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Mucosal Candidiasis

Updated : May 15, 2024





Background

Mucosal candidiasis, or oral thrush or oropharyngeal candidiasis, is a common fungal infection caused by the yeast Candida albicans. This infection is mainly found in individuals with weakened immune systems, such as those with HIV/AIDS or undergoing chemotherapy.

According to the National Library of Medicine, the symptoms of mucosal candidiasis can include white, creamy lesions on the tongue, inner cheeks, gums, tonsils, or back of the throat, which can be painful or cause difficulty swallowing. Other symptoms may include a sore throat, redness or swelling in the affected area, and cracking or dryness at the corners of the mouth.

Epidemiology

Mucosal candidiasis is a common infection, particularly among people with weakened immune systems. It is estimated that up to 75% of healthy individuals have Candida in their mouths, but only a tiny percentage of these people will develop symptoms of infection.

The incidence of mucosal candidiasis is higher in specific populations, such as people with HIV/AIDS, cancer patients undergoing chemotherapy, and individuals taking medications that suppress the immune system. In these populations, the incidence of candidiasis can range from 20-80%.

Mucosal candidiasis is more common in older adults, who may be more likely to have underlying health conditions that increase their risk of infection.

Other risk factors for mucosal candidiasis include smoking, wearing dentures or other oral appliances, and poor oral hygiene.

Geographic variation in the prevalence of mucosal candidiasis has been observed, with higher rates reported in developing countries.

In recent years, there has been concern about the emergence of antifungal resistance among Candida species, which may make treatment of mucosal candidiasis more difficult.

Anatomy

Pathophysiology

The pathophysiology of mucosal candidiasis involves several factors:

  • Disruption of the normal microbiota: Certain bacteria in the mouth and other mucosal surfaces help to keep Candida in check. However, factors such as antibiotics or a weakened immune system can disrupt this balance, allowing Candida to overgrow.
  • Adherence to host tissues: Candida can adhere to and invade host tissues, allowing them to colonize and cause infection. It does this by producing proteins called adhesins that bind to host cells.
  • Host immune response: When Candida overgrows and causes infection, the body’s immune system responds by activating inflammatory pathways and recruiting immune cells to the site of infection. In some cases, however, the immune response may be inadequate or ineffective, allowing the infection to persist.
  • Fungal virulence factors: Candida has several virulence factors that enable it to evade host defenses and cause tissue damage. For example, it produces enzymes that degrade host tissues and toxins that damage host cells.

Etiology

Some of the common factors that can contribute to the development of mucosal candidiasis include:

  • Antibiotics and other medications: Antibiotics and other medications that suppress the immune system, such as corticosteroids, can disrupt the balance of microorganisms in the body, allowing Candida to grow uncontrollably.
  • Hormonal changes: Hormonal changes, such as those that occur during pregnancy or menopause, can alter the balance of microorganisms in the body and contribute to the development of mucosal candidiasis.
  • Poor oral hygiene: Poor oral hygiene, such as not brushing or flossing regularly, can allow Candida to grow on the tongue, gums, and other mucous membranes in the mouth.
  • Diet: A diet high in sugar and carbohydrates can promote the growth of Candida, leading to mucosal candidiasis.
  • Smoking: Smoking can weaken the immune system and contribute to developing mucosal candidiasis.

Genetics

Prognostic Factors

Underlying health conditions: Patients with weakened immune systems, such as those with HIV/AIDS or cancer, are at higher risk of developing severe and recurrent mucosal candidiasis. Treatment outcomes may be more challenging in these cases.

The severity of infection: The severity of the infection can also affect the prognosis of mucosal candidiasis. Mild infections may respond well to topical antifungal medications, while severe infections may require systemic therapy and hospitalization.

Treatment adherence: Compliance with prescribed medications is critical to treat mucosal candidiasis successfully. Failure to follow the treatment plan, incomplete course of medication, or discontinuation of therapy before completion can lead to recurrence or treatment failure.

Concurrent medication: Medications that can compromise the immune system, such as corticosteroids, can make the treatment of mucosal candidiasis more challenging, as they can promote the growth of Candida.

Overall health status: Patients with underlying chronic health conditions or poor nutritional status may be more susceptible to recurrent infections. Hence, addressing these factors to improve the prognosis of mucosal candidiasis is essential.

