Oral Candidosis: Pathophysiology and Best Practice for Diagnosis, Classification, and Successful Management

Oral candidosis is the most common fungal infection that frequently occurs in patients debilitated by other diseases or conditions. No candidosis happens without a cause; hence oral candidosis has been branded as a disease of the diseased. Prior research has identified oral candidosis as a mark of systemic diseases, such as hematinic deficiency, diabetes mellitus, leukopenia, HIV/AIDS, malignancies, and carbohydrate-rich diet, drugs, or immunosuppressive conditions. An array of interaction between Candida and the host is dynamic and complex. Candida exhibits multifaceted strategies for growth, proliferation, evasion of host defenses, and survival within the host to induce fungal infection. Oral candidosis presents a variety of clinical forms, including pseudomembranous candidosis, erythematous candidosis, angular cheilitis, median rhomboid glossitis, cheilocandidosis, juxtavermillion candidosis, mucocutaneous candidosis, hyperplastic candidosis, oropharyngeal candidosis, and rare suppurative candidosis. The prognosis is usually favorable, but treatment failure or recurrence is common due to either incorrect diagnosis, missing other pathology, inability to address underlying risk factors, or inaccurate prescription of antifungal agents. In immunocompromised patients, oropharyngeal candidosis can spread to the bloodstream or upper gastrointestinal tract, leading to potentially lethal systemic candidosis. This review therefore describes oral candidosis with regard to its pathophysiology and best practice for diagnosis, practical classification, and successful management.

Clinical and microbiological signs of oral candidosis in patients with COVID-19 receiving different pathogenetic therapy and having different levels of oral hygiene

Relevance. A lot of researchers consider that COVID-19 patients may develop fungal infections at the middle or late stages of the disease, which may in turn deteriorate the course of the main disease. Our purpose was to analyze the signs of oral fungal infections in coronavirus patients with different levels of oral hygiene and receiving various treatment. Materials and methods. 90 new coronavirus patients (CT-1, CT-2) of mean age 53.98 ± 1.06 y.o. were examined during the study. The prevalence of Candida yeast-like fungi and contamination were analyzed in three patient groups according to the oral hygiene level and the main disease therapy. The oral hygiene level was assessed by O*Leary plaque score index; all teeth were dyed and the ratio of the stained surfaces to all surfaces was calculated. Results. The three group results showed that Candida fungi were significantly more often encountered in patients with O*Leary plaque index of more than 50% in comparison with patients with O*Leary plaque control index from 0 to 50%. Clinical signs of candidiasis, such as tongue coating, peeling of the lips, cracks at the lip corners, are more often diagnosed in patients with low oral hygiene level (more than 50% of the surfaces stained). Conclusion. If tests for opportunistic fungal infections are positive in COVID-19 patients, especially in case of concomitant neutropenia, indications for additional antifungal therapy should be considered. Clinical signs of oral candidiasis and high contamination of the oral cavity with Candida fungi, as well as the oral hygiene level, can be the early markers of co-infection in COVID-19 patients.

CONTRIBUTION OF THE MYCOLOGY LABORATORY IN THE MANAGEMENT OF ORAL CANDIDOSIS IN IMMUNODEPRESSED PATIENTS

The authors report a series of 49 cases of oral candidiasis including 20 symptomatic, listed on 100 immunocompromised patients collected at the Mohammed V Military Hospital in Rabat over a 12-month period. The objective of this work was to define the risk factors that lay the foundation for fungal proliferation in the mouth, through early detection in asymptomatic or non-asymptomatic patients. Mycological analysis in the laboratory was based on direct examination and culture on Sabouraud chloramphenicol medium with and without cycloheximide, then identification of the fungal species by API 20 C AUX galleries and the VITEK 2 compact® . The prevalence of oral candidiasis was 49%. The mean age of the patients was 54 years with a sex ratio M / F of 1.04. The contributing factors identified were hyposialia (p = 0.0337), corticosteroid therapy (p = 0.025 and dental removable prostheses (p = 0.000791). The fungal species identified were Candida albicans (79%), Candida dubliniensis (7%), Candida ciferrii (4%), Candida famata (4%), Candida glabrata (4%) and Candida lusitaniae (2%). Conclusion: The oral localization of candidiasis remains very frequent in immunocompromised subjects. Their treatment involves first of all the search for contributing factors and early detection in the presence of asymptomatic forms that only mycological analysis can identify the variety.

