Oral Candidiasis
Disease Details
Family Health Simplified
- Description
- Oral candidiasis, also known as thrush, is a fungal infection in the mouth caused by the yeast Candida, leading to white patches on the tongue and inner cheeks.
- Type
- Oral candidiasis is a fungal infection caused by Candida species, primarily Candida albicans. It is not inherited genetically but occurs due to an overgrowth of the fungus, often related to factors such as immunosuppression, antibiotic use, diabetes, or poor oral hygiene.
- Signs And Symptoms
- Signs and symptoms are dependent upon the type of oral candidiasis. Often, apart from the appearance of the lesions, there are usually no other signs or symptoms. Most types of oral candidiasis are painless, but a burning sensation may occur in some cases. Candidiasis can, therefore, sometimes be misdiagnosed as burning mouth syndrome. A burning sensation is more likely with erythematous (atrophic) candidiasis, whilst hyperplastic candidiasis is normally entirely asymptomatic. Acute atrophic candidiasis may feel like the mouth has been scalded with a hot liquid. Another potential symptom is a metallic, acidic, salty or bitter taste in the mouth. The pseudomembranous type rarely causes any symptoms apart from possibly some discomfort or bad taste due to the presence of the membranes. Sometimes the patient describes the raised pseudomembranes as "blisters." Occasionally there can be dysphagia (difficulty swallowing), which indicates that the candidiasis involves the oropharynx or the esophagus, as well as the mouth. The trachea and the larynx may also be involved where there is oral candidiasis, and this may cause hoarseness of the voice.
- Prognosis
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The severity of oral candidiasis is subject to great variability from one person to another and in the same person from one occasion to the next. The prognosis of such infection is usually excellent after the application of topical or systemic treatments. However, oral candidiasis can be recurrent. Individuals continue to be at risk of the condition if underlying factors such as reduced salivary flow rate or immunosuppression are not rectifiable.Candidiasis can be a marker for underlying disease, so the overall prognosis may also be dependent upon this. For example, a transient erythematous candidiasis that developed after antibiotic therapy usually resolves after antibiotics are stopped (but not always immediately), and therefore carries an excellent prognosis—but candidiasis may occasionally be a sign of more sinister undiagnosed pathology, such as HIV/AIDS or leukemia.
It is possible for candidiasis to spread to/from the mouth, from sites such as the pharynx, esophagus, lungs, liver, anogenital region, skin or the nails. The spread of oral candidiasis to other sites usually occurs in debilitated individuals. It is also possible that candidiasis is spread by sexual contact. Rarely, a superficial candidal infection such as oral candidiasis can cause invasive candidiasis, and even prove fatal. The observation that Candida species are normally harmless commensals on the one hand, but are also occasionally capable of causing fatal invasive candidiases has led to the description "Dr Jekyll and Mr Hyde".The role of thrush in the hospital and ventilated patients is not entirely clear, however, there is a theoretical risk of positive interaction of candida with topical bacteria. - Onset
- Oral candidiasis, or thrush, typically has a gradual onset. It is characterized by the appearance of creamy white lesions on the tongue, inner cheeks, and sometimes the roof of the mouth, gums, and tonsils. These lesions can cause discomfort and may bleed if scraped. Factors such as weakened immune systems, antibiotics, diabetes, and wearing dentures can contribute to the development of this condition.
- Prevalence
- Oral candidiasis, also known as oral thrush, is a common fungal infection caused by the Candida species, primarily Candida albicans. Its prevalence varies widely based on several factors, including age, immune status, and overall health. It is particularly common in infants, older adults, and individuals with weakened immune systems, such as those with HIV/AIDS, cancer, or diabetes. Usage of certain medications, such as antibiotics and corticosteroids, can also increase the risk. While exact prevalence rates can vary, it is estimated that up to 5-7% of newborns and around 5-8% of healthy adults may experience oral candidiasis at some point. The prevalence is significantly higher in immunocompromised individuals.
- Epidemiology
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In humans, oral candidiasis is the most common form of candidiasis, by far the most common fungal infection of the mouth, and it also represents the most common opportunistic oral infection in humans with lesions only occurring when the environment favors pathogenic behavior.
