/I INVESTIGATION FOR INVESTIGATION FOR CANDIDIASISCANDIDIASIS

Dr Usha Dr Usha

CONTENTS :-

1. Definition

2.Classification

3. Clinical features and Differential

Diagnosis

4. Investigation for candiasis

5. Conclusion

6. references

CANDIDIASIS

It is multiplicity of

disease caused by yeast

like fungi C. Albicans

-Most common oral

manifestation

-Other species……

Classification:- 1.Acute Pseudomembranous Atrophic (Antibiotic sore mouth ) 2.Chronic Atrophic -Denture stomatitis (type I& II) -Median rhomboid glossitis -Angular chelitis cotinue……

Hyperplastic Denture stomatitis (papillary type) Median rhomboid glossitis (nodular type) Candidal leukoplakia Multifocal 3.Mucocutaneous Syndrome associated Localized /Generalized 4.Immunocompromised state

Predisposing Factors. The following predisposing factors for oral candidiasis have been defined by clinical observation:

1. Marked changes in oral microbial flora (due to the use of

antibiotics [especially broad-spectrum antibiotics], excessive

use of antibacterial mouth rinses, or xerostomia).2. Chronic local irritants (dentures and orthodontic appliances)3. Administration of corticosteroids (aerosolized

inhalant and topical agents are more likely to cause

candidiasis than systemic administration)

4. Poor oral hygiene5. Pregnancy6. Immunologic deficiency — congenital or childhood (chronic familial

mucocutaneous candidiasis ± endocrine candidiasis syndrome [hypoparathyroidism, hypoadrenocorticism], and immunologic immaturity of infancy) — acquired or adult (diabetes, leukemia,

lymphomas, and AIDS) — iatrogenic (from cancer chemotherapy, bone

marrow transplantation, and head and neck radiation)7. Malabsorption and malnutrition

CLINICAL FEATURES:-1.Acute pseudomembranous

candidiasis-Patchy white plaques or flecks on

mucosal surface.

- can be scraped – leave area of erythema.

Painful lesion . Rapid onset of bad taste and loss of

taste Burning sensation of mouth and throat. Differential diagnosis- food debris habitual cheek biting

Acute atrophic candidiasis presents as a red patch of atrophic or erythematous raw and painful

mucosa, with minimal evidence of the white pseudomembranous .

Antibiotic sore mouth- a common form of atrophic candidiasis

symptoms of oral burning, bad taste, or sore throat during

chronic iron deficiency anemia

ACUTE ATROPHIC CANDIDIASIS

CHRONIC ATROPHIC CANDIDIASIS DENTURE STOMATITIS (DENTURE SORE MOUTH)

.

Three clinical stages :-

First stage consists of numerous palatal petechiae The second stage displays a more diffuse erythema involving most (if not all) of the denture-covered mucosa

The third stageincludes the development of tissue granulation or nodularity(papillary hyperplasia) commonly involving the central areas of the hard palate and alveolar ridges

ANGULAR CHELITIS:-

MEDIAN RHOMBOID GLOSSITIS

Erythematous patches of atrophic papillae located in the

central area of the dorsum

more nodular,the condition is referred to as hyperplastic median rhomboid

CHRONIC HYPERPLASTIC CANDIDIASIS:-

CANDIDAL LEUKOPLAKIA

CHRONIC MULTIFOCAL CANDIDIASIS:-

CHRONIC MUCOCUTANEOUS CANDIDIASIS:-

DIFFERENTIAL DIAGNOSIS

Leukoplakia Lichan planus chemical burns Gangrenous stomatitis Drug reaction Syphilitic mucous patches

INVESTIGATION

Final diagnosis Design treatment Plan

1.CULTURE:-Sample collection – from oral scraping Imprint culture :- Sample--- Piece of foam soaked in liquid growth

medium--- pressed on mucosal surface - then inoculated.

Culture medium:- Sabouraud’sAgar Blood Agar Cornmeal Agar CHROMagar Pagano-Levin Agar

Inoculation At 37. For 48-72 hr Creamy white colonies, flat or hemispherical in shape ( Beer like aroma in sabouraud’s agar)

2.MICROSCOPIC EXAMINATION BY DIFFERENT STAINING:-

----Heat fixed smear is prepared Staining by :- 20% kOH Gram staining Periodic acid-Schiff stain Brown and brenn stain Gomoris methanamine silver

3. HISTOPATHOLOGIC EXAMINATION:- Biopsy specimen

fixing with 10% formalin + staining examination

hyphal penetration down to spinous cell layer, may invade entire epithelium,

connective tissue.

4.HUMAN SALIVARY MUCIN INVESTIGATION:-

MUC7-12-mer-L and 12-mer-D peptide ---- show potent antifungal activity ---- Their level is detected.

5.Rapid identification by DNA probe:-

- species specific probes are used to differentiate

C. dubliniesis .

6.RAPID IDENTIFICATION BY ORAL RINSE SOLUTION:-

Rinsing of mouth with 10 ml of sterile

phosphate buffered saline

Collect saliva after 1min.

Centrifuge for 10 min.

Incubation in serum at 37.C for 3 hr.

Germ tubes are seen.

7. IDENTIFICATION BY SPECIFIC PROBES:-

-By polynucleotide and Oligonucleotide

probes.

8.ELECTROPHORESIS & WESTERN BLOT TECHNIQUE:-

Sodium dodecyl SO4 -2 polyacrylamide gel electrophoresis & western blot

demonstrate outer cell wall layer of candida