Fungal infection in the mouth – HIV Infections?

Posted by Frank 06/03/2017 0 Comments Information HIV & AIDS,

Fungal infection in the mouth – HIV Infections?

 

BACKGROUND

Up to 75 percent of the population may be carriers of candida albicans. Under normal circumstances there is no basis for this is carrying the infection to develop into an infection - oral candidiasis (thrush). But when the environment changes in the oral cavity, such as illness and / or medication, significantly increases the risk of oral candidiasis. Fungal infection of the oral cavity can be the first signs of HIV infection.

 

Internationally seen various types of fungal infections in the oral cavity. In USA, virtually all oral fungal infections caused by various Candida species. The dominant species is Candida albicans, but some more therapy resistance variations also occur in small but increasing extent, for example, Candida glabrata and Candida krusei. Candida tropical is sometimes seen in neutropenic patients. In patients with AIDS is sometimes seen a particular species, Candida dubliniensis. This is more treatment-resistant, often to fluconazole (Diflucan). In total, it in humans found 17 different species of Candida.

 

Oral candidiasis occurs in all ages and are equally common in men as in women. In recent years, there has been an increased incidence of oral candidiasis after treatment with broad-spectrum antibiotics.

 

 

Division

Previously, oral candidiasis divided into several subsections. Today we are talking mainly about:
 

  • Erythematous candidiasis (red mushroom)
  • Pseudomembranous candidiasis (the white fungus)

For further broken the terms acute and chronic, which then describe the duration and clarify symptoms.

There is also a modern classification of oral candidiasis which divides the picture of the disorder:
 
Primary oral candidiasis (thrush solely related to the oral cavity)
Secondary oral candidiasis (yeast infection occurs in addition to the oral cavity also in other places in / on body)

 

CAUSES

The most common cause of oral candidiasis is reduced resistance of the individual, local or general.


Locally

Locally, the decreased resistance due to the burden a dental prosthesis is often combined with inadequate prosthetic function and / or poor oral hygiene, and reduced salivary secretion. The latter is a very common cause. Other local factors may include:
 

  • tobacco smoking
  • Frequent sugar-containing meals
  • Changes in the saliva quality

 

Generally

Generally reduced resistance can be seen at a number of different medical conditions that impair the immune system, for example:
 

  • tumor Diseases
  • Immunodeficiency diseases (especially T cell defect [HIV])
  • hematologic diseases
  • lack Permission
  • Malnutrition
  • endocrine diseases
  • Drug therapy such as antibiotics, chemotherapy and steroids

 

Symptoms and clinical findings
 

Symptoms

The subjective symptoms of oral candidiasis is often moderate. Many patients experience altered taste sensation, and especially at erythematous candidiasis are burning a common symptom. Smarting is also more pronounced at the infection with Candida glabrata and Candida crusei.

 

clinical findings
 

pseudomembranous candidiasis

In this form, the one usually white dots and plaques on the lining. If you scrape away the white layer is the underlying mucosa often redness and bleed easily.

 

erythematous candidiasis

Usually seen an intense redness mucosa. Not infrequently there is simultaneous burning. A classical variant is the so-called protein estimation (usually asymptomatic), i.e. a strongly flushing mucosa under the denture base for removable dentures.

Oral candidiasis often occurs along with cracks in the corners of the mouth, angular cheilitis.


differential diagnoses
 

Pain can be a symptom of many different conditions, not only oral candidiasis. Burning are common at various deficiency states. Burning sensation is also common opportunistic infections in the oral cavity with eg bacteria from the gut.

Other differential diagnoses:

Lichen (oral lichen planus, lichenoid reaction) - reticular not white lines, mainly buccal mucosa. Can also sometimes occur in an erosive form, and not infrequently mixed both forms. May occur with or without pain. Smarting constitute therapeutic indication. Treatment is local, with strong steroids, and often gives rise to candida as a side effect.

Leukoplakia - white single spot in the oral mucosa, not scrabbly, which have no explanation.


Lingua geografica is a change (normal variation) that occurs only on the tongue. White and red areas provide an image resembling a map. The white areas are not scrabbly.


Virus infections or viral reactivation usually have a completely different symptom such as severe pain and a clinical picture with usually less frequent blister formation, or ulceration (common).

 

INVESTIGATION

At pseudomembranous candidiasis is usually the clinical appearance enough to make a diagnosis. At erythematous candidiasis, may be difficult and sampling is usually necessary. Sampling is a must if given therapy are ineffective.
 

  • From lining scrapings taken for microbiological culture. To exclude only required abundant growth of Candida in test results.
  • For optimum test results are needed microscopy. The presence of fungal hyphae indicate infection.


TREATMENT
 

Acute forms, especially in children, often heal by themselves in 1-4 weeks. Drug-associated candidiasis disappear when the current drug therapy (eg antibiotics) ends.

 

In all fungal treatment, it is important that, if possible, remedy the underlying factors. Good oral and denture hygiene is a prerequisite for a successful result.


Dry mouth must be treated with saliva stimulants and saliva substitutes.

 

Drug therapy may be administered locally or systemically. Two things should be kept in mind when initiating therapy: first treatment must, in order to avoid relapse, continued for at least 1-2 weeks after symptoms. Partly shall not systemic and local combined.

 

Oral cavity status is an important indicator of the lack of efficacy of systemic fungal treatment. There you can pay attention to early signs of resistance development by fungal infection develop despite ongoing systemic treatment. During concomitant local treatment prevented this control.

 

At protesstomatit it is important to also treat the prosthesis. In addition to the medicaments tell treatment with chlorhexidine or Nystatin need prosthesis often adjusted by the dentist.

 

Tags: Fungal HIV