Orale candidiasis bij huidziekten - Symptomen, Diagnose en Behandeling

Histopathology

Oral candidiasis is a clinical diagnosis. Further evaluation is necessary when a differential diagnosis is required and for cases resistant to antifungal therapy.[8] However, a biopsy is indicated for chronic hyperplastic candidiasis due to its risk of malignant transformation.[8] The commonly implemented methods for identifying Candida are 10% potassium hydroxide stain and culture with sabouraud dextrose agar.[8] Differentiation of specific species is possible with special culture mediums like Chromagar Candida.[9] ELISA and PCR tests are used in cases of invasive candidiasis and to differentiate Candida dubliniensis from Candida albicans.[8]

Pseudomembranous candidiasis, also known as oral thrush, is the classic and most common presentation of oral candidiasis, but several other types exist. Candidiasis can appear in the oral cavity as white or erythematous lesions.[3] White lesions develop as pseudomembranous or hyperplastic lesions, erythematous lesions include atrophic lesions in acute and chronic forms, angular cheilitis, median rhomboid glossitis, and linear gingival erythema.[3] Other rare oral types that cannot be included in these categories are cheilocandidiasis, chronic mucocutaneous candidiasis, and chronic multifocal candidiasis.[3]

Acute Pseudomembranous Candidiasis

Pseudomembranous candidiasis is the most frequently encountered oral candidiasis, accounting for a third of cases.[3] It is most commonly seen in newborns and immunocompromised patients,[5] but the elderly are also susceptible.[3] Other risk factors include topical steroids use in the form of inhalers, gels, or rinses and decreased salivary flow.[5]

Hyperplastic Candidiasis

Hyperplastic candidiasis presents as slightly raised and well-circumscribed white plaques, usually on the buccal mucosa, which may extend to the labial commissures.[3] The lesions may also be nodular or spotted.[3] Unlike oral thrush, hyperplastic candidiasis cannot be easily wiped off.[3] Smoking seems to be linked to the development of the lesion, and smoking cessation is required for complete resolution.[4]

Prognosis

Although unlikely in an immunocompetent host, oral candidiasis can lead to pharyngeal involvement, which presents as dysphagia and respiratory distress. A significant concern for immunocompromised patients is the systemic dissemination of the disease. Candidal esophagitis is a prevalent complication of oral candidiasis in those with HIV/AIDS.

Patients with oral candidiasis should receive counseling regarding the future spread of the disease. They must also understand the importance of diagnosing and treating any immunosuppressive conditions.

Patients using steroid inhalers must be advised to rinse their mouth with water every time after application.[12]

Oral candidiasis has been linked to malnutrition, iron, and vitamin deficiency, patients must be advised on appropriate nutrition.[3]

Patients must receive appropriate advice regarding dentures and dental hygiene, which can prevent the development of oral candidiasis.

Quellenangaben

• Ai R, Wei J, Ma D, Jiang L, Dan H, Zhou Y et al. A meta-analysis of randomized trials assessing the effects of probiotic preparations on oral candidiasis in the elderly. Arch Oral Biol 2017, 83: 187-192. Aufgerufen am 23.08.2024.
• Carvalho CG, Medeiros-Filho JB, Ferreira MC. Guide for health professionals addressing oral care for individuals in oncological treatment based on scientific evidence. Support Care Cancer 2018, 26(8): 2651-2661. Aufgerufen am 23.08.2024.
• Clarkson JE, Worthington HV, Eden OB. Interventions for preventing oral candidiasis for patients with cancer receiving treatment. Cochrane Database Syst Rev 2007, (1): CD003807. Aufgerufen am 23.08.2024.
• Deutsches Krebsforschungszentrum (DKFZ), Krebsinformationsdienst (KID). Fieber bei Krebs: Beschwerden und Behandlungsmöglichkeiten. 2021. Aufgerufen am 23.08.2024.
• Deutsches Krebsforschungszentrum (DKFZ), Krebsinformationsdienst (KID). Mund- und Zahnpflege bei Krebs. 2010. Aufgerufen am 23.08.2024.
• Lyu X, Zhao C, Yan ZM, Hua H. Efficacy of nystatin for the treatment of oral candidiasis: a systematic review and meta-analysis. Drug Des Devel Ther 2016, 10: 1161-1171. Aufgerufen am 08.06.2020.
• Pankhurst CL. Candidiasis (oropharyngeal). BMJ Clin Evid 2013: 1304. Aufgerufen am 23.08.2024.
• Peterson DE, Boers-Doets CB, Bensadoun RJ et al. Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for diagnosis, treatment, and follow-up. Ann Oncol 2015, 26 (Suppl 5): v139-151. Aufgerufen am 23.08.2024.
• Pienaar ED, Young T, Holmes H. Interventions for the prevention and management of oropharyngeal candidiasis associated with HIV infection in adults and children. Cochrane Database Syst Rev 2010, (11): CD003940. Aufgerufen am 23.08.2024.
• Worthington HV, Clarkson JE, Khalid T et al. Interventions for treating oral candidiasis for patients with cancer receiving treatment. 2010, (7): CD001972. Aufgerufen am 23.08.2024.
• Yang C, Gong G, Jin E et al. Topical application of honey in the management of chemo/radiotherapy-induced oral mucositis: A systematic review and network meta-analysis. Int J Nurs Stud 2019, 89: 80-87. Aufgerufen am 23.08.2024.
• Zhang LW, Fu JY, Hua H et al. Efficacy and safety of miconazole for oral candidiasis: a systematic review and meta-analysis. Oral Dis 2016, 22(3): 185-195. Aufgerufen am 23.08.2024.

Etiology

Candida species cause oral candidiasis, most commonly Candida albicans, isolated from more than 80% of lesions.[3] Candida albicans is a dysmorphic yeast that can present as both hyphal and yeast forms depending on the environment.[3]

Candida is part of the normal oral microflora of immunocompetent individuals.[3] Around 30 to 60% of adults and 45 to 65% of infants carry candida species in their oral cavities.[5][3][5] Most of these species live in the oral cavity as a commensal population rather than a pathological one.[5]

Risk factors for the pathologic colonization of Candida include but are not limited to malnourishment, age extremes (young children and elderly), metabolic disease, immunocompromising conditions, concomitant infections, radiation therapy, organ transplantation, long-term steroid treatment, antibiotic treatment, and salivary gland hypofunction.[5]

Wie erkennt man Mundsoor?

Normalerweise ist Mundsoor von einem geschulten Auge schnell zu erkennen, auf Grund seines typischen Aussehens und den weißen Belägen im Mundraum. Nichtsdestotrotz wird dein Arzt eine ausführliche körperliche Untersuchung bei dir durchführen und deine Krankengeschichte aufnehmen, da es bestimmte Faktoren gibt, die eine Erkrankung begünstigen. Beispielsweise durch inhalative Glukokortikoide, Zahnprothesen oder eine Immunsuppression, z.B. im Rahmen einer HIV-Infektion oder einer Tumorerkrankung.

Um die Diagnose zu sichern und um zu untersuchen, um welchen Erreger es sich handelt, wird dein Arzt zusätzlich eine mikrobiologische Untersuchung anordnen. Dies geschieht in der Regel durch einen Abstrich an der Mundschleimhaut. So lässt sich der Erreger identifizieren und eine adäquate Therapie einleiten.

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