this ppt is about different types of candidiasis. it describes about predisposing factors, classification and types of candidiasis. clinical & histological features of all types of candidiasis with pictures is discussed along with differential diagnosis, investigations and treatment.
2. Known as Candidosis, Moniliasis, Thrush
‘Candida’ white robes worn by the candidates for the Roman
Senate,
‘albicans’ (Latin word) to whiten.
Thus ‘candida albicans’ literally translated can be defined as whitening white.
• Candidiasis refers to multiplicity of disease caused by yeast like fungus.
• Candida is the most common oral fungal infections in humans.
Introduction
3. Candida albicans is most common organism inhabiting
the mouth
Other spcies are :
C. tropicalis
C. parapsilosis
C. stellatoidea
C. Krusei
C. guilliermondii
C. dubliniensis
C. glabrata
4. CANDIDA:
-Normal flora
Exist in Mouth, Gastrointestinal tract
Vagina, skin in 20 % of normal Individuals
-Colonization increases with age, in pregnancy
-Important etiological agent presenting as opportunistic infection in
Diabetus and HIV patients
6. FACTORS PRE-DISPOSING TO ORAL
CANDIDIASIS :-
Systemic factors :-
Physiologic:
Old age, Infancy, Pregnancy .
Endocrine:
Diabetes mellitus, hypothyroidism .
Nutritional Deficiencies :
Iron , Folate or vitamin B12 deficiency.
Malignancies :
Acute leukemia , agranulocytosis.
Immune defects , Immunosuppression , AIDS , Thymic
Aplasia , Corticosteroids
7. Local Factors:
• Xerostomia
-Sjogrens Syndrome, irradiation, drug therapy.
• Broad spectrum Antibiotics.
• Corticosteroids
• High carbohydrate diet
• Dentures
-change in environmental conditions, trauma, denture
usage, denture cleanliness.
• Smoking Tobacco
8. Classification
1. Acute Candidiasis
- Pseudomembranous type
- Atrophic type
2. Chronic Candidiasis
- Atrophic type
- Hypertrophic type
- Candida-associated angular chelitis
3. Systemic Candidiasis
- Candidal endocarditis
- Candidal meningitis
- Candidal septicaemia
4. Mucocutaneous Candidiasis
- Localised type
- Familial type
- Syndrome associated candidiasis
9. ACUTE PSEUDOMEMBRANEOUS CANDIDIASIS
(THRUSH )
Best recognized form of candidiasis
Development of white plaques
- Cottage Cheese or Curdled Milk resemblance
- composed of tangled masses of hyphae, yeasts,
desquamated epithelial cells and debris
- underlying mucosa appears normal or erythematous
10. Occurs characteristically on
buccal mucosa, palate and
dorsal tongue
Usually asymptomatic
Patients may complains
burning sensation of mucosa or
unpleasant taste in mouth
Oral thrush commonly occurs
among children, debilitated
elderly persons and AIDS
patients.
11. - Can be scraped off with tongue blade or by dry gauze
sponge
- May be initiated by broad spectrum antibiotics or
immune dysfunction
12. HISTOPATHOLOGY
Hyperplastic epithelium with superficial necrotic and
desquamating parakeranitized layer.
Hyperplastic epithelium is infiltrated by cadidal hyphae
and yeast cells along withPMN.
Often there is separation between the superficial
pseudomembrane and the deeper layers of epithelium.
The candidal hyphae often appears as a weakly basophilic
thread like structure.
Lamina propria is infiltrated by chronic inflammatory cells.
13.
14. ACUTE ATROPHIC
CANDIDIASIS:
( Erythematous Candidiasis)
Also called “antibiotic sore mouth”
Follows long course of broad spectrum
antibiotics
Patients complains of pain & burning
sensation of mucosa
Diffuse loss of filliform papillae of the
dorsal tongue resulting in a reddened
bald appearance of tongue
15. HISTOPATHOLOGY
Thin, atrophic, non- keratinized epithelium with
occasional presence of candidal hyphae.
Chronic inflammatory cell infiltration is seen in the
epithelium as well as in the lamina propria.
Histologically these lesions resemble ‘oral thrush’
without the pseudomembrane.
16. CHRONIC ATROPHIC
CANDIDIASIS:
Candida associated lesions
Also known as denture sore mouth
Characterized by varying degrees of
diffuse erythema and edema in
denture bearing areas.
- Usually in maxillary prostheses
more often seen among females
than males.
17. Usually asymptomatic
It is regarded as secondary candidal infection of oral
tissues modified by continuous wearing of ill-fighting
dentures and associated poor oral hygiene.
Histologically , shows presence of candidal hyphae
penetrating the keratin layer of host epithelium
18. ANGULAR CHEILITIS: -
Also called Perleche
Characterized by erythema,
fissuring and scaling of corners of
mouth
Typically occurs along with
multifocal candidiasis
19. It occurs at the angle of the mouth among persons
having deep commissural folds secondary to over closure
of mouth.