An Intriguing Case of Ectopic Benign Migratory Glossitis Resembling Secondary Syphilis: A Case Report

Oral mucosal lesions presenting as erythematous patches usually pose difficulties for a clinical diagnosis. They elicit an array of differential diagnosis that mainly includes oral candidosis, contact mucosal reaction, oral lichenoid lesion, oral psoriasiform, autoimmune disease, and, not to forget, secondary syphilis. In this present case, all those above-mentioned possibilities were ruled out, while secondary syphilis stood as the main diagnosis. As this was also later excluded by a negative serological treponemal test, the final diagnosis rested on an ectopic manifestation of benign migratory glossitis (BMG), whose diagnosis was based on the clinical aspects of the lesions, along with their spontaneous disappearance in a short period of time (a hallmark of this condition) and the presence of fissured tongue, a manifestation that occurs very often in concomitance with BMG.

Candida prevalence and oral hygiene due to orthodontic therapy with conventional brackets

Background Conventional brackets are often used during orthodontic therapy of patients with malocclusion. The complex construction of such brackets greatly inhibits oral hygiene, which predisposes to increased carriage of microbiota. Orthodontic brackets could act as reservoir of yeast and predispose to oral candidosis. The aim of this study was to assess Candida prevalence and the role of oral hygiene during fixed appliance therapy. A further aim was to characterize the isolated yeasts according to their ability to form biofilms. Methods Seventeen participants (average age 17 ± 7 years) were monitored by taking oral rinses and elastomeric ligature samples, and by evaluating the approximal plaque index (API) and gingival bleeding index (GBI) before and after placement of the orthodontic conventional brackets for 12 weeks. Isolated yeasts were counted and biofilm formation was evaluated. Results One hundred and sixteen samples (67 oral rinses and 49 orthodontic elastomers) were collected. Ten patients (58.8% subjects) were Candida-carriers (two were colonized after bracket placement) and C. albicans was the most common species. The average number of yeasts in the oral cavity showed some fluctuation during the study, but in general had an upward trend (adj. R2 = 0.7967, p = 0.07025). A correlation was found between median number of yeasts and the periodontal indices (API, GBI). The average API values decreased in the Candida-carriers (adj. R2 = 0.95; p = 0.01709), while average GBI values increased in the noncarriers (adj. R2 = 0.92; p = 0.0256). Conclusions Treatment with orthodontic appliances promotes Candida yeast colonization, which is variable over time in terms of strain and species, with dominance of C. albicans, and without increased biofilm-forming activity. The API value decreases over time in carriers, and the GBI value increases in uncolonized patients, which may have predictive significance for the development of oral candidiasis during orthodontic treatment.

Candida prevalence and oral hygiene due to orthodontic therapy with conventional brackets

