Candidiasis of the oral mucosa

Candidiasis - mycosis of the skin and mucous membrane, nails, internal organs, caused by yeast-like fungi of the genus Candida, in particular, C. Albicans. Candidiasis can affect almost all areas of skin and mucous membrane without exception. Often, the candidiasis of the oral mucosa occurs with traumatic damage to the mucous membrane (mechanical damage to improperly installed dentures, thermal and chemical burns), with atmospheric occupational exposure and many others. Etc. There are several forms of the disease that are often combined: a candidiasis of the mucous membrane of the oral cavity and genital organs, candidiasis of skin folds, etc.

[1], [2], [3], [4], [5], [6], [7], [8]

Risk factors

The development of candidiasis is promoted by hypoparathyroidism, a violation of carbohydrate metabolism associated with pancreatic hypofunction, a violation of the protein-forming function of the liver, intestinal dysbiosis, which occurs most often with prolonged antibiotic treatment (auromycin, teramycin) and corticosteroids.

Newborns, age over 65 years, use of inhaled and systemic glucocorticoids, broad-spectrum antibiotics, immunosuppressants and cytostatics, endotracheal intubation, AIDS, diabetes, malignant neoplasms, dentures.

Candidiasis of the oral mucosa (yeast stomatitis, or thrush) often develops in infants and elderly people, especially weakened chronic, serious diseases. First, there is dryness of the oral mucosa, then multiple white spots in the sky, tongue, cheeks. When they merge, large whitish-gray films are formed, which later easily separate; under them are found superficial opalescent species ("dry") erosion.

Symptoms of candidiasis of the oral mucosa

There are acute and chronic forms of candidiasis of the oral mucosa.

Acute form - acute pseudomembranous candidosis (thrush, sormicosis), the most common form of lesion. It is manifested by the formation of white or bluish-white spots on the mucous membrane of the mouth, sometimes resembling a curdled formation, the accumulation of which at different sites is not the same. The surface of the mucosa under the plaque can be hyperemic, eroded or ulcerated with moderate bleeding. Progression of the disease can lead to a loss of the pharynx, this is accompanied by soreness and swallowing disorders.

Acute atrophic candidiasis usually occurs when using broad-spectrum antibiotics. In this case, it is possible to damage any part of the oral mucosa, most often - the tongue. The mucous membrane becomes hyperemic, edematous and inflamed, easily injured.

Chronic hyperplastic candidiasis is characterized by the appearance on the hyperemic mucosa of the oral cavity and pharynx of tightly soldered plaques. Often the plaque is located on the back of the tongue in a region typical for a diamond-shaped glossitis. Patients at the same time feel a considerable dryness in the oral cavity, a constant desire to moisten the mouth, and also hyposalivation, which aggravates the patient's discomfort, is noted.

Chronic atrophic candidiasis is characterized by atrophy of the papillae on the back of the tongue or manifests itself in the form of an atrophic rhomboid glossitis. Chronic atrophic candidiasis often occurs when using dentures. This condition rarely accompanies the expressed subjective sensations, the most frequent clinical manifestation is angular stomatitis (redness, painful cracks in the corners of the mouth). On examination, the edema and hyperemia of the gums and the hard palate contacting the prosthesis are revealed.

Candidiasis is characterized by the appearance in the depth of the follicles of pharyngeal tonsils of white shiny plugs. Tonsils are hyperemic, painless. This form of candidiasis usually has a chronic course, the body temperature does not increase, there is no pain when swallowed.

Chronic generalized (granulomatous) candidiasis occurs usually in children with immunodeficiency, insufficiency of parathyroid gland function. It manifests itself, as a rule, in early childhood in the form of thrush, candidiasis cheilitis, as well as lesions of the larynx, trachea, bronchi, small-focal pneumonia, and sometimes cavities are formed.

Chronic hyperplastic candidiasis occurs when smoking and prolonged traumatization of the mucous membrane with a denture, the appearance on the mucous membrane of the cheeks and the back of the tongue of painless white or transparent plaques with uneven edges is typical. Unlike thrush, plaques of chronic hyperplastic candidiasis are difficult to remove from the mucous membrane.

Attention should also be paid to the disease, so rare in our latitudes, as rhinosporidiosis caused by the parasitic fungus Rhinosporidium Seeberi. The disease is characterized by a picture of deep chronic mycosis, the main element of which are large red crimson polyposis tumors - soft vascular in the nose, nasopharynx, conjunctiva of the eyes, rarely in the vagina, urethra and skin. It affects domestic animals (horses, cows, donkeys, etc.). The ways of human infection are not clear. Infection can occur in sewage water, ponds. It occurs in Argentina, North America, Africa, India, Italy, Iran, Great Britain; In Russia and the CIS republics there are isolated cases.

Diagnostics

Diagnosis is based on the detection of budding cells of the pseudomycelia Candida spp in the material obtained from the affected mucous membranes.

[9], [10], [11], [12], [13]

Treatment of mucous candidiasis of the oral cavity

Treatment of candidiasis of the oral mucosa is the administration of antifungal agents (nystatin, levorin, nizoral, etc.). In chronic candidiasis, immunotherapy is performed. Patients receiving long-term treatment with broad-spectrum antibiotics and corticosteroids are recommended to use nystatin for glycerol for the prevention of candidiasis. Locally prescribe lubrication of affected areas with mycostatin solution on glycerin.

The use of systemic and topical antifungal agents, antiseptics. The drug of choice - fluconazole, its use usually within 1-3 days leads to the disappearance of clinical signs of candidiasis of the oral cavity. The duration of fluconazole depends on the severity of immunosuppression. Antimycotics for topical administration are also effective, but with their use the effect is slower. An important condition for successful treatment is the elimination or reduction of the severity of risk factors (correction of diabetes mellitus, optimization of antibacterial therapy, etc.). If the treatment is not effective or the relapses of the disease, antifungal therapy is modified, taking into account the type of pathogen and its sensitivity to antimycotics. If other antimycotics are ineffective, immunocompromised patients undergo short treatment with amphotericin B.