Article Type : Research Article
Authors : Bouguezzi A*, Slim A, Khalifa C, Chokri A, Hentati H and Selmi J
Keywords : Oral candidosis; Candida albicans; Antifungal therapy; Oral health; Treatment guidelines; Immunocompromised patients
Oral candidosis (also
known as oral candidiasis) is a fungal infection primarily caused by Candida
species, most notably Candida albicans. This condition, which affects the oral
mucosa, can range from mild symptoms such as oral thrush to more severe, chronic
forms that complicate overall oral health. It is often seen in
immunocompromised individuals, but it can also affect healthy individuals under
certain conditions. The treatment of oral candidosis remains a challenge due to
the variety of clinical manifestations and underlying risk factors. This
article aims to provide a consensus on the management and treatment of oral
candidosis, summarizing evidence-based practices and expert recommendations for
antifungal therapy, adjunctive treatments, and the management of risk factors.
Oral candidosis is an opportunistic fungal infection
caused by Candida species, with Candida albicans being the predominant
pathogen. The infection affects the oral mucosa and can present in a variety of
clinical forms, ranging from acute pseudomembranous candidiasis (thrush) to
chronic hyperplastic candidiasis. Oral candidosis is common among patients with
risk factors such as immunocompromised, diabetes, denture wear, and the use of
broad-spectrum antibiotics or corticosteroids. The management of oral
candidosis is essential to prevent complications such as tissue damage,
discomfort, and systemic spread, especially in vulnerable populations like
those with HIV/AIDS, cancer patients undergoing chemotherapy, and the elderly.
This consensus aims to provide a comprehensive overview of the current
approaches for diagnosing, treating, and preventing oral candidosis, based on
the latest clinical guidelines and expert opinion.
Clinical Features and
Diagnosis
Oral candidosis presents in various forms, which can be differentiated based on clinical features:
A definitive diagnosis is made clinically, although microbiological culture, histopathology, and molecular tests such as PCR may be required in persistent or atypical cases [1,2].
Risk Factors
Several factors predispose individuals to the
development of oral candidosis, particularly those that compromise immune function
or alter the local oral environment:
Antifungal
Therapy
The primary treatment for oral candidosis is antifungal therapy. The choice of antifungal agent depends on the severity of the infection, the patient's immune status, and the clinical form of candidiasis. The following are the most commonly used antifungal treatments:
Nystatin
suspension: Often used for acute
pseudomembranous candidiasis, nystatin is swished and swallowed to target the
oral and esophageal mucosa.
Clotrimazole
lozenges: An effective option for local treatment
of oral candidiasis.
Miconazole
gel: Another effective topical antifungal,
especially for denture-associated candidiasis.
Topical treatments are preferred in immunocompetent patients or those with localized infections [11].
Fluconazole:
The most commonly prescribed systemic antifungal for candidosis, fluconazole
has good bioavailability and is effective against Candida albicans.
Itraconazole:
An alternative for patients intolerant to fluconazole or with resistant
infections.
Amphotericin
B: Reserved for cases of resistant or
disseminated candidiasis due to its broad antifungal activity [12,13].
Adjunctive
Treatments
Management
of Risk Factors
Addressing
the underlying risk factors is crucial for effective treatment and prevention
of recurrence:
Preventing the recurrence of oral candidosis is often
a long-term challenge, particularly in immunocompromised patients. Key
strategies include:
Prophylactic
Antifungal Treatment: In high-risk
populations, such as those undergoing chemotherapy or organ transplantation,
antifungal prophylaxis may be considered to prevent initial or recurrent
infections [20,21].
Regular
Oral Care: Daily oral hygiene practices, including
brushing and the use of antimicrobial mouthwashes, can help reduce the oral
load of Candida and prevent infection
[22].
Oral candidosis is a common condition that can
significantly affect patients' oral health and quality of life, particularly in
those with underlying risk factors such as immunocompromise, diabetes, and
denture use. The treatment of oral candidiasis primarily involves antifungal
therapy, which can be tailored to the severity of the infection and the
patient’s clinical status. A multidisciplinary approach that includes
management of underlying risk factors, patient education, and regular follow-up
is essential to prevent recurrence and improve patient outcomes. With proper
treatment, the prognosis for oral candidosis is generally good, though
attention to risk factors is critical for preventing further complications.