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Mucosal Candidiasis Follow-up

  • Author: Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC); Chief Editor: William D James, MD  more...
 
Updated: Feb 12, 2016
 

Deterrence/Prevention

Patients should avoid smoking, medications that impair salivation, antibiotics, corticosteroids, and other immunosuppressants.

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Complications

Antifungal azole resistance currently is a significant clinical concern, particularly in persons with HIV disease and in other immunocompromised conditions. Azole resistance appears to arise because of changes in the target enzyme 14-alpha sterol demethylase, reduced fungal membrane permeability to azoles, changes in delta-5 and delta-6 desaturase, or increased efflux of azoles from the organisms.

Ketoconazole resistance has been reported, but is not a concern, since fluconazole is active against at least some ketoconazole-resistant Candida species.

Emergence of resistance during fluconazole therapy currently is a true clinical concern, especially in persons who use illegal intravenous drugs. The commercially available E test is a simple reliable test useful in detecting fluconazole-resistant C albicans. Fluconazole resistance appears to result from a mutation and may appear in patients who have received no fluconazole, since resistance may be transferred, possibly through sexual transmission. Previous fluconazole use and severe immune defects are risk factors for fluconazole resistance. Intermittent fluconazole or low-dose therapy is more likely than continuous or high-dose therapy to induce resistant species. One US study found that at least 1 fungal species resistant to fluconazole was isolated from 41% of patients with AIDS; other studies found that as many as 20% of patients had fluconazole-resistant oral candidosis.

Some evidence exists of cross-resistance of some C albicans and non-C albicans isolates to ketoconazole, fluconazole, and itraconazole, although the clinical significance of this in HIV disease remains to be established. Some studies indicate that ketoconazole and itraconazole may be clinically effective, despite some cross-resistance. Itraconazole in particular may remain effective, although clinical efficacy may be impaired. Approximately 30% of fluconazole-resistant isolates may be resistant to itraconazole. Itraconazole also is effective as a cyclodextrin solution in patients with fluconazole-resistant candidosis.

Therapy in fluconazole-resistant cases includes topical amphotericin, higher oral doses of fluconazole (200-600 mg/d), a fluconazole suspension as an oral rinse, or the use of ketoconazole (400 mg/d) or itraconazole (200-400 mg/d). Oral, intravenous, or liposomal amphotericin also may be effective, and, although resistance to oral amphotericin eventually arises, intravenous amphotericin appears to remain effective.

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Prognosis

The prognosis is good for most infections in the immunocompetent host, but in patients who are immunocompromised, antifungal resistance is commonplace. Candidosis may predispose individuals to esophageal spread.

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Patient Education

For patient education resources, see the Yeast and Fungal Infections Center, as well as Candidiasis (Yeast Infection).

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Contributor Information and Disclosures
Author

Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC) Emeritus Professor, University College London; Visiting Professor, Universities of Athens, BPP, Edinburgh, Granada, Helsinki and Plymouth

Crispian Scully, MD, MRCS, PhD, MDS, CBE, FDSRCS(Eng), FDSRCPS, FFDRCSI, FDSRCSE, FRCPath, FMedSci, FHEA, FUCL, FSB, DSc, DChD, DMed(HC), Dr(HC) is a member of the following medical societies: Academy of Medical Sciences, British Society for Oral Medicine, European Association for Oral Medicine, International Academy of Oral Oncology, International Association for Dental Research, International Association for Oral and Maxillofacial Pathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Franklin Flowers, MD Department of Dermatology, Professor Emeritus Affiliate Associate Professor of Pathology, University of Florida College of Medicine

Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Surgery

Disclosure: Nothing to disclose.

References
  1. Stoopler ET, Sollecito TP. Oral mucosal diseases: evaluation and management. Med Clin North Am. 2014 Nov. 98 (6):1323-52. [Medline].

  2. Boriollo MF, Bassi RC, dos Santos Nascimento CM, Feliciano LM, Francisco SB, Barros LM. Distribution and hydrolytic enzyme characteristics of Candida albicans strains isolated from diabetic patients and their non-diabetic consorts. Oral Microbiol Immunol. 2009 Dec. 24(6):437-50. [Medline].

  3. Olczak-Kowalczyk D, Daszkiewicz M, Krasuska-Slawinska, Dembowska-Baginska B, Gozdowski D, Daszkiewicz P, et al. Bacteria and Candida yeasts in inflammations of the oral mucosa in children with secondary immunodeficiency. J Oral Pathol Med. 2012 Aug. 41(7):568-76. [Medline].

  4. Meighani G, Aghamohammadi A, Javanbakht H, Abolhassani H, Nikayin S, Jafari SM, et al. Oral and dental health status in patients with primary antibody deficiencies. Iran J Allergy Asthma Immunol. 2011 Dec. 10(4):289-93. [Medline].

  5. Alnuaimi AD, Wiesenfeld D, O'Brien-Simpson NM, Reynolds EC, McCullough MJ. Oral Candida colonization in oral cancer patients and its relationship with traditional risk factors of oral cancer: a matched case-control study. Oral Oncol. 2015 Feb. 51 (2):139-45. [Medline].