Background: Conventional brackets are often used during orthodontic therapy of patients with malocclusion. The complex construction of such brackets greatly inhibits oral hygiene, which predisposes to increased carriage of microbiota. Orthodontic brackets could act as reservoir of yeast and predispose to oral candidosis. The aim of this study was to assess Candida prevalence and the role of oral hygiene during fixed appliance therapy. A further aim was to characterize the isolated yeasts according to their ability to form biofilms. Methods: Seventeen participants (average age 17 ± 7 years) were monitored by taking oral rinses and elastomeric ligature samples, and by evaluating the approximal plaque index (API) and gingival bleeding index (GBI) before and after placement of the orthodontic conventional brackets for twelve weeks. Isolated yeasts were counted and biofilm formation was evaluated. Results: One hundred and sixteen samples (67 oral rinses and 49 orthodontic elastomers) were collected. Ten patients (58.8% subjects) were Candida-carriers (two were colonized after bracket placement) and C. albicans was the most common species. The average number of yeasts in the oral cavity showed some fluctuation during the study, but in general had an upward trend (adj. R2 = 0.7967, p = 0.07025). A correlation was found between median number of yeasts and the periodontal indices (API, GBI). The average API values decreased in the Candida-carriers (adj. R2 = 0.95; p = 0.01709), while average GBI values increased in the noncarriers (adj. R2 = 0.92; p = 0.0256). Conclusions: Treatment with orthodontic appliances promotes Candida yeast colonization, which is variable over time in terms of strain and species, with dominance of C. albicans, and without increased biofilm-forming activity. The API value decreases over time in carriers, and the GBI value increases in uncolonized patients, which may have predictive significance for the development of oral candidiasis during orthodontic treatment.

Candida prevalence and oral hygiene due to orthodontic therapy with conventional brackets

Background Conventional brackets are often used during orthodontic therapy patients with malocclusion. Nevertheless, their complicated construction greatly inhibits oral hygiene, which predisposes to the increased carriage of the microbiota. It seems that orthodontic brackets could be a reservoir of yeast and predisposing to develop oral candidosis. Objectives The aim of this study was to assess changes in Candida species prevalence and periodontal parameters after orthodontic brackets placement in patients who received oral hygiene instruction; to determine role of elastic ligatures in those changes; to characterize isolated yeasts according to their ability to biofilm formation. Patients/Methods 17 participants (average age 17±7 years) have been monitored by taking oral rinses, elastomeric ligatures samples and evaluation of API and GBI Indexes before and after placement of orthodontic conventional brackets for 12 weeks. Isolated yeasts was counted and used to the biofilm formation assay. Results 116 samples (67 oral rinses and 49 orthodontic elastomers) were collected. 51% of patients were carriers of Candida in which C. albicans was the most common species. The average number of colonies (CFU/ml) obtained from oral rinses showed an upward trend depending on duration of the study and some correlation with periodontal indexes (API, GBI) was found. One third of the analysed strains have shown ability to form greater biofilm than control strain. Conclusions Orthodontic ligatures surface permit biofilms creation and orthodontic brackets change dynamic oral microbiota. Maintaining proper oral hygiene is crucial for every orthodontic patient.

Contrast Enhanced Ultrasound of Splenic Lymphoma Involvement Case presentation

The study present a case of splenic lymphoma in a middle-aged male, showing up with abdominal pain, weight loss and recurrent oral candidosis. Blood test revealed remarkable leukocytosis, anemia and thrombocytopenia. Abdominal ultrasound showed marked splenomegaly with multiple hyperechogenic lesions. Contrast enhanced ultrasound (CEUS), performed on the lower pole of the spleen, showed a lesion lightly hypoenhanced in the arterial time, with progressive washout and marked hypoenhancement in the late phase, raising the suspicion of a malignant pathology. MRI results were consistent with a high suspicion of splenic malignancy, a possible lymphoid infiltration. The peripheral blood smear revealed lymphocytosis with villous lymphocytes, a variant form of hairy cell leukaemia. Iliac crest bone marrow biopsy confirmed the diagnosis. Our aim behind highlighting the topic is to underline the role of CEUS in identifying a malignant lesion, promptly leading us to further hematological investigation.

