Oral mucosal candidiasis

Candidiasis is a 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 the skin and mucous membrane without exception. Often, candidiasis of the oral mucosa occurs with traumatic damage to the mucous membrane (mechanical damage from improperly installed dental prostheses, thermal and chemical burns), with atmospheric occupational hazards, etc. There are several forms of the disease, which are often combined with each other: candidiasis of the oral mucosa and genitals, candidiasis of skin folds, etc.

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Risk factors

The development of candidiasis is facilitated by hypoparathyroidism, carbohydrate metabolism disorders associated with pancreatic hypofunction, disorders of the protein-forming function of the liver, intestinal dysbacteriosis, which occurs most often with long-term treatment with antibiotics (auromycin, terramycin) and corticosteroids.

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

Candidiasis of the oral mucosa (yeast stomatitis, or thrush) most often develops in infants and the elderly, especially those weakened by chronic, severe diseases. Dryness of the oral mucosa first appears, then multiple whitish pinpoint plaques appear on the palate, tongue, and cheeks. When they merge, large whitish-gray films are formed, which are later easily separated; superficial opalescent ("dry") erosions are found underneath them.

Symptoms of oral candidiasis

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

Acute form - acute pseudomembranous candidiasis (thrush, soormycosis), the most common form of the lesion. It is manifested by the formation of white or bluish-white spots on the mucous membrane of the oral cavity, sometimes resembling a cheesy formation, the accumulation of which in different areas is not the same. The surface of the mucous membrane under the plaque can be hyperemic, eroded or ulcerated with moderate bleeding. Progression of the disease can lead to damage to the pharynx, this is accompanied by pain and difficulty swallowing.

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

Chronic hyperplastic candidiasis is characterized by the appearance of tightly fused plaques on the hyperemic mucous membrane of the oral cavity and pharynx. Often the plaque is located on the back of the tongue in the area typical of rhomboid glossitis. Patients feel significant dryness in the oral cavity, a constant desire to moisten the mouth, and hyposalivation is also noted, which aggravates the patient's discomfort.

Chronic atrophic candidiasis is characterized by atrophy of the papillae on the back of the tongue or manifests itself as atrophic rhomboid glossitis. Chronic atrophic candidiasis most often occurs when using dentures. This condition is rarely accompanied by pronounced subjective sensations, the most common clinical manifestation is angular stomatitis (redness, painful cracks in the corners of the mouth). Upon examination, swelling and hyperemia of the gums and hard palate in contact with the denture are detected.

Candidal tonsillitis is characterized by the appearance of white shiny plugs in the depths of the follicles of the pharyngeal tonsils. The tonsils are hyperemic and painless. This form of candidiasis usually has a chronic course, the body temperature does not rise, there is no pain when swallowing.

Chronic generalized (granulomatous) candidiasis usually occurs in children with immunodeficiency, insufficiency of the parathyroid glands. It usually manifests itself in early childhood in the form of thrush, candidal cheilitis, as well as damage to the larynx, trachea, bronchi, small-focal pneumonia, sometimes cavities are formed.

Chronic hyperplastic candidiasis occurs with smoking and long-term trauma to the mucous membrane by a denture, characterized by the appearance of painless white or transparent plaques with jagged edges on the mucous membrane of the cheeks and the back of the tongue. Unlike thrush, plaques of chronic hyperplastic candidiasis are difficult to remove from the mucous membrane.

It is also worth paying attention to such a rare disease 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 raspberry-shaped polypous tumors - soft vascular in the nose, nasopharynx, on the conjunctiva of the eyes, less often in the vagina, urethra and on the skin. Affects domestic animals (horses, cows, donkeys, etc.). The ways of human infection are unclear. Infection can occur in waste water, ponds. It is found in Argentina, North America, Africa, India, Italy, Iran, Great Britain; in Russia and the CIS republics, isolated cases are observed.

Diagnostics

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

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Treatment of oral mucosal candidiasis

Treatment of oral mucosal candidiasis involves prescribing antifungal agents (nystatin, levorin, nizoral, etc.). In chronic candidiasis, immunotherapy is used. Patients who have been receiving long-term treatment with broad-spectrum antibiotics and corticosteroids are recommended to prescribe nystatin on glycerin to prevent candidiasis. Local lubrication of affected areas with mycostatin solution on glycerin is prescribed.

Use of systemic and topical antifungal drugs, antiseptics. The drug of choice is fluconazole, its use usually for 1-3 days leads to the disappearance of clinical signs of oral candidiasis. The duration of fluconazole use depends on the severity of immunosuppression. Antifungal drugs for local use are also effective, but their effect occurs more slowly. An important condition for successful treatment is the elimination or reduction of risk factors (correction of diabetes mellitus, optimization of antibacterial therapy, etc.). If treatment is ineffective or the disease relapses, antifungal therapy is modified, taking into account the type of pathogen and its sensitivity to antifungal drugs. If other antifungal drugs are ineffective in immunocompromised patients, short-term treatment with amphotericin B is carried out.