Introduction:
Candida is a group of fungi first isolated in 1844 from the sputum obtained from a tuberculosis patient. Candidiasis is caused by a yeast-like fungus or the Candida albicans species although several other sub-variants of candida fungus may be involved in causing this fungal infection of the oral cavity. Candida species usually exist in three forms known as the pseudohyphae, yeast, and also chlamydospore forms that rapidly thrive or grow in conditions similar to the oral cavity at 77 to 98.6 Fahrenheit, (detected orally by biochemical indicators or tests).
Like other fungi, these are usually non-photosynthetic, eukaryotic organisms with a characteristic cell wall that is external to their plasma membranes. These fungus even have a nuclear pore complex within the nuclear membrane. However, the mere presence of this fungus itself in the mouth is unlikely to cause candida infection (of the mouth) as it is normally present in the oral cavity, in the vagina, and in the gastrointestinal tract in healthy individuals. The invasion of such an infection by this fungus usually happens when several local or systemic predisposing factors contribute instead to the pathogenesis of the fungus in the oral cavity tissues or mucosa.
What Are the Underlying Factors That Cause Secondary Candidiasis?
Immunocompromised status of individuals like HIV (human immunodeficiency virus) infection, prolonged state of hospitalization, or chronic debilitating illnesses like the following are among the primary factors.
-
Nutritional deficiencies.
-
Myxedema (a rare complication of a thyroid-related condition).
-
Hypoparathyroidism (a medical condition that occurs when either of the parathyroid glands is not active).
-
Tuberculosis (bacterial disease affecting the lungs).
-
Diabetes mellitus (elevated blood glucose levels).
-
Anemia (a condition arising due to less production of healthy red blood cells).
Use of corticosteroids or corticosteroid therapy, poorly maintained dentures, chronic smoking, alcoholism, old age, infancy, or pregnancy. These individuals may also be predisposed to fungal Infections.
What Are the Various Secondary Candida Infections?
The commonly occurring secondary candidiasis infections or secondary candida-associated lesions are as follows:
1. Chronic Atrophic Candidiasis or Denture Stomatitis: Also called colloquially in dental literature as denture sore mouth, the infected denture region, usually the mucosal or ridge area bearing or in contact with the denture has a characteristic diffuse erythema or edema (redness or swelling) associated in this region of the oral cavity. Women are affected more commonly than men and the upper jaw mucosa is most commonly affected.
Though anti-fungal treatment would be the choice of treatment by the oral surgeon who will also suggest strict oral hygiene measures, there would still also be further presence of keratotic lesions (rough scaly patch on skin) that are superimposed upon this candida infection in the mouth, making this a complicated secondary candida associated disease. These include even possible precancerous lesions that do not regress only in treatment to antifungal therapy.
2. Chronic Mucocutaneous Candidiasis: This is a complex chronic group of secondary candidiasis infections that affects the skin, scalp, nails, and mucous membranes of the mouth. This has a genetic mode of inheritance or would be rather an inherited disorder with autosomal recessive characteristics. Lesions occur very early in life around the first decade itself, usually below five years of age, and have an equal gender distribution. The affected pediatric cases usually exhibit a complex form of Isolated IgA immunoglobulin cell-mediated impaired immunity. Oral manifestations may not only be severe but also compromise the patient's functional status.
3. Chronic Localized Mucocutaneous Candidiasis: In contrast to the previously mentioned lesions, this condition does not exhibit any genetic mode of inheritance. However these secondary candida lesions are also possible to occur early in life usually with oral involvement, granulomatous masses may form over the skin, face, and scalp which is a typical sign of localized mucocutaneous candidiasis. In the oral cavity, a dental surgeon recognizes the presence of several white plaques typically in the mucosal membranes. Nail involvement is also common.
4. Chronic Diffuse Mucocutaneous Candidiasis: This is a late-onset disease and appears instead as per oral pathology literature to be a hypersensitivity reaction to candida antigens in the body. This disease typically manifests as a vesicular and papular rash in patients suffering from chronic candidiasis already. The suffering patients exhibit extensive forms of crusting involving the limbs, scalp, face, groin, and shoulders. Intraorally, the mucous membranes are severely affected just as in chronic candidiasis. Hence it is a diffuse hypersensitivity reaction or rather a chronic secondary form of candidiasis disease with severe oral manifestations. This condition may appear after adulthood and is usually the least occurring incidence in terms of secondary candida group of Infections.
5. Candidiasis Endocrinopathy Syndrome: This is an endocrine syndrome or condition manifesting with severe oral features in relation usually to hypothyroidism, hypoparathyroidism, ovarian insufficiency, diabetes mellitus, or Addison's disease. Enamel hypoplasia occurring in young children is usually an added feature that signifies the early outset of this disease. Candida infections tend to be superimposed upon existing systemic endocrine disease conditions with the oral mucous membranes being commonly involved and other parts like nails, skin, and scalp are also affected by candida fungus.
What Is the Diagnosis of Secondary Candidiasis?
There are several tests that are used for the detection of antibodies, especially in investigating the invasive forms or secondary forms of candidiasis. These are :
-
Slide Agglutination Method: A quick diagnostic procedure that uses clumping, or agglutination, on a slide to identify the presence of particular antibodies or antigens in a sample.
-
Immunodiffusion Method: A method that looks for the formation of precipitin lines between an antigen and an antibody to determine whether a particular antibody or antigen is present.
-
The Phytohemagglutination Method: It is frequently employed in immunological tests and blood typing, and uses plant lectins to agglutinate red blood cells.
-
Methods for Coelectosynersis: Immunological tests based on the coaggregation of cells or particles coated with antigens when certain antibodies are present.
-
Immunoprecipitation Method: Antigen-antibody complexes are precipitated using immunoprecipitation methods to separate certain proteins for examination.
-
A and B Immunofluorescence Technique: Identifies blood group antigens A and B by fluorescence microscopy.
-
Unspecific Candida Antigens Method: Identifies the existence of candida antigens.
What Is the Treatment of Secondary Candidiasis?
Though primary candidiasis lesions can always be treated by an oral surgeon or dentist only through anti-fungal medication effectively (with topical application of antifungal ointments like Amphotericin B), this may not prove effective in chronic secondary infections of candidiasis.
In chronic mucocutaneous states, especially in candidiasis with immunosuppression (in individuals who are on systemic therapies or hospitalized long-term), topical agents may not be effective. In such instances, systemic administration of medications (Amphotericin B or Clotrimazole) is certainly required. Over a time period, the oral surgeon may notice the improvement in the patient's clinical features or symptoms.
Conclusion:
Secondary or chronic form and oral candidiasis is indeed a serious pathologic disease entity that needs both oral and systemic management by the physician and oral surgeon. With the appearance of symptoms, individuals should consult a health care professional for a timely diagnosis, that can help in devising proper oral or systemic management.