Ocena oddziaływania na grzyby drożdżopodobne olejku szałwiowego (Oleum Salviae)

Introduction. The essential oils were known and used in ancient Times. The oil and extracts of sage are utilized in folk medicine and for food condiment, in cosmetics and perfumes. Sage (Salvia officinalis) belonging to the Labiatae family. Plant grow all over the world. Sage has a number of properties in it antiflogistic and antimicrobial. The oil is used for the treatment of different kind of diseases, including bronchitis, cough, arthritis, rheumatism, ulcers, inflammation of skin, alimentary tract and in Alzheimer’s disease. Etheric oil contain following compounds: α- and β-thujone, 1,8-cineole, camphor, borneol, α-pinene, β-pinene, β-caryophyllene, β-sabinene, limonene, α-humulene, myrcene, α-terpineol, viridiflorol and camphene. The chemical compounds of the oil have antioxidant and antimicrobial properties. Aim. The aim of the dates was to evaluate the susceptibility of yeastlike fungi to sage. Material and methods. A total 30 strains of yeastlike fungi isolated from patients with oral candidosis was tested. The strains were identified with system API 20 C AUX (BioMèrieux), production chlamydospore and pseudohyphe. The susceptibility (MIC) yeastlike fungi to sage oil was determined by means plate dilution technique in Sabouraud’s agar. The suspension contained 105 CFU per spot were spread Steers replicator over the surface of agar containing oil or without sage agar plates (strains growth control). Inoculated agar plates were incubated in aerobic conditions at 37°C for 24-48 hrs. The MIC was defined as a lowest concentration of the oil inhibited growth of fungal strains. Results. The results indicated that the sage oil was active against yeastlike fungi in concentrations 0.5-≥ 2.0 mg/ml. The MIC for 66% strains from genus Candida albicans ≥ 2.0 mg/ml. Similarly C. krusei strains were susceptible in range 0.5-≥ 2.0 mg/ml. The oil was less active towards C. glabrata and C. tropicalis strains (MIC 1.0-≥ 2.0 mg/ml). The most susceptible were the strains from genus of C. parapsilosis. The growth was inhibited within the range from 0.5 to 1.0 mg/ml. The strain from genus of Rhodotorula rubra was susceptible on 0.12-0.5 mg/ml and Saccharomyces cerevisiae on 0.25 mg/ml. Conclusions. Sage oil showed antifungal activity. The more susceptible to oil were the strains of Candida parapsilosis, Rhodotorula rubra and Saccharomyces cerevisiae. Oil was less active toward strains Candida glabrata, Candida tropicalis and Geotrichum candidum.

Candida and Oral Candidosis—A Review

Oral candidiasis (also called candidosis) is an opportunistic infection affecting the oral mucosa. These lesions are very common and caused by yeast Candida albicans. C. albicans are normal component of oral microflora and around 30 to 50% carry these organisms. The rate of carriage increases with advancing age of the patient. C. albicans are recovered from patient’s mouth over the age of 60 years. Other species such as C. glabrata, C. tropicalis, C. guilliermondii, and C. krusei are infrequently but consistently isolated. Oral candidosis can be classified into primary and secondary candidiasis. The factors involved in the pathogenicity of C. albicans have been reviewed. The pathogenesis of different biotypes and strains of C. albicans varies. A relationship has been suggested between the adherence of C. albicans to surfaces and its ability to colonize and cause disease. An important aspect of the pathogenicity of C. albicans may be its nonspecific affinity and binding to acrylic resin and other plastics. The factors affecting adhesion of yeasts, related to yeast cells, related to host cells and environmental factors, and the main factors which increase the susceptibility of oral candidiasis have been reviewed. The different types of oral lesions, their identification by different methods, management, and treatment of oral candidiasis also have been highlighted.Oral candidosis as a common opportunistic infection has gained importance after the discovery of human immunodeficiency virus infection. Candidiasis was always an endogenous infection. There are few cases of exogenous infection in intravenous drug abusers and contact lens users. Esophageal candidiasis is the earliest and most cases of lesions seen in acquired immunodeficiency syndrome patient. The diagnosis and reporting of oral candidiasis should be done with utmost care. The finding of yeast cells in large numbers and presence of pseudohyphae indicate invasion and causative agent of infection. The diagnosis of Candida infection can be confirmed by various techniques and recently discovered advanced methods.The confirmation of Candida infection depends on clinical diagnosis, proper collection of specimen, and careful evaluation in methodology and reporting.