Wednesday, 7 September 2011

Candidiasis

Oral candidiasis is most commonly associated with Candida albicans , although other species such as C.glabrata & C. tropicalis are frequently part of the normal flora.Anumber of factors predispose patients to develop candidiasis: infacy, old age, antibiotic therapy, storoid & other immunosuppresive drugs, xerostromia, anemia, endocrine disorders & primary & acquired immunodeficiency.Candiddiasis is a common finding in people with HIV infection. Reports describe oral candidiasis during the acute stage of HIV infection, but it occurs most commonly with falling CD4+T cell count in middle & latter stages of HIV disease.Several reports indicate that most persons with HIV infection carry a single strain of Candida during clinically apparent candidiasis & when Candidiasis is quiescent.
Clinical Features

  • Site- patient with HIV usually has lesion of hard palate & soft palate
  • Appearance-the clinical appearances of oral candidiasis vary. The most common presentations include pseudomembranous & erythematous candidiasis, which are equally predictive of the development of AIDS & angular cheilitis.
  • Symptoms-these lesions may be associated with a variety of symptoms, including a burning mouth, problems in eating spicy food & changes in taste.
All three of these common forms may appear in one individual.
  • Pseudomembranous candidiasis (Thrush)-Characteristic creamy white, removable plaques on the oral mucosa are caused by overgrowth of fungal hyphae mixed with desquamated epithelium & inflammatory cells. the mucosa may appear red when the plaque is removed. this type of candidiasis may involve any part of the mouth or pharynx.
  • Erythematous candidiasis- It appears cas flat, red patches of varying size. It is commonly occurs on the palate & the dorsal surface of the tongue. It is frequently subtle in appearance & clinicians may easily overlook lesions, which may persist for several weeks if untreated.
  • Angular cheilitis-It appears clinically as redness, ulceration, & fissuring, either unilaterally or bilaterally at the corners of the mouth.It can appear alone or in conjunction with another form of candidiasis
Diagnosis
Candida is a commensal organism in the oral cavity.
acndidiasis is diagnosed by its clinical appearance & by detection of organisms on smears. smears taken from clinical lesions are examined, using potassium hydroxide(KOH), PAS, or gram's stain
Management
Oral candidiasis may be treated either topically or systematically.Treatment should me maintained for 7 days. response to treatment if often good.

  • Topical treatment- it is preferred because they limit systemic absorption, but the effectiveness depends entirely on patients compliance.some of the agents rae. Clotrimazole, 1% gentian violet, Nystatin 
  • Systemic-Nystatin 250mg TDS for 2 weeks, Ketokonazole, Fluconazole, Itraconazole

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