Oral Candidiasis

Candida infection of a persistent palatal ulcer in a 20-month-old child

A 20 month-old infant presented with a painless, persistent lesion on the hard palate which had been present for 6 months. The lesion was aggressive in appearance, approximately 2 cm in diameter with raised, rolled edges, and there was what appeared to be granulation tissue present together with some necrotic slough in its base. It was considered to represent a traumatized area with superimposed secondary Candida infection. A direct smear of the lesion was positive for Candida. Antifungal therapy, and an attempt to avoid further irritation by advising the mother not to give the child a feeding bottle whenever possible, resulted in complete healing of the lesion. There has been no recurrence in 2 years.

A review of oral fungal infections and appropriate therapy

Dental health care providers must recognize oral fungal pathogens that often are markers for early signs of immune deterioration. After accurate identification, appropriate therapy can be initiated. Predisposing factors for development of oral fungal infections, identification of oral fungal infections, treatment options and their relative costs are reviewed.

There's a fungus among us!

Candida infections can be extremely persistent and often are a source of considerable frustration for parents and professionals. Appropriate management of the initial infection is critical. Too often the treatment is inadequate or carried out for too short a period. A fungus is an amazing organism, deceptive in its simplicity, tenacious in its adaptability. Management of candidiasis challenges the lactation consultant to provide not only assessment and intervention but reassurance and reassessment in order to preserve the breastfeeding relationship.

Differentiation of sugar assimilation characteristics and colony phenotypes in pathogenic and commensal oral candidal isolates

A comparison of sugar assimilation patterns has been made using 72 oral candidal isolates recovered from diseased and non-diseased patients. Significant differences were demonstrated between isolates recovered from diseased versus healthy mouths. In addition, significant changes in colony phenotype (switch frequency and morphologic predominance) were found to relate to predictive data generated from carbon source utilization data. These results suggest that biochemical properties and colony phenotypic characteristics may hold promise in predicting the behavior of oral candidal isolates in disease.

Oral candidosis. Clinical, historical, and therapeutic features of 100 cases

Oral candidosis is an increasingly important disease that affects a significant percentage of the population. Traditionally known as an opportunistic pathogen, the broader clinical scope of oropharyngeal candidal infections is now being recognized. The clinical and historical features of 100 patients referred for diagnosis and management of candidosis have been reviewed. The age, gender, chief complaint, medical history, medications, and clinical findings have been noted. A wide range of clinical signs and symptoms, and the rationale behind the topical and systemic antifungal therapies provided to this patient population, are discussed.

Common lesions of the oral mucosa. A guide to diseases of the lips, cheeks, tongue, and gingivae

Canker sores and cold sores are common, relatively banal diseases of the oral mucosa and lips, occurring most often in young persons. Some otherwise healthy patients may have a more severe variant, such as major aphthous ulcers, recurring lesions of aphthous stomatitis, or acute herpetic gingivostomatitis. Other patients may present with severe recurrent herpes simplex labialis or chronic oral candidiasis, and in these patients an immunodeficiency state must be considered.

Assessment of antimicrobial treatment of denture stomatitis using an in vivo replica model system: therapeutic efficacy of an oral rinse

Five denture stomatitis patients demonstrating Candida albicans on both maxillary dentures and palates volunteered to test the effects of Peridex oral rinse in treating their oral disease. They used Peridex rinse both as a mouthrinse and as a denture soak for a period of 24 days. Agar replicas of the tissue-fitting surfaces of the maxillary dentures revealed elimination of C. albicans. Significant decreases in palatal inflammation were also noted, although some inflammation was still evident. Several weeks after the termination of Peridex oral rinses, inflammation increased as concentrations of C. albicans on the denture surface returned to pretreatment levels. A marked similarity in the site-specific localization of this yeast species on the denture was noted before and after Peridex rinse treatment.

Role of pH in salivary histidine-rich polypeptide antifungal germ tube inhibitory activity

Purified synthetic salivary histidine-rich polypeptides (HRPs) 2, 3, 4, 5 and 6 were found to inhibit Candida albicans conversion of blastospores to germ tubes. HRP-4 was the best inhibitor within the pH 5 to 7 range tested and all of the HRPs were observed to lose potency as the pH was raised from 5 to 7. The pH pattern obtained with a synthetic homologous histidine peptide suggested that the protonated form of the histidine imidazole residues of the HRPs was important to the germ tube antifungal activity. Similar pH inhibition profiles of germ tube formation by parotid saliva and the HRPs were also observed.

Parameters affecting the inhibition of Candida albicans GDH 2023 and GRI 2773 blastospore viability by purified synthetic salivary histidine-rich polypeptides

Purified synthetic salivary histidine-rich polypeptides, HRPs 2, 3, 4, 5, and 6, were observed to inhibit Candida albicans blastospore viability at yeast cell concentrations ranging from 10(2) to greater than 10(6) colony forming units per ml. Among the HRPs, HRP-4 was the best inhibitor with significant killing activity noted at a peptide concentration of 0.5 microgram per ml. Antifungal potency under growth conditions was observed to be dependent upon pH. In contrast, killing did not vary throughout the pH range tested under non-growth conditions. Electron microscopy results demonstrated HRP damage at pH 5 which appeared to be initiated at the membrane. At pH 7.4, micrographs revealed clear evidence of intracellular destruction suggesting more extensive damage at neutral as compared to acidic pH. These results suggest that within the changing realm of the oral cavity, the HRPs would be expected to be potent killers of C. albicans.

Candidiasis in the breastfeeding mother and infant

Candidiasis in a breastfeeding mother and infant is described. The mother's breasts were a continuous source of Candida albicans, resulting in persistent thrush in the infant. The infant and mother were successfully treated with clotrimazole in a gel form. This report emphasizes the importance of treating both the infected mother and infant to prevent reinfection and ensure successful breastfeeding.