Oropharyngeal candidiasis is common during cancer care, and it is a very common oral sign in individuals with HIV. Oral candidiasis occurs in about two thirds of people with concomitant AIDS and esophageal candidiasis.The incidence of all forms of candidiasis have increased in recent decades. This is due to developments in medicine, with more invasive medical procedures and surgeries, more widespread use of broad spectrum antibiotics and immunosuppression therapies. The HIV/AIDs global pandemic has been the greatest factor in the increased incidence of oral candidiasis since the 1980s. The incidence of candidiasis caused by NCAC species is also increasing, again thought to be due to changes in medical practise (e.g., organ transplantation and use of indwelling catheters). - Intractability
- Oral candidiasis, also known as oral thrush, is not considered intractable. It is typically manageable and treatable with antifungal medications. The condition may recur, particularly in individuals with underlying risk factors such as immunosuppression, diabetes, or extensive use of antibiotics, but it generally responds well to appropriate treatment.
- Disease Severity
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Oral candidiasis, also known as oral thrush, is generally considered a mild to moderate condition but can vary in severity based on the patient's overall health.
1. **Mild to Moderate**: In healthy individuals, it typically presents as white, creamy patches on the tongue, inner cheeks, gums, or tonsils, accompanied by redness or soreness. It can cause discomfort but is usually manageable and treatable with antifungal medications.
2. **Severe**: In immunocompromised patients, such as those with HIV/AIDS, undergoing cancer treatment, or taking immunosuppressive drugs, oral candidiasis can become more severe. It may extend to the esophagus (esophageal candidiasis), causing pain, difficulty swallowing, and a more significant impact on overall health, requiring more aggressive treatment.
Severity is often correlated with the individual's immune status and any underlying health conditions. - Healthcare Professionals
- Disease Ontology ID - DOID:14262
- Pathophysiology
- Oral candidiasis, commonly known as oral thrush, is primarily caused by an overgrowth of the fungus Candida albicans. The pathophysiology generally involves the disruption of the normal oral microbial balance, which allows Candida to proliferate. Several factors can contribute to this disruption, including immunosuppression (due to conditions like HIV/AIDS or medications such as corticosteroids and immunosuppressants), diabetes mellitus, antibiotic use (which can reduce bacterial populations that compete with Candida), and poor oral hygiene. The overgrowth of Candida leads to white, creamy lesions on the tongue, inner cheeks, and sometimes the palate, tonsils, and throat. These lesions can be painful, cause a burning sensation, and may bleed when scraped.
- Carrier Status
- Carrier status for oral candidiasis refers to the condition where individuals carry Candida species, typically Candida albicans, in their oral cavity without showing symptoms of infection. Many healthy individuals can be asymptomatic carriers of Candida in their mouth.
- Mechanism
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Oral candidiasis, commonly known as oral thrush, is primarily caused by the overgrowth of the fungus *Candida albicans* in the mucous membranes of the mouth. Here are the details on its mechanisms and molecular mechanisms:
**Mechanism:**
1. **Colonization**: *Candida albicans* is a normal commensal organism in the human oral cavity. Under certain conditions, such as immunosuppression, antibiotic use, or disruption of normal oral flora, *Candida* can overgrow.
2. **Adhesion**: *Candida albicans* can adhere to epithelial cells in the oral cavity through adhesins, which are surface proteins that facilitate binding to host tissues.
3. **Invasion**: The fungus can transition from a yeast to a more invasive hyphal form. Hyphae penetrate the epithelial layers, causing damage to the mucosal tissues.
4. **Biofilm Formation**: *Candida* can form biofilms on oral surfaces, including dentures, which provide a protective environment against the host immune system and antifungal agents.
**Molecular Mechanisms:**
1. **Adhesion Molecules**: *Candida albicans* uses various adhesins, such as agglutinin-like sequence (ALS) proteins, to bind to host cells. These interactions are mediated by specific receptors on the surface of epithelial cells.
