (PHIL)".