Clinical History

The clinical history of mucosal candidiasis, also known as oral thrush, can vary depending on the severity of the infection, the location of the infection, and the underlying health status of the patient. Here are some of the standard clinical features of mucosal candidiasis:

  • White patches on the tongue, inner cheeks, or roof of the mouth: These patches may look like cottage cheese and are caused by an overgrowth of Candida yeast on the mucous membranes.
  • Soreness or burning sensation in the mouth: Patients with mucosal candidiasis may experience pain or discomfort, especially when eating or drinking.
  • Redness or inflammation: The affected areas may appear red or inflamed and bleed easily when touched or scraped.
  • Difficulty swallowing: In severe cases of mucosal candidiasis, patients may have trouble swallowing due to the white patches on the throat.
  • Loss of taste: Mucosal candidiasis can affect the sense of taste, making food taste bland or unpleasant.
  • Cracking or scaling at the corners of the mouth: In some cases, mucosal candidiasis can cause cracking or scaling at the corners of the mouth, a condition known as angular cheilitis.

Physical Examination

The critical elements of a physical examination for mucosal candidiasis:

  • Inspection of the oral cavity: The healthcare provider will examine the oral cavity for white patches on the tongue, inner cheeks, or roof of the mouth. They may use a tongue depressor to view the affected areas better.
  • Examination of the throat: If the infection has spread, the healthcare provider may use a tongue depressor and a flashlight to examine the back of the throat for white patches or inflammation.
  • Assessment of pain and discomfort: The healthcare provider will ask the patient about any pain, discomfort, or difficulty swallowing associated with the infection.

 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Bacterial infections: Bacterial infections of the oral cavity, such as streptococcal pharyngitis or tonsillitis, can cause similar symptoms to mucosal candidiasis, such as sore throat and difficulty swallowing. However, bacterial infections are typically associated with fever and other systemic symptoms, which are less common in candidiasis.

Viral infections: Viral infections, such as herpes simplex virus or cytomegalovirus, can cause ulcers or blisters in the oral cavity that may be mistaken for candidiasis. However, these infections are typically associated with more severe symptoms and may be more challenging to treat.

Allergic reactions: Some individuals may be allergic to certain foods, medications, or dental products, which can cause redness, swelling, or blisters in the oral cavity. These symptoms may be mistaken for candidiasis but can typically be distinguished based on the patient’s history and the absence of white patches on the mucous membranes.

Oral cancer: In rare cases, white patches or ulcers in the oral cavity may be a sign of oral cancer. Healthcare providers may perform a biopsy to rule out cancer if there is a concern.

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK545282/

Mucosal Candidiasis

Updated : May 15, 2024




Mucosal candidiasis, or oral thrush or oropharyngeal candidiasis, is a common fungal infection caused by the yeast Candida albicans. This infection is mainly found in individuals with weakened immune systems, such as those with HIV/AIDS or undergoing chemotherapy.

According to the National Library of Medicine, the symptoms of mucosal candidiasis can include white, creamy lesions on the tongue, inner cheeks, gums, tonsils, or back of the throat, which can be painful or cause difficulty swallowing. Other symptoms may include a sore throat, redness or swelling in the affected area, and cracking or dryness at the corners of the mouth.

Mucosal candidiasis is a common infection, particularly among people with weakened immune systems. It is estimated that up to 75% of healthy individuals have Candida in their mouths, but only a tiny percentage of these people will develop symptoms of infection.

The incidence of mucosal candidiasis is higher in specific populations, such as people with HIV/AIDS, cancer patients undergoing chemotherapy, and individuals taking medications that suppress the immune system. In these populations, the incidence of candidiasis can range from 20-80%.

Mucosal candidiasis is more common in older adults, who may be more likely to have underlying health conditions that increase their risk of infection.

Other risk factors for mucosal candidiasis include smoking, wearing dentures or other oral appliances, and poor oral hygiene.

Geographic variation in the prevalence of mucosal candidiasis has been observed, with higher rates reported in developing countries.

In recent years, there has been concern about the emergence of antifungal resistance among Candida species, which may make treatment of mucosal candidiasis more difficult.

The pathophysiology of mucosal candidiasis involves several factors:

  • Disruption of the normal microbiota: Certain bacteria in the mouth and other mucosal surfaces help to keep Candida in check. However, factors such as antibiotics or a weakened immune system can disrupt this balance, allowing Candida to overgrow.
  • Adherence to host tissues: Candida can adhere to and invade host tissues, allowing them to colonize and cause infection. It does this by producing proteins called adhesins that bind to host cells.
  • Host immune response: When Candida overgrows and causes infection, the body’s immune system responds by activating inflammatory pathways and recruiting immune cells to the site of infection. In some cases, however, the immune response may be inadequate or ineffective, allowing the infection to persist.
  • Fungal virulence factors: Candida has several virulence factors that enable it to evade host defenses and cause tissue damage. For example, it produces enzymes that degrade host tissues and toxins that damage host cells.

