Oral mycosis – types, causes, symptoms, treatment

Proven content

Oral candidiasis (oral candidiasis) is an opportunistic fungal infection that is a common disease of the oral cavity. It is caused by a dimorphic yeast-like fungus from the Candida strain of the Cryptococoidiae family. About 90 strains are known.

Oral mycosis – types

Candida albicans is a particularly pathogenic strain of oral mycosis, although others are pathogenic as well:

1. Candida tropicalis,
2. Candida stellatoidea,
3. Candida pseudotropicalis,
4. candida krusei,
5. Candida parakruzei (parapsilosis),
6. Candida guilliermondii,
7. Candida zeylanoides,
8. Candida broke
9. Torulopsis glabrata,
10. Geotrichum white.

The pathogenic potential of these strains is insignificant, they reside saprophytically in the mouth in 60-70% of people. On the other hand, they become pathogenic under certain conditions, with the appearance of many contributing factors that disturb the biocenosis of the system. Candida carriers have an average of 300-500 colonies per ml of saliva. The number of colonies changes daily, higher numbers are observed in the early morning and late afternoon.

Resistance to Candida infection is complex due to various forms of oral mycosis, the different forms of Candida, and the relationship between the mucosal and systemic immune systems. Salivary antibodies are expected to inhibit Candida adherence to epithelial cells. In addition, there are a number of antifungal proteins in saliva, including histatin and calprotectin. In 90% of healthy people, positive skin reactions to C. albicans antigens are observed, which proves the specific acquired immunity to this species of yeast. Various immune deficiencies have been found in the course of oral mycosis.

Immune mechanisms they relate to specific, cellular, humoral or impaired function of granulocytes. On the one hand, primary and secondary immunological defects lead to the development of fungal infections, and on the other hand, mycosis impairs the functioning of immune mechanisms. In the course of oral mycosis, disturbances of the cellular response in the form of an increased percentage of active NK cytotoxic cells, impaired transformation and proliferation of T lymphocytes after stimulation with mitogen and with specific fungal antigens, abnormal lymphokine activity in the leukocyte migration inhibition test in the presence of Candida antigens. Candida antigens are of three main types in immunoassay: cell wall, culture filtrate, and cytoplasmic antigens. The method of choice in diagnosis is ELISAwhere purified cytoplasmic proteins are used as the antigen Candida albicans.

Often recurring oral mycoses should be consulted with your family doctor. Online consultation under the National Health Fund (NFZ) contracts via the halodoctor.pl portal.

Oral mycosis factors

General factors predisposing to oral mycosis are:

1. nutritional errors, poor absorption, a diet rich in carbohydrates,
2. deficiencies of folic acid, iron, zinc, B and C vitamins,
3. genetic nature,
4. immunological disorders: congenital and acquired, drug-induced, decreased immunity, decreased overall immunological reactivity, disorders of neutrophil and T-lymphocyte functions,
5. endocrine dysfunctions, especially hypoparathyroidism and thyroid gland, adrenal insufficiency, multi-endocrinopathies,
6. age, especially in infancy and the elderly, some physiological conditions: pregnancy, menopause,
7. napromienianie,
8. gastrointestinal diseases – hyperacidity, insufficient acidity, peptic ulcer disease,
9. some diseases of the oral mucosa, e.g. leukoplakia, lichen planus,
10. debilitating general diseases: uremia, leukemia, Hodgkin’s disease, acidosis, tuberculosis,
11. blood diseases, aplastic anemia, leukemia, agranulocytosis, neutropenia,
12. kidney disease
13. HIV infection (in AIDS patients 80% of oral mycosis),
14. neoplastic disease, lymphoma, thymoma, cancer,
15. organ transplantation,
16. administration of certain drugs: antibiotics, immunosuppressants, mainly corticosteroids, cytostatic drugs, cytotoxic drugs, psychotropic contraceptives, anticholinergics.

Local factors predisposing to oral mycosis are:

1. poor oral hygiene,
2. quantitative and qualitative changes in salivation, xerostomia, Sjögren’s syndrome,
3. favorable changes in the bacterial flora,
4. use of prosthetic restorations,
5. the presence of deep gingival pockets,
6. chronic inflammation of the mucosa,
7. microtrauma, especially of mechanical origin,
8. carious lesions.

In order to treat oral mycosis, it is used: its abundant growth in pure breeding, direct isolation and identification; growth in Sabouraud’s medium (fungus specific); detection – due to the dimorphism of the fungus – of the mycelial form (pseudo-hyphae – mycelial – more often associated with Candida infection); to a lesser degree blastospore (budding – yeast), serological reactions – agglutination, precipitation, flocculation; complement fixation, immunofluorescence, candidin skin tests, biochemical criteria, Oricult test (scrap or smear test).

