candidal growth in oral micro flora & its characteristic features.

1. /IINVESTIGATION FORINVESTIGATION FOR
CANDIDIASISCANDIDIASIS
Dr UshaDr Usha

2. CONTENTS :-
1. Definition
2.Classification
3. Clinical features and Differential
Diagnosis
4. Investigation for candiasis
5. Conclusion
6. references

3. CANDIDIASIS
It is multiplicity of
disease caused by yeast
like fungi C. Albicans
-Most common oral
manifestation
-Other species……

4. Classification:-
1.Acute Pseudomembranous
Atrophic
(Antibiotic sore mouth )
2.Chronic Atrophic
-Denture stomatitis
(type I& II)
-Median rhomboid glossitis
-Angular chelitis
cotinue……

5. Hyperplastic
Denture stomatitis
(papillary type)
Median rhomboid glossitis
(nodular type)
Candidal leukoplakia
Multifocal
3.Mucocutaneous
Syndrome associated
Localized /Generalized
4.Immunocompromised state

6. Predisposing Factors. The following predisposing
factors for oral candidiasis have been defined by clinical
observation:
1. Marked changes in oral microbial flora (due to the use of
antibiotics [especially broad-spectrum antibiotics],
excessive
use of antibacterial mouth rinses, or xerostomia).
2. Chronic local irritants (dentures and orthodontic
appliances)
3. Administration of corticosteroids (aerosolized inhalant
and topical agents are more likely to cause candidiasis
than systemic administration)

7. 4. Poor oral hygiene
5. Pregnancy
6. Immunologic deficiency
— congenital or childhood (chronic familial
mucocutaneous
candidiasis ± endocrine candidiasis syndrome
[hypoparathyroidism, hypoadrenocorticism],
and immunologic immaturity of infancy)
— acquired or adult (diabetes, leukemia, lymphomas,
and AIDS)
— iatrogenic (from cancer chemotherapy, bone marrow
transplantation, and head and neck radiation)
7. Malabsorption and malnutrition

8. CLINICAL FEATURES:-
1.Acute pseudomembranous candidiasis
-Patchy white plaques or flecks on
mucosal surface.

9.  - can be scraped – leave area of
erythema.
 Painful lesion .
 Rapid onset of bad taste and loss of taste
 Burning sensation of mouth and throat.
Differential diagnosis-
food debris
habitual cheek biting

10.  Acute atrophic candidiasis
 presents as a red patch of atrophic
 or erythematous raw and painful mucosa,
with minimal evidence
 of the white pseudomembranous .
Antibiotic sore mouth- a common form of
atrophic candidiasis
 symptoms of oral burning, bad taste, or
sore throat during
 chronic iron deficiency anemia

11. ACUTE ATROPHIC CANDIDIASIS

12. CHRONIC ATROPHIC CANDIDIASIS
DENTURE STOMATITIS (DENTURE SORE MOUTH)
 .

13. Three clinical stages :-
 First stage consists of numerous palatal
petechiae The second stage displays a
more diffuse erythema involving most (if
not all) of the denture-covered mucosa
 The third stageincludes the development
of tissue granulation or
nodularity(papillary hyperplasia)
commonly involving the central areas of
the hard palate and alveolar ridges

14.  ANGULAR CHELITIS:-

15.  MEDIAN RHOMBOID GLOSSITIS

16.  Erythematous patches of
 atrophic papillae located in the central
area of the dorsum
more nodular,
the condition is referred to as hyperplastic
median rhomboid

17.  CHRONIC HYPERPLASTIC CANDIDIASIS:-

18.  CANDIDAL LEUKOPLAKIA

19.  CHRONIC MULTIFOCAL CANDIDIASIS:-

20.  CHRONIC MUCOCUTANEOUS
CANDIDIASIS:-

22. DIFFERENTIAL DIAGNOSIS
 Leukoplakia
 Lichan planus
 chemical burns
 Gangrenous stomatitis
 Drug reaction
 Syphilitic mucous patches

23. INVESTIGATION
Final diagnosis Design treatment
Plan

24. 1.CULTURE:-
Sample collection – from oral scraping
Imprint culture :-
Sample--- Piece of foam soaked in liquid growth
medium--- pressed on mucosal surface - then
inoculated.
Culture medium:- Sabouraud’sAgar
Blood Agar
Cornmeal Agar
CHROMagar
Pagano-Levin Agar

25. Inoculation
At 37. For 48-72 hr
Creamy white colonies, flat or
hemispherical in shape
( Beer like aroma in sabouraud’s agar)

27. 2.MICROSCOPIC EXAMINATION BY
DIFFERENT STAINING:-
----Heat fixed smear is prepared
Staining by :-
20% kOH
Gram staining
Periodic acid-Schiff stain
Brown and brenn stain
Gomoris methanamine silver

29.  3. HISTOPATHOLOGIC EXAMINATION:-
Biopsy specimen
fixing with 10% formalin + staining
examination
hyphal penetration down to spinous cell
layer, may invade entire epithelium,
connective tissue.

30. 4.HUMAN SALIVARY MUCIN
INVESTIGATION:-
MUC7-12-mer-L and 12-mer-D peptide
---- show potent antifungal activity
---- Their level is detected.

31.  5.Rapid identification by DNA probe:-
 - species specific probes are used to
differentiate
 C. dubliniesis
 .

32.  6.RAPID IDENTIFICATION BY ORAL
RINSE SOLUTION:-
Rinsing of mouth with 10 ml of sterile
phosphate buffered saline
Collect saliva after 1min.
Centrifuge for 10 min.

33.  Incubation in serum at 37.C for 3 hr.
 Germ tubes are seen.

34. 7. IDENTIFICATION BY SPECIFIC PROBES:-
-By polynucleotide and Oligonucleotide
probes.

35.  8.ELECTROPHORESIS & WESTERN BLOT
TECHNIQUE:-
Sodium dodecyl SO4 -2 polyacrylamide
gel electrophoresis & western blot
demonstrate outer cell wall layer of
candida