Some of the common factors that can contribute to the development of mucosal candidiasis include:

  • Antibiotics and other medications: Antibiotics and other medications that suppress the immune system, such as corticosteroids, can disrupt the balance of microorganisms in the body, allowing Candida to grow uncontrollably.
  • Hormonal changes: Hormonal changes, such as those that occur during pregnancy or menopause, can alter the balance of microorganisms in the body and contribute to the development of mucosal candidiasis.
  • Poor oral hygiene: Poor oral hygiene, such as not brushing or flossing regularly, can allow Candida to grow on the tongue, gums, and other mucous membranes in the mouth.
  • Diet: A diet high in sugar and carbohydrates can promote the growth of Candida, leading to mucosal candidiasis.
  • Smoking: Smoking can weaken the immune system and contribute to developing mucosal candidiasis.

Underlying health conditions: Patients with weakened immune systems, such as those with HIV/AIDS or cancer, are at higher risk of developing severe and recurrent mucosal candidiasis. Treatment outcomes may be more challenging in these cases.

The severity of infection: The severity of the infection can also affect the prognosis of mucosal candidiasis. Mild infections may respond well to topical antifungal medications, while severe infections may require systemic therapy and hospitalization.

Treatment adherence: Compliance with prescribed medications is critical to treat mucosal candidiasis successfully. Failure to follow the treatment plan, incomplete course of medication, or discontinuation of therapy before completion can lead to recurrence or treatment failure.

Concurrent medication: Medications that can compromise the immune system, such as corticosteroids, can make the treatment of mucosal candidiasis more challenging, as they can promote the growth of Candida.

Overall health status: Patients with underlying chronic health conditions or poor nutritional status may be more susceptible to recurrent infections. Hence, addressing these factors to improve the prognosis of mucosal candidiasis is essential.

The clinical history of mucosal candidiasis, also known as oral thrush, can vary depending on the severity of the infection, the location of the infection, and the underlying health status of the patient. Here are some of the standard clinical features of mucosal candidiasis:

  • White patches on the tongue, inner cheeks, or roof of the mouth: These patches may look like cottage cheese and are caused by an overgrowth of Candida yeast on the mucous membranes.
  • Soreness or burning sensation in the mouth: Patients with mucosal candidiasis may experience pain or discomfort, especially when eating or drinking.
  • Redness or inflammation: The affected areas may appear red or inflamed and bleed easily when touched or scraped.
  • Difficulty swallowing: In severe cases of mucosal candidiasis, patients may have trouble swallowing due to the white patches on the throat.
  • Loss of taste: Mucosal candidiasis can affect the sense of taste, making food taste bland or unpleasant.
  • Cracking or scaling at the corners of the mouth: In some cases, mucosal candidiasis can cause cracking or scaling at the corners of the mouth, a condition known as angular cheilitis.

The critical elements of a physical examination for mucosal candidiasis:

  • Inspection of the oral cavity: The healthcare provider will examine the oral cavity for white patches on the tongue, inner cheeks, or roof of the mouth. They may use a tongue depressor to view the affected areas better.
  • Examination of the throat: If the infection has spread, the healthcare provider may use a tongue depressor and a flashlight to examine the back of the throat for white patches or inflammation.
  • Assessment of pain and discomfort: The healthcare provider will ask the patient about any pain, discomfort, or difficulty swallowing associated with the infection.

 

Bacterial infections: Bacterial infections of the oral cavity, such as streptococcal pharyngitis or tonsillitis, can cause similar symptoms to mucosal candidiasis, such as sore throat and difficulty swallowing. However, bacterial infections are typically associated with fever and other systemic symptoms, which are less common in candidiasis.

Viral infections: Viral infections, such as herpes simplex virus or cytomegalovirus, can cause ulcers or blisters in the oral cavity that may be mistaken for candidiasis. However, these infections are typically associated with more severe symptoms and may be more challenging to treat.

Allergic reactions: Some individuals may be allergic to certain foods, medications, or dental products, which can cause redness, swelling, or blisters in the oral cavity. These symptoms may be mistaken for candidiasis but can typically be distinguished based on the patient’s history and the absence of white patches on the mucous membranes.

Oral cancer: In rare cases, white patches or ulcers in the oral cavity may be a sign of oral cancer. Healthcare providers may perform a biopsy to rule out cancer if there is a concern.

https://www.ncbi.nlm.nih.gov/books/NBK545282/