It is also worth remembering that in the case of oral mycosis, you should go to the dentist. You can arrange a dental consultation at the Acrodent dental clinic.

Acute candidiasis

Kandydoza ostra niemowląt (acute oral candidiasis of children), called soor, appears in the first days of a baby’s life as initially tiny, milky white eruptions that then merge into white spaces resembling curdled milk. The lesions remain on the inflamed substrate.

Acute pseudomembranous candidiasis (acute pseudomembranous candidiasis) it appears as soft, white, sheepskin-like blooms similar to curdled milk. Efflorescence is quite strongly connected with the ground, therefore, when you try to detach them, bleeding spots appear. Foci in different eyes and sides of the mouth can merge into confluent spaces.

Acute atrophic candidiasis (candidiasis acuta atrophica) it is characterized by a vivid red color caused by thinning of the epithelium. It is often found in antibiotic therapy, with drugs administered orally, also in heavy tobacco smokers. The bothersome symptoms include burning of the mucosa and considerable sensitivity to spicy and acidic foods. Atrophic changes in the papillae of the tongue lead to a smooth image. As a result of drying the epithelium, it causes cracks and erosions.

Chronic candidiasis

Chronic hyperplastic candidiasis (chronica hyperplastica candidiasis) it often arises on the basis of already present proliferative changes and is a complication of them.

Chronic atrophic candidiasis (candidiasis chronica atrophica) it arises mainly in people who wear removable prosthetic restorations XNUMX hours a day. Hence a special location is the hard palate. Diffuse reddening of the palate and smoothing of the tongue are clinically visible under the denture plate. This typical prosthetic inflammation of the oral mucosa (stomatitis protethica) is caused by: mechanical trauma, the action of bacterial agents, a reaction to the chemical components of the material of prosthetic restorations, disturbances in salivation, but the main pathogenic factors are the disturbance of the oral cavity biocenosis and infection with yeast-like fungi. Optimum conditions for their multiplication are created under the denture plate. Cleansing by saliva is impossible, food debris is deposited under the denture plate, bacterial plaque accumulates, temperature rises, oxygen access to the mucosa is impeded. These optimal conditions accompany the plates of the upper jaw, especially those made of acrylic, and concern the palate.

It favors the occurrence of an infection wearing dentures XNUMX hours a day, also injuries related to the act of chewing and rough, rough, insufficiently smooth and porous surfaces of the plate as well as an acidic and anaerobic environment. The degree of adhesion of Candida colonies – the greatest is to natural teeth, less to acrylic material, then to metal and the smallest to porcelain. Children who wear orthodontic appliances are also infected, and 47% of them had positive culture results. Typically, the stomatitis protethica lesions cover the mucosa surface covered by the prosthesis plate and are sharply demarcated from the healthy adjacent mucosa. Histologically, there is a decrease in the thickness of the epithelium, the absence of the stratum corneum, enlargement of the intercellular spaces, infiltrates consisting of plasma cells, lymphocytes and multinucleated cells.

Treatment of oral mycosis lesions it should be carried out for a sufficiently long period of time in view of the possibility of relapse once the drug intake is stopped. It is necessary to use an antifungal medication for at least two weeks after the eruptions have disappeared. In relation to people resistant to antifungal therapy, there is a suggestion of the presence of an undetected immune defect in them.

In addition to pharmacological treatment of oral mycosis, it is important to eat a low carbohydrate diet, plenty of vegetables and fruit, and drinking sour milk, yogurt, and kefir.

In order to treat oral mycosis, the following are used:

1. brushing of efflorescence with iodine preparations: Tinct. Jodi 1,0 Dijodani 2,0 Glycerini 20,0 Glycerini 20,0;
2. dips with 2% aqueous solutions of brilliant green;
3. soaps with 2% aqueous solutions of methylene blue;
4. Salt. aquosa 10% Natrii bicarbonici 50,0 – 1/2 teaspoon per glass of rinse water;
5. Aphthin – for brushing the mucosa;
6. Natrii bicarbonici 3,0, Glycerini 50,0 – for brushing;
7. The new statue:
8. Nystatyni pro susp. 2 IU – brushing suspension – 400 times a day,
9. Nystatyni in tabl. a 500 IU – suck tablets,
10. Natamycyna:
11. Pimafucini dragee 100 mg – suck 3 dragee 4-XNUMX times a day,
12. Pimafucini cream – apply 2-3 times a day,
13. Pimafucorti liquid – 2-3 times a day for coating,
14. Amphotericin B;
15. Fungizone in a suspension – to the dust;
16. Imidazole:
17. Miconazole (Dactarin 2% Cream),
18. Ketokonazol (Nizoral 2% cream),
19. Clotrimazole – XNUMX% cream,
20. Chlorhexidine – 0,2% – rinse solution.
21. Nystatyni pro susp. 2 IU – brushing suspension – 400 times a day,
22. Nystatyni in tabl. a 500 IU – suck tablets,
23. Pimafucini dragee 100 mg – suck 3 dragee 4-XNUMX times a day,
24. Pimafucini cream – apply 2-3 times a day,
25. Pimafucorti liquid – 2-3 times a day for coating,
26. Miconazole (Dactarin 2% Cream),
27. Ketokonazol (Nizoral 2% cream),
28. Clotrimazole – XNUMX% cream,
29. Chlorhexidine – 0,2% – rinse solution.