2. **Hyphal Formation**: Morphogenetic switching from yeast to hyphal form is regulated by multiple signaling pathways, including the cyclic AMP (cAMP)-protein kinase A (PKA) pathway and the mitogen-activated protein kinase (MAPK) pathway. These pathways control genes involved in filamentation, adhesion, and invasion.
3. **Hydrolytic Enzymes**: *Candida* secretes proteases (Sap proteins), lipases, and phospholipases that degrade host cell membranes and extracellular matrix components, facilitating tissue invasion.
4. **Immune Evasion**: *Candida albicans* can evade the host immune response through various mechanisms, including antigenic variation, secretion of factors that inhibit phagocytosis, and manipulation of host immune signaling pathways.
5. **Biofilm-specific Genes**: Biofilm formation involves the coordinated expression of genes such as *BCR1*, *EFG1*, and *TEC1*, which are crucial for the development and maintenance of the biofilm structure.
These molecular processes enable *Candida albicans* to establish infection, cause tissue damage, and persist in the oral cavity, leading to clinical symptoms of oral candidiasis. - Treatment
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Oral candidiasis can be treated with topical anti-fungal drugs, such as nystatin, miconazole, Gentian violet or amphotericin B. Surgical excision of the lesions may be required in cases that do not respond to anti-fungal medications.Underlying immunosuppression may be medically manageable once it is identified, and this helps prevent recurrence of candidal infections.
Patients who are immunocompromised, either with HIV/AIDS or as a result of chemotherapy, may require systemic prevention or treatment with oral or intravenous administered anti-fungals. However, there is strong evidence that drugs that are absorbed or partially absorbed from the GI tract can prevent candidiasis more effectively than drugs that are not absorbed in the same way.If candidiasis is secondary to corticosteroid or antibiotic use, then use may be stopped, although this is not always a feasible option. Candidiasis secondary to the use of inhaled steroids may be treated by rinsing out the mouth with water after taking the steroid. Use of a spacer device to reduce the contact with the oral mucosa may greatly reduce the risk of oral candidiasis.In recurrent oral candidiasis, the use of azole antifungals risks selection and enrichment of drug-resistant strains of candida organisms. Drug resistance is increasingly more common and presents a serious problem in persons who are immunocompromised.Prophylactic use of antifungals is sometimes employed in persons with HIV disease, during radiotherapy, during immunosuppressive or prolonged antibiotic therapy as the development of candidal infection in these groups may be more serious.The candidal load in the mouth can be reduced by improving oral hygiene measures, such as regular toothbrushing and use of anti-microbial mouthwashes. Since smoking is associated with many forms of oral candidiasis, cessation may be beneficial. - Compassionate Use Treatment
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For oral candidiasis, compassionate use treatments and off-label or experimental treatments might include:
1. **Amphotericin B:** Typically used for systemic fungal infections, it can be considered for severe or refractory cases of oral candidiasis when other treatments fail.
2. **Voriconazole:** Primarily used for invasive fungal infections, Voriconazole might be used off-label for severe oral candidiasis.
3. **Posaconazole:** Another broad-spectrum antifungal, posaconazole can be used off-label for treating severe cases.
4. **Echinocandins (e.g., caspofungin, micafungin, anidulafungin):** These are usually reserved for invasive candidiasis but can be considered for severe or recurrent oral candidiasis under special circumstances.
5. **Photodynamic Therapy (PDT):** Experimental treatment utilizing light-sensitive compounds and a specific light wavelength to target fungal cells.
These treatments are generally considered when standard antifungal medications like nystatin or fluconazole are ineffective or contraindicated. Always consult with a healthcare professional before considering alternative treatments. - Lifestyle Recommendations
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For oral candidiasis (commonly known as oral thrush), lifestyle recommendations include:
1. **Good Oral Hygiene**: Brush your teeth at least twice daily and use dental floss regularly. Clean your dentures thoroughly if you wear them.
2. **Healthy Diet**: Limit your intake of sugary foods and drinks, as sugar can promote the growth of Candida.
3. **Regular Dental Check-ups**: Visit your dentist regularly for check-ups and cleanings.
