INVESTIGATIONS OF ORAL CANDIDIASIS

1. INVESTIGATIONS OF
ORAL CANDIDIASIS
DEPARTMENT OF ORAL
MEDICINE AND RADIOLOGY

2. CONTENTS
 INTRODUCTION
 ETIOLOGY
 CLINICAL FEATURES
 INVESTIGATIONS
 CONCLUSION
 REFERENCE

3. INTRODUCTION
 Candidiasis is a disease caused by infection with
yeast like fungus , candida albicans , although other
species may also be involved such as C.tropicalis
,C.krusei , C.glabrata etc.
 Its occurrence has increased remarkably since the
prevalent use of antibiotics, which destroy the
normal inhibitory bacterial flora and
immunosuppressive drugs, particularily
corticosteroids and cytotoxic drugs.

4. ETIOLOGY
 Factors that alter immune system
 Blood dyscrasias
 Old age
 Radiation therapy
 HIV infection
 Endocrine abnormalities
 Diabetes mellitus
 Hypothyroidism
 Pregnancy
 Corticosteroid therapy
 Heavy smoking
 Antibiotic therapy
 Iron folic acid or vitamin deficiency

5. CLINICAL FEATURES
 Pseudomembraneous candidiasis is the most
common form.
 A burning sensation usually precedes the appearance
of as soft, creamy white to yellow, elevated plaques,
that are easily wiped off from the affected oral tissues
and leave an erythematous, eroded or ulcerated
surfaces which may be tender.
 Involvement of upper respiratory tract and
oesophagus is seen.
 Prodromal symptoms of rapid onset of a bad taste
and the loss of taste in adults.

6.  CHRONIC HYPERPLASTIC CANDIDIASIS:
1} Whitish areas to large dense opaques hard
and rough to touch.
2}sites are anterior buccal mucosa along the
occlusal line and laterodorsal tongue.
 CHRONIC ATROPHIC (ERYTHEMATOUS)
CANDIDIASIS:
1] red patch or velvet textured plaque
2] site is hard palate under a denture, dorsal
surface of tongue and mucosal surfaces

7.  CHRONIC MULTIFOCAL ORAL CANDIDIASIS:
1) Seen in multiple oral sites in combination
with angular cheilitis, median rhomboid
glossitis, and palatal lesions.
2) seen in chronic smokers
 CHRONIC MUCOCUTANEOUS CANDIDIASIS:
1. Rare syndromes with definable immune
defects in which there is persistent
mucocutaneous candidiasis that responds
poorly to tropical antifungal therapy.

8. INVESTIGATIONS
 SMEAR EXAMINATION:
1: histological examination of intraoral
scrapings.
2: a 10 to 20% KOH preparation can be used
for immediate microscopic identification of
yeast cells.
3: yeast cells appear dark blue after gram
staining and red / purple in PAS staining.

9.  HEMATOLOGICAL EXAMINATION:
1) since its associated with nutritional
deficiencies, blood dyscrasias or HIV.
2) estimation of lymphocyte and wbc,
blood sugar and serum ferritin.

10.  BIOPSY:
1) If clinically present as candidal leukoplakia,
epithelial dysplasia , squamous cell
carcinoma or lichen planus.
 Microbiology:
1) culture with sabouraud’s dextrose agar.
2) to distinct between yeast species.

11.  IMPRINT CULTURE TECHNIQUE:
1) this technique uses a sterile plastic foam pad
dipped in sabouraud’s broth placed inside suspects
mouth for 60seconds
2) colony counts in excess of 30 colony forming
units per mm2 and 49 CFU in denture wearers
suggestive of candidial infection.

12.  ORAL RINSE TECHNIQUE:
1) 10ml sterile phosphate buffered saline or sterile
water rinse for 10min.
2) rinse is centrifuged at 1700g for 10min and the
deposit resuspended in 1ml of sterile PBS.
3) now inoculation done in an appropriate media to
assess the colony forming units.

13.  IMMUNOLOGICAL TESTS:
1) delayed skin hypersensitivity to candida
antigens{ test for cell mediated immunity}
2) for testing humoral immunity ,candida
agglutinin test, candida complement fixation test, the
immunofluorescence and ELISA can be used.
3) ELISA IS THE BEST TEST OF CHOICE AS ITS
CHEAP, SENSITIVE AND QUICK.

14. CONCLUSION
Treatment of candida overgrowth does not seek the
eradication of candida from the diet or the person, but
rather a restoration of the proper and balanced
ecological relationship between man and yeast.

15. REFERENCE
 TEXTBOOK OF ORAL MEDICINE ORAL
DIAGNOSIS AND RADIOLOGY 2ND EDITION BY
RAVIKIRAN ONGOLE.
 BURKIT LW ORAL MEDICINE : DIAGNOSIS AND
TREATMENT