In cases of stomatitis protethica, the above-mentioned fungicidal drugs, including miconazoles in the form of a gel, can be used. It is also important to replace the prosthetic restoration.

It is believed that exclusively pharmacological treatment of oral mycosis it gives 30% of permanent healings, and 95% together with prosthetic treatment.

Infection Candida albicans it also accompanies other diseases of the oral mucosa, such as angular cheilitis, hairy tongue, geographic tongue and rhomboidal inflammation of the middle part of the tongue.

Angular inflammation of the lips

Cheilitis angularis is a staphylococcal-streptococcal-fungal infection.

General factors predisposing to this disease are:

1. skin diseases (impetigo, seborrheic eczema, Besnier’s prurigo, acne), especially if they are located on the face, close to the mouth,
2. circulatory disorders,
3. blood diseases: hypochromic anemia, malignant anemia, leukemia, Hodgkin’s disease,
4. metabolic disorders, diabetes,
5. gastrointestinal diseases: acidosis, hyperacidity,
6. hormonal disorders, hypoparathyroidism, hypothyroidism,
7. vitamin deficiency: B2, B6, PP,
8. some physiological conditions, pregnancy, menopause,
9. allergic changes,
10. trophic disorders.

Local factors, predisposing to angular cheilitis:

1. anatomical shaping of the facial integuments, small vertical dimension of the face,
2. sagging facial muscles,
3. lowering the occlusal occlusal height,
4. bite disorders,
5. folding and graining of the skin at the corners of the mouth,
6. congenital fistulas of the corners of the mouth,
7. constant habitual mouth breathing,
8. excessive salivation, saliva leakage and a significant dry mouth,
9. poor oral hygiene,
10. wearing prosthetic supports, defects in their workmanship,
11. electro-galvanic damage in the presence of dissimilar metals in the oral cavity,
12. mechanical injuries.

The lesions more often affect both angles of the mouth than one. Initially, a focus of macerated skin is formed, surrounded by an inflammatory rim. The lip may be slightly swollen. The irritation from chewing and speaking then leads to cracks and nicks, and sometimes to fissures and cuts.

Treatment:

1. administration of vitamin B2, B6, folic acid,
2. if possible, remove predisposing factors,
3. the use of anti-inflammatory drugs,
4. the use of antifungal drugs,
5. administration of antiallergic drugs,
6. the use of drugs preventing excessive drying of the lips,
7. locally:
8. Rp. Hydrocortisoni 0,1,
9. 3% boric acids,
10. Eucerini aa 10,0,
11. Nystatyni 2000000 (4 tablets),
12. DS for application to the angles of the mouth.
13. Rp. Hydrocortisoni 0,1,
14. 3% boric acids,
15. Eucerini aa 10,0,
16. Nystatyni 2000000 (4 tablets),
17. DS for application to the angles of the mouth.

Black tongue, hairy (lingua nigra, villosa)

The incidence of 0,37%. It arises as a result of excessive growth, increased keratosis of the filamentous papillae of the tongue and an accumulation of dark pigment between them. During the chewing act, there is no physiological abrasion or exfoliation of the filamentous papillae. The lesions take on a yellow, brown, even black color. They are located on the dorsal surface of the tongue, in the midline, in front of the papillae surrounding the tongue, and have a triangular shape. Sometimes there are symptoms in the form of burning or tickling of the palate.

Etiopathogenetically black tongue formation is associated with fungal infection, often following oral administration of antibiotics. The changes sometimes persist for a long time, especially in heavy tobacco smokers. The treatment is to scrape the excessively enlarged filamentous papillae with a teaspoon and prescribe antifungal drugs.

In addition to the described mycosis in the oral cavity, other forms of mycoses, parasitic and protozoal diseases can be found, although rarely.

Some of the ones seen in the mouth include:

1. mycoses: blastomycosis, aspergillosis, histoplasmosis, coccidiosis, cryptococcosis, mucormycosis, sporotrichosis,
2. parasitic diseases: amoebiasis, cysticercosis, coccidiosis.

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