Alternate Names: Candidiasis - oral - adult; Adult oral candidiasis
Causes and Risks: Candida albicans is the organism that causes oral candidiasis and other forms of infection. It is an opportunistic organism meaning that it invades only when the conditions for its growth are optimal.
Oral thrush is a form of oral candidiasis that is frequently seen in infants and is not considered abnormal. However, oral candidiasis in adults should always be considered abnormal and occurs only when conditions that depress the immune system are present. These include AIDS, immunosuppression for transplant recipients, individuals in chemotherapy, diabetes, advanced age, generalized poor health, and inherited abnormalities of the immune system.
Classical symptoms of oral candidiasis include the appearance of whitish velvety plaques on the mucous membranes of the mouth and tongue. If the whitish material is scraped away the base may be red (erythematous) with pinpoint bleeding.
In immunocompromised people the infection may be massive, coating much of the surface of the mouth and tongue. In addition it may spread to the esophagus producing esophagitis candida with resulting painful difficult swallowing. Ultimately, the infection may become disseminated throughout the body.
The incidence of oral candidiasis in adults has increased dramatically with the spread of AIDS. HIV infected people are at high risk for oral candidiasis which often may be one of the first signs of HIV infection. (Note: in women, persistent or recurrent candidal vulvovaginitis may be a presenting sign of HIV infection).
Hard figures on the incidence of oral candidiasis in adults are not available but the incidence is thought to have doubled in the last decade. Extension of candidal infection is also seen more frequently including disseminated candidiasis (throughout the body). The death rate from disseminated candidiasis may reach 70%.
Prevention: There are no specific preventative measures available for adult oral candidiasis. Instead, the underlying cause must be determined and corrected whenever possible.
AIDS is a special case as it is considered a sexually-transmitted disease and is somewhat preventable by appropriate sexual behavior and avoidance of blood exposure. See AIDS.
Symptoms:
- whitish velvety plaques in the mouth and on the tongue
- slow increase in number and size of lesions
Signs and Tests:
- microscopic examination of scrapings reveals Candida species
- culture of mouth lesions grow Candida species
Treatment: There are two facets to treatment of adult oral candidiasis. The first is to improve the immune status of the individual. For example, in diabetics, good control of the diabetes may be enough to clear the infection without other treatment.
In people with AIDS it may not be possible to improve immune functioning. Then, powerful antifungal medications may be required.
The second facet is the direct treatment of the infection. Topical antifungal agents include:
- nystatin
- chlortrimazole (or other closely related agents)
These drugs are applied directly to the oral lesions or used as a liquid wash.
Resistant infections or infections in which dissemination has already taken place are treated with IV medications such as:- Amphotericin B
- ketoconazole (or other closely related agents)
Prognosis: Adult oral candidiasis can be cured. However, the long term outlook is dependent on the immune status of the individual and the cause of the immune deficit.
Complications:
You develop symptoms suggestive of oral candidiasis. If you have participated in high risk sexual activity at some time in the past, often as many as 5 to 10 years previously, and have developed any types of lesions in the mouth evaluation by a physician is indicated.
