1. CANDIDIASIS

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

5. Macroscopic and Microscopic
appearance of Candida spp

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.

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

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.

25. Localised Mucocutaneous
Candidiasis
 This is characterised by
long standing and
persistent candidal
infections in the oral
cavity, skin, nails and
vaginal mucosa,etc.

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.

29. SYSTEMIC CANDIDIASIS

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.

33. Differential Diagnosis
 Chemical burns
 Mucous patch of syphilis
 Traumatic ulcers
 Leukoplakia
 Lichen planus

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

39. Emerging Methods for detection of
Candida Infections
 Molecular Methods
 PCR