Data and Picture Interpretation Stations: Cases 1–45
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar in ENT OSCEs, 2023
Oral candidiasis is an infection of the oral cavity caused by Candida Albicans and in the majority of cases is associated with immunosuppression. Typical causative factors include age, diabetes, HIV/AIDS and steroid usage. Users of inhaled steroids are recommended to rinse their mouth out with water after every use. Clinically, oral candidiasis typically presents with painless, white pseudomembranous plaques. Diagnosis is generally clinical but plaques can be cultured. Testing for the underlying cause, based on the history is often required. Antifungal treatment is usually effective. Nystatin oral suspension (100000 units/mL) 5 mL orally four times daily is used first line. Fluconazole and itraconazole are indicated for severe or refractory disease.
Nails (Onychomycosis): Clinical Aspects
Raimo E Suhonen, Rodney P R Dawber, David H Ellis in Fungal Infections of the Skin, Hair and Nails, 2020
C. albicans can frequently be isolated from the subungual area of onycholytic nails as well as from the proximal nail fold in chronic paronychia. However, in both these conditions, Candida colonisation is a secondary phenomenon since topical or systemic antimycotics do not cure the nail abnormalities. Nail invasion by C. albicans usually indicates an underlying immunological defect and is most frequently seen in chronic mucocutaneous candidiasis; in the latter, C. albicans invasion of the nail plate is associated with an inflammatory reaction of the proximal nail fold, nail matrix, nail bed and hyponychium. The affected digits have a terminal swollen appearance, with erythema and swelling of the proximal and lateral nail folds. The nail bed is hyperkeratotic and the nail plate is thickened and highly dystrophic as a result of diffuse ‘fragmentation’. Complete disruption of the nail plate is almost always observed. Oral candidiasis is present in the majority of affected individuals.
Head and neck cancer
Peter Hoskin, Peter Ostler in Clinical Oncology, 2020
The oral mucosa is very sensitive to radiation, the reaction beginning during the second week of radiotherapy as erythema and soreness, progresses to severe discomfort manifested as a fibrinous mucositis leading to dysphagia and difficulty in mastication. This can be lessened by advising patients to use a very soft toothbrush to avoid gingival trauma, regular mouthwashes to prevent secondary infection, avoid smoking, alcohol, spicy foods and food or drink that is very hot or very cold. Soluble aspirin 600 mg gargled and swallowed four times a day can relieve oral and oropharyngeal discomfort. Oral candidiasis should be treated promptly with a topical or systemic antifungal. Local anaesthetic lozenges are also useful. A dry mouth is very common during radiotherapy and might recover only partially or not at all. It results from radiation damage to the parotids and minor salivary gland(s) at the site of radiation beam entry and/or exit from the oral cavity, predisposing the patient to dental caries, making swallowing difficult and exacerbating any radiation mucositis. Loss of or altered taste will also occur. Artificial saliva sprays are the treatment of choice but oral hygiene is also important. Careful monitoring or nutrition is necessary and many patients will require nutritional support with some form of enteral nutrition and in some cases a prophylactic gastrostomy (PEG) may be placed to facilitate nutrition during treatment.
Development of purified cashew gum mucoadhesive buccal tablets containing nystatin for treatment of oral candidiasis
Published in Drug Development and Industrial Pharmacy, 2021
Ana Paula de Sá Pinto Abrahão Magalhães, Helena Keiko Toma, Flávia Almada do Carmo, Claudia Regina Elias Mansur
Oral candidiasis is one of the most recurrent fungal infections in humans and its clinical manifestation generally occurs due to low immunity, since fungi of the Candida genus are part of the normal human microbiota. Candida albicans accounts for around 80% of infections and can colonize the cavity, either alone or in combination with non-albican species, including Candida glabrata and Candida tropicalis [1,2]. The typical colonization rate of Candida albicans varies with age, affecting neonates (∼45%), healthy children (∼45–65%), healthy adults (∼30–45%) and elderly, particularly those living in nursing homes (∼65–88%). Also, it is common in users of dental prostheses (∼50–65%), and in immunocompromised patients, such as those with HIV and/or undergoing chemotherapy for acute leukemia (∼90%) [1,3,4]. With the increase in immunosuppressive comorbidities, including diabetes, cancer and AIDS, an increase in the number of reported cases of opportunistic infections by oral Candida was observed [3,4]. Although not fatal for most patients, it can cause significant discomfort and, in elderly or hospitalized patients, it can result in high morbidity due to poor nutrition and also the occurrence of invasive and life-threatening systemic infection caused by Candida [3].
Synbiotic Musa acuminata skin extract and Streptococcus salivarius K12 inhibit candida species biofilm formation
Published in Biofouling, 2022
Nurul Alia Risma Rismayuddin, Puteri Elysa Alia Mohd Badri, Ahmad Faisal Ismail, Noratikah Othman, H.M.H.N. Bandara, Mohd Hafiz Arzmi
Oral diseases are caused by various factors, including poor oral hygiene, heavy alcohol consumption, tobacco smoking, unbalanced diet, immunodeficiency, and microbial infection such as Candida (Khajuria and Metgud 2015; Grossmann et al. 2021). Among the important clinical manifestations of oral candidiasis are denture-associated stomatitis (Tobouti et al. 2016), rhomboid glossitis (Kaur et al. 2017), leukoplakia (Millsop and Fazel 2016), angular cheilitis (Shetti et al. 2011), and chronic mucocutaneous candidiasis (Kopacova et al. 2005). Even though Candida albicans is the most commonly isolated yeast associated with human infections; however, non-albicans Candida spp. (NAC) such as Candida tropicalis, Candida parapsilosis, and Candida glabrata have also been reported to be associated with 35% to 65% of all systemic Candida infections (Krcmery and Barnes 2002).
Mycotic infections – mucormycosis and oral candidiasis associated with Covid-19: a significant and challenging association
Published in Journal of Oral Microbiology, 2021
Manjusha Nambiar, Sudhir Rama Varma, Mohamed Jaber, S. V. Sreelatha, Biju Thomas, Arathi S. Nair
The clinical presentation of pseudomembranous oral candidiasis is diagnostic because of the classic white appearance of the lesion [11]. Another relevant diagnostic feature of pseudomembranous candidiasis is that these white lesions can be wiped off by gentle scraping with gauze, leaving an underlying erythematous surface [12]. Other diagnostic methods include exfoliative cytology, potassium peroxide staining, imprint specimen for microbiology culture, culture analysis of oral swabs specimen, salivary assays, and oral mucosal biopsy. Periodic acid–Schiff staining is helpful to obtain definitive diagnosis [11]. In most of the reported cases of COVID-19, a thorough intra-oral examination and correlation with other underlying factors aids the clinician in arriving at the diagnosis of oral candidiasis.