It can also occur among persons with lip-licking habits,
denture wearing, or deficiency of riboflavin, vit B-12 and
folic acid deficiency,etc.
Infection can be due to C.Albicans or Combined effect of
C.albicans + Staphylococcus Aureus
Infrequently involves perioral skin , secondary to action
keeping skin moist ( in case of chronic lip licking ,
thumb sucking) – can be known as Cheilocandidiasis
20. CHRONIC HYPERPLASTIC
CANDIDIASIS
Least common of all types
Non scrapable
It appears as a slightly elevated, indurated, persistent, white
plaque or patch on the oral mucosa that often resembles oral
leukoplakia. (candidal leukoplakia)
The lesions could be bilateral and are mostly seen on the buccal
mucosa near the commissure.
Some lesions may also develop over the tongue or the palate, etc.
21. Homogeneous or speckled (nodular)
Development of chronic hyperplastic candidiasis is often
favoured by certain conditions like smoking, denture wearing
and occlusal frictions.
Histopathologically shows increased frequency of epithelial
dysplasia
Diagnosis confirmed by demonstration of candidal hyphae
within the lesion and resolution of lesion after antifungal
therapy
22.
23. HISTOPATHOLOGY
Hyperplastic, acanthotic epithelium with
parakeratosis.
Intercellular edema and PMN infitration sometimes
causing separation between different layers of the
epithelium.
Microabscess formation in some cases.
Atrophy of the epithelium with loss of keratin in the
clinically erythematous areas.
Candidal hyphae invading the parakeratinized layer at
right angles to the surface.
24. .
Epithelial displasia may be
present in some cases.
Chronic inflammatory cell
infiltration in the underlying
connective tissue.
PAS-stained sections best
demonstrate the presence of
candidal hyphae in the tissue.
26. Familial Mucocutaneous Candidiasis
It is believed to be transmitted genetically as
autosomal recessive trait and most of the patients are
mildly affected.
A traid of mucocutaneous candidiasis, thymoma and
myositis has been reported.
27. Candidiasis Endocrinopathy Syndrome
Transmitted as autosomal recessive trait.
Chronic oral candidiasis occuring mostly in the second
decade of life.
Hypoparathyroidism, Addison’s disease, diabetes
mellitus and hypothyroidism.
28. Syndrome –associated candidiasis
Severe candidiasis (both acute and chronic variety) are
well recognised opportunistic infections in
immunosuppressed patients, particularly those
suffering from AIDS.
Depressed cell-mediated immunity is believed to be
the cause for the development of these lesions.
30. Candidal Endocarditis
Patients who have undergone prosthetic heart valve
replacements and those who are using long time venous
catheters are at risk for developing candidal endocarditis.
Clinically the patient often develops fever, dyspnoea,
edema and congestive cardiac failure, etc.
Candidal growth in the valve may result in the
development of major venous embolism.
31. Candidal Meningitis
Spread of candidal organisms into the brain results in
meningitis, which could be a consequence of oral
candidiasis and in such cases, the organism scan be
detected from the CSF.
Patients often develop fever, headache, stiffness in the
body and hemiplegia.
The condition is often fatal.
32. Candidal Septicaemia
It occurs due to disseminated spread of candidal
organisms throughout the body and it can be
secondary to severe oral or oropharyngeal candidiasis.
Clinically the patient often develops fever, chill,
nausea, vomiting, shock and coma, etc.
The condition can be fatal if not treated in time.
34. Laborarory
Saliva culture
Biopsy and staining with PAS or Gomori methenamine
silver stain
Serodiagnosis
Imaging
CT , or MRI to evaluate the submucosal extent
Investigation
35. Other
CBC with differential (eg, to evaluate for neutropenia or
lymphopenia)
Immunologic testing
Metabolic panel (eg, to evaluate for diabetes or malnutrition)
HIV serostatus testing
36. Treatment
Tropical and systemic administration of nystat is done
in conventional cases.
In immunosuppressedpatients, systemic
administration of amphotericin-B and fluconazole
may be necessary.
Removal of primary etiological factors and
improvement of oral hygiene is essential.
37. EXFOLIATIVE CYTOLOGY: -
Candidal hyphae can also be demonstrated by exfoliative
cytology by PAS stain
Hyphae are stained magenta color by PAS stain
RAPID DIAGNOSTIC TEST: - Gram’s staining
10% - 20% KOH preparation used for rapid diagnosis
KOH lyses background of epithelial cells allowing yeast
and hyphae to be seen
38. Easier Identification
Germ tube test
- Identifies C.albicans from other Candida species
- Majority of Diagnostic laboratories depend on this test