  6. Lafleur MD, Qi Q, Lewis K. Patients with long-term oral carriage harbor high-persister mutants of Candida albicans. Antimicrob Agents Chemother. 2010 Jan. 54(1):39-44. [Medline].

  7. Conti HR, Peterson AC, Brane L, Huppler AR, Hernández-Santos N, Whibley N, et al. Oral-resident natural Th17 cells and γδ T cells control opportunistic Candida albicans infections. J Exp Med. 2014 Sep 22. 211 (10):2075-84. [Medline].

  8. Rane HS, Hardison S, Botelho C, Bernardo SM, Wormley F Jr, Lee SA. Candida albicans VPS4 contributes differentially to epithelial and mucosal pathogenesis. Virulence. 2014. 5 (8):810-8. [Medline].

  9. Break TJ, Jaeger M, Solis NV, Filler SG, Rodriguez CA, Lim JK, et al. CX3CR1 is dispensable for control of mucosal Candida albicans infections in mice and humans. Infect Immun. 2015 Mar. 83 (3):958-65. [Medline].

  10. Redding SW, Dahiya MC, Kirkpatrick WR, et al. Candida glabrata is an emerging cause of oropharyngeal candidiasis in patients receiving radiation for head and neck cancer. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Jan. 97(1):47-52. [Medline].

  11. Junqueira JC. Models hosts for the study of oral candidiasis. Adv Exp Med Biol. 2012. 710:95-105. [Medline].

  12. Tinoco-Araujo JE, Araujo DF, Barbosa PG, Santos PS, Medeiros AM. Invasive candidiasis and oral manifestations in premature newborns. Einstein (Sao Paulo). 2013 Jan-Mar. 11(1):71-5. [Medline].

  13. Shephard MK, Schifter M, Palme CE. Multiple oral squamous cell carcinomas associated with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Dec. 114(6):e36-42. [Medline].

  14. Sitheeque MA, Samaranayake LP. Chronic hyperplastic candidosis/candidiasis (candidal leukoplakia). Crit Rev Oral Biol Med. 2003. 14(4):253-67. [Medline].

  15. Golecka M, Oldakowska-Jedynak U, Mierzwinska-Nastalska E, Adamczyk-Sosinska E. Candida-associated denture stomatitis in patients after immunosuppression therapy. Transplant Proc. 2006 Jan-Feb. 38(1):155-6. [Medline].

  16. Tanida T, Okamoto T, Okamoto A, et al. Decreased excretion of antimicrobial proteins and peptides in saliva of patients with oral candidiasis. J Oral Pathol Med. 2003 Nov. 32(10):586-94. [Medline].

  17. Moris DV, Melhem MS, Martins MA, Souza LR, Kacew S, Szeszs MW, et al. Prevalence and antifungal susceptibility of Candida parapsilosis complex isolates collected from oral cavities of HIV-infected individuals. J Med Microbiol. 2012 Dec. 61:1758-65. [Medline].

  18. Niimi M, Firth NA, Cannon RD. Antifungal drug resistance of oral fungi. Odontology. Feb 2010. 98(1):15-25.

  19. Karbach J, Ebenezer S, Warnke PH, Behrens E, Al-Nawas B. Antimicrobial effect of Australian antibacterial essential oils as alternative to common antiseptic solutions against clinically relevant oral pathogens. Clin Lab. 2015. 61 (1-2):61-8. [Medline].

  20. Pappas PG, Kauffman CA, Andes DR, Clancy CJ, Marr KA, Ostrosky-Zeichner L, et al. Executive Summary: Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15. 62 (4):409-17. [Medline].

  21. Kraft-Bodi E, Jørgensen MR, Keller MK, Kragelund C, Twetman S. Effect of Probiotic Bacteria on Oral Candida in Frail Elderly. J Dent Res. 2015 Sep. 94 (9 Suppl):181S-6S. [Medline].

  22. Scardina GA, Ruggieri A, Messina P. Chronic hyperplastic candidosis: a pilot study of the efficacy of 0.18% isotretinoin. J Oral Sci. 2009 Sep. 51(3):407-10. [Medline].

  23. Scully C, el-Kabir M, Samaranayake LP. Candida and oral candidosis: a review. Crit Rev Oral Biol Med. 1994. 5(2):125-57. [Medline].

 
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Pseudomembranous candidosis.
Erythematous candidosis in HIV/AIDS.
Denture-related stomatitis; a common form of oral candidiasis. From Scully C, Flint SF, Bagan JV, Porter SR, Moos K. Atlas of Oral and Maxillofacial Diseases. 2010. Informa, London.
Angular stomatitis; a common form of oral candidiasis, typically seen in patients with denture-related stomatitis, especially those in whom the denture needs adjustment. In others, it may be a sign of diabetes, nutritional deficiency, or immune defect.
Multifocal candidosis; lingual lesions.
Chronic hyperplastic candidosis; typically affects the tongue dorsum or the commissures of the lips; potentially malignant.
 
 
 
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