4. **Smoking Cessation**: Avoid smoking or using tobacco products, as these can increase the risk of developing oral thrush.
5. **Limit Alcohol**: Reduce or avoid alcohol consumption, which can disrupt oral flora.
6. **Balanced Diet**: Ensure you have a balanced diet to support your immune system, including adequate vitamins and minerals.
7. **Stay Hydrated**: Drink plenty of water to keep your mouth moist, which helps prevent infection.
8. **Rinse Mouth**: Rinse your mouth with a saltwater solution or an antifungal mouthwash as directed by your healthcare provider.
9. **Manage Underlying Conditions**: Work on managing any underlying health conditions, such as diabetes, which can contribute to the development of candidiasis.
10. **Medication**: Follow the antifungal medication regimen prescribed by your healthcare provider to treat the infection effectively. - Medication
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Oral candidiasis, also known as oral thrush, is a fungal infection caused by Candida species. The primary medication used to treat it includes antifungal agents such as:
1. **Topical antifungals:**
- Nystatin (mouthwash or lozenges)
- Clotrimazole (lozenges)
- Miconazole (gel)
2. **Systemic antifungals (for more severe cases):**
- Fluconazole (oral tablets)
- Itraconazole (oral solution)
Nan refers to a non-applicable or not available category, indicating that there is no relevant information or specific entry to be provided under that term for oral candidiasis. - Repurposable Drugs
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Repurposable drugs for oral candidiasis:
1. **Fluconazole**: An antifungal originally approved for various fungal infections and often used for treating oral candidiasis.
2. **Nystatin**: An antifungal specifically used for oral and gastrointestinal candidiasis.
3. **Itraconazole**: Another antifungal that can be repurposed for oral candidiasis.
4. **Clotrimazole**: Often used in lozenge form to treat oral fungal infections.
These drugs are known for their antifungal properties and can potentially be repurposed to treat oral candidiasis effectively. - Metabolites
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In the context of oral candidiasis (thrush), some key metabolites involved include:
- **Ethanol**: A byproduct of Candida metabolism.
- **Acetaldehyde**: Another metabolite produced during the metabolism of ethanol by Candida.
- **Candidalysin**: A peptide toxin produced by Candida albicans that contributes to tissue damage and immune response.
- **Mannan**: A polysaccharide component of the Candida cell wall that can be detected as an antigen.
These metabolites can contribute to the pathogenicity and symptoms of the infection. - Nutraceuticals
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Nutraceuticals, defined as food-derived products that provide health benefits beyond basic nutrition, have been explored for managing oral candidiasis. They may include probiotics, certain vitamins, and herbal extracts that possess antifungal properties or boost the immune system, potentially helping in the prevention or adjunctive treatment of oral candidiasis. For effective use, consulting a healthcare professional is recommended.
Regarding the term "nan," there might be confusion. If you meant "nanotechnology," it involves using nanomaterials to enhance the delivery and efficacy of antifungal agents in treating oral candidiasis. Nanoparticles can improve drug penetration and reduce side effects, offering a promising approach for future treatments. - Peptides
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Oral candidiasis, also known as thrush, is a fungal infection caused by the Candida species, most commonly Candida albicans. Treatment may involve antifungal medications, and some emerging research has investigated the use of peptides and nanoparticles (nan) for targeted therapy.
**Peptides**: Antimicrobial peptides (AMPs) have been studied for their potential to combat fungal infections, including oral candidiasis. These peptides can disrupt the cell membranes of the fungus, leading to its death. Examples include histatin and defensins, which are naturally occurring peptides in the human body with antifungal properties.
**Nanoparticles (Nan)**: Nanoparticles offer a promising approach for delivering antifungal agents directly to the site of infection with increased efficacy and reduced toxicity. Silver nanoparticles, for instance, have shown significant antifungal activity against Candida species. Additionally, nanoparticles can be engineered to carry antifungal drugs, improving their stability and bioavailability.
Overall, while traditional antifungal treatments remain the standard, research into peptides and nanoparticles holds promise for more effective and targeted treatments for oral candidiasis.