Classification of Oral Candida Infections

Candida species can be found as commensals in the mouths approximately 40% of normal subjects in amounts up to approximately 800 colony forming units (CFU)/ml. There is usually some underlying precipitating factor for oral candidiasis, often an immunodeficiency and in patients with various forms of candidiasis (Table 3.2), salivary counts of greater than 20,000 CFU/ml may be found. Oral candidiasis is a common condition, especially in patients with xerostomia, those taking immunosup-pressive drugs, those with other oral diseases, and in patients with HIV infection where approximately 40% may have oral candidiasis. All forms of candidiasis are

Table 3.1. Host Factors Predisposing to Oral Candidiasis

Local

Reduced salivary flow—e.g., Sjogren's syndrome, drugs Epithelial changes, e.g., lichen planus, leukoplakia Changes in commensal flora High carbohydrate diet Smoking

Systemic

Altered hormone state Diabetes Hypothyroidism Hyperparathyroidism

Adrenal suppression Iron or folate deficiencies

Immunosuppression

Drugs

Immunodeficiencies Altered polymorph function strongly associated with smoking. Oral can-didiasis is most commonly caused by the yeast Candida albicans, and to a far lesser extent by C. parapsilosis, C. tropicalis, C. glabrata, C. krusei, C. pseudotropicalis, and C. guilliermondi (Odds and Webster, 1988). More recently oral candidiasis has been associated with C. dubliniensis in HIV-infected individuals (Sullivan et al., 1995), other immunocompromised groups, and in Sjogren's syndrome (Challacombe et al., unpublished).

Acute pseudomembranous candidiasis (thrush, Fig. 3.1A) is a common infection in very young, elderly, or debilitated people. The white plaques are easily removable and contain Candida hyphae, spores, epithelial cells, and polymorphs (Fig. 3.1B). The condition is chronic in those with HIV-induced immune deficiency.

Acute atrophic candidiasis (Fig. 3.1C) is also known as antibiotic sore mouth because it frequently occurs during antibiotic therapy. This is a response to the suppression of the normal bacterial flora, and there is a widespread erythematous stomatitis with accompanying depapillation of the tongue.

Chronic atrophic candidiasis (CAC) (Fig. 3.1D) is also known as denture sore mouth and is very common. It presents as a relatively asymptomatic confluent erythema and inflammation of the entire denture-bearing mucosa of the palate. This results

Table 3.2. Classification of Oral Candidiasis

Acute

Acute/chronic

Chronic

Pseudomembranous

Erythematous candidiasis

Hyperplastic candidiasis

candidiasis (thrush)

(HIV-associated)

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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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