44. Candida infections

Candidiasis.

Candidiasis is a fungal infection caused by a yeast (a type of fungus) called Candida, the most common is Candida albicans. Candida normally lives on the skin and inside the body, in places such as the mouth, throat, gut, and vagina, without causing any problems. Candida can cause infections if it grows out of control or if it enters deep into the body (for example, the bloodstream or internal organs like the kidney, heart, or brain).

Candidiasis that develops in the mouth or throat is called thrush or oropharyngeal candidiasis. Candidiasis in the vagina is commonly referred to as a yeast infection. Invasive candidiasis occurs when Candida species enter the bloodstream or affect internal organs like the kidney, heart, or brain.

Types of Candidiasis

I. CANDIDA INFECTIONS IN THE MOUTH, THROAT AND ESOPHAGUS

Uncommon in healthy adults. People who are at higher risk for getting candidiasis in the mouth and throat include babies, especially those younger than 1 month of age, and people with at least one of these factors:

• Wear dentures
• Have diabetes
• Have cancer
• Have HIV/AIDS
• Take antibiotics or corticosteroids, including inhaled corticosteroids for conditions like asthma
• Take medications that cause dry mouth or have medical conditions that cause dry mouth
• Smoke

❖ Classification of oral candidiasis, based on presentation:

1. Acute forms

1. a) Pseudomembranous candidiasis - Classic candida infection. It typically presents with loosely attached membranes which are made up of fungal organisms and cellular debris. If the pseudomembrane is removed bleeding and inflammation can result. It is predominantly seen in patient medicated with antibiotics, immunosuppressants.

1. b) Erythematous candidiasis - Candidiasis with red appearance. The redness may be due to atrophy, also due to increased vascularization inflammation). The lesion has a diffuse border which helps to distinguish it from erythroplakia which has a sharp demarcation. It usually appears secondarily to pseudomembranous candidiasis. It is mainly seen in the palate and the dorsum of the tongue of patients who are using inhalation steroids.
2. Chronic forms
3. a) Chronic plaque-type and nodular candidiasis – also called candidal leukoplakia or Chronic hyperplastic candidiasis.

Typical presentation:

• White plaques which may be difficult to differentiate from oral leukoplakia. It has been associated with malignant transformation.

1. b) Denture stomatitis
2. c) Angular cheilitis

1. d) Oral candidiasis, associated with HIV - More than 90% of patients with AIDS (acquired immunodeficiency syndrome) have oral candidiasis during the course of HIV infection.

The most common types of oral candidiasis in HIV patients are:

1. Pseudomembranous candidiasis
2. Erythematous candidiasis