Kandidiasis mulut

Dr Putra Hendra SpPD

UNIBA
 Lining Mucosa

Don’t forget the soft palate

 ORAL CAVITY
 LIPS
 TEETH
 GINGIVA
 ORAL MUCOUS MEMBRANES
 PALATE
 TONGUE
 ORAL LYMPHOID TISSUES
 Patologi Oral
 Kongenital
 Traumatik
 Toksik
 Inflammatory
 Infectious
 Viral, bacterial, fungal
 Autoimmune

 Neoplastik
 Inflammatory
 Etiologi
 Viral
 Bacterial
 Fungal
 Flora normal

Flora normal adalah sekumpulan

mikroorganisme (bakteri, jamur, protozoa)
yang hidup pada pada kulit dan saluran
lendir (mukosa) manusia dan tidak
menyebabkan sakit.
Normal Flora Locations & Species

Basically every surface Note that much of those

(except deep lungs locations not mentioned are
and, perhaps, the sterile in healthy
stomach). individuals.
 Fungal Infections

 Candidiasis
 Deep fungal infections
 Mucormycosis
 Opportunistic Fungal Infections
 Require impairment of host immunity to cause serious infection
 Clinical infection - localized to severe systemic infection
 Yeasts:
 Candida spp. (albicans, tropicalis, parapsilosis, krusei, glabrata,
lusitaniae, kefyr, guilliermondii etc.)
 Cryptococcus neoformans
 Filamentous fungi:
 Aspergillus spp. (fumigatus, niger, flavus)
 Zygomycetes (Rhizopus, Mucor, Rhizomucor, Absidia)
 Fusarium spp.
 Penicillium spp. (marneffei)
 Pseudallescheria boydii (Scedosporium apiospermium)
 Curvularia spp.
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 Predisposing Factors
(Non-Immunologic)
 Chemotherapy (cytotoxic) - mucosal
damage of GI, respiratory, GU tracts
 Antibiotics - Broad spectrum; loss of
normal flora, esp. anaerobic
 Invasive devices - breach
skin/mucosal defences, i.e. intravenous
lines, urinary catheters, tracheostomies
 Invasive procedures - surgery,
10diagnostic biopsies
 Predisposing Factors
(Immunologic)
 Cancer (esp. hematological malignancy)
 Key defect: Neutropenia
 Organ Transplantation (bone marrow,
liver, lung, kidney)
 Key defect: Neutropenia, Impaired T cell
function
 Cellular Immune Dysfunction (AIDS,
lymphoma, CMC)
 Key defect: Impaired T cell function
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 Transmission of Opportunistic
Fungi

 Candida, Trichosporon, Malassezia

 ENDOGENOUS
 antibiotic
suppression of normal flora, fungal
overgrowth
 EXOGENOUS
 hand carriage health care worker

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 Candida
 MOST COMMON invasive fungal infection in
immunocompromised patients
 Species implicated in human disease most often:
 C. albicans
 C. tropicalis
 C. parapsilosis
 C. krusei (fluconazole resistant)
 C. glabrata
 C. lusitaniae (amphotericin B resistant)

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 Candida - Clinical
 Mucous membrane infections
 Thrush (oropharyngeal)
 Esophagitis
 Vaginitis
 Cutaneous infections
 Paronychia (skin around nail bed)
 Onychomycosis (nails)
 Diaper rash
 Balanitis
 Chronic mucotaneous candidiasis

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 children with T-cell abnormality
 Mucosal candidiasis

Oral thrush
15 Vaginal candidiasis
 Cutaneous candidiasis

Onychomycosis and paronychia Chronic mucocutaneous candidiasis

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 Penyebaran kandida
 Urinary tract infection
 Fungemia
 Disseminated (systemic, invasive) infection
 Immunocompromised patients
 Cancer/chemotherapy
 Neonatal candidiasis
 Endophthalmitis (eye)
 Liver and spleen
 Kidneys
 Skin
 Brain
17  Lungs
 Disseminated candidiasis

Endophthalmitis Disseminated skin lesion

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 Candidiasis (cont.)

 Types
 Pseudomembranous candidiasis
 Erythematous candidiasis
 Denture stomatitis
 Chronic hyperplastic candidiasis
 Angular cheilitis
 Chronic mucocutaneous candidiasis
 Median rhomboid glossitis
Pseudomembranous Candidiasis

 A white curdlike material is present

on the mucosal surface.
 The mucosa is erythematous
underneath.
 The patient may complain of a burning
sensation and/or a metallic taste.
Pseudomembranous Candidiasis (cont.)
 Erythematous Candidiasis

 The presenting complaint is an

erythematous, often painful mucosa.
 Maybe localized to one area of oral
mucosa or be more generalized
Erythematous Candidiasis (cont.)
 Denture Stomatitis
(Chronic Atrophic Candidiasis)
 The most common type of
candidiasis
 The mucosa is erythematous, but the
change is limited to the mucosa covered
by a full or partial denture.
 The pattern follows the outline of the
RPD or denture.
 Usually asymptomatic
 Denture Stomatitis
(Chronic Atrophic Candidiasis)
 Chronic Hyperplastic Candidiasis
(Candidal Leukoplakia)
 A white lesion that does not wipe off the
mucosa
 It will respond to antifungal medication.
 A lesion that does not respond to antifungal
medication should be biopsied.
Chronic Hyperplastic Candidiasis
(Candidal Leukoplakia)
 Angular Cheilitis

 Erythema or fissuring at the labial

commissures
 Most commonly from Candida, but may
be caused by other factors such as
nutritional deficiency
Angular Cheilitis
 Chronic Mucocutaneous Candidiasis

 A severe form that usually occurs in

patients who are severely
immunocompromised
 Thepatient has chronic oral and genital
mucosal candidiasis and skin lesions as well.
 Median Rhomboid Glossitis

 An erythematous, often rhomboid

shaped, flat to raised area on the
midline of the posterior dorsal tongue
 Candida has been identified in some
lesions, and some lesions disappear with
antifungal treatment.
 The response is not consistent, though.
Median Rhomboid Glossitis
057
058
060
071
069
 Laboratory
 Specimens - Blood, tissue (biopsy or
autopsy), sterile fluid, urine, CSF, skin,
respiratory secretions
 Microscopy (direct on specimen - except
blood and urine)
 Gram stain, Calcofluor
 Histopathology (tissues)
 H & E - stain poorly
 GMS, PMS - stain well

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  Culture (all specimens)
 Colony morphology
 White, smooth, creamy, sometimes
wrinkled
 Laboratory identification
 Unique color on chromagar
 antigen, antibody and metabolite detection
 NOT useful in routine practice
 Low sensitivity and specificity
 PCR
 Nomore sensitive than blood culture in
studies to date
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 Candida species
Candida albicans
Sabouraud Agar
Morphology: Creamy white yeast,
may be dull, dry irregular and
heaped up, glabrous and tough

Chromagar
producing green pigmented colonies
on specially designed medium to
speciate certain yeasts based on
color they produce

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 Candida antifungal susceptibility
testing

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Deep Candidiasis

Figure 1. Four forms of invasive candidiasis

(www.doctorfungus.org)
 Candida - Treatment
 Menghindari faktor predisposisi
 Lepas infus, kateter
 Imidazole (topical): clotrimazol, Econazol,
miconazol
 Antifungal therapy for systemic infection
 Amphotericin B IV
 Azoles (fluconazole, itraconazole,
voriconazole, posaconazole) orally,
intravenous
 Flucytosine (only with Ampho B because of
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resistance)