Orofaringealny candidiasis

Description:

The combination of a candidosis glossitis, pharyngitis and stomatitis (orofaringealny candidiasis) is rather eurysynusic disease at the persons suffering from various forms of immunodeficiencies, first of all AIDS.

Symptoms Orofaringealny candidiasis:

From the clinical point of view it is necessary to differentiate acute and chronic orofaringealny candidiasis. At acute process the general reaction of an organism which is shown intoxication phenomena (weakness, an indisposition, fatigue, rise in body temperature, etc.) is possible though its intensity is often low. Distinguish recuring (arises repeatedly after clinical recovery) and persistent (the clinic of pathological process remains a long time with bigger or smaller degree of manifestation) disease forms. Orofaringealny mycosis can be shown in the form of limited process or widespread (diffusion) that is most characteristic of the acute course of a disease. Local manifestations are rather various and are defined not so much by a species of the mushroom which caused pathological process, how many anti-mycotic activity of a specific individual.

Distinguish the following types of the localized oropharyngeal candidiasis: cheilitis, angular cheilitis (perleches), ulitis, glossitis, stomatitis, tonsillitis, pharyngitis.

At a candidosis cheilitis patients complain of dryness, burning of lips. The red border is hyperemic, moderately edematous, an ischerchena radially located grooves. Thin, skintight scales are often visualized. A current of a cheilitis the most often chronic that leads to development of a makrokheyliya. Lips (lower is more often) are considerably thickened, edematous, hyperemic, dry, with stratification of scales and serous crusts, there are multiple cross located deep cracks. At patients with chronic candidiasis the cheilitis is often combined with an angular cheilitis that can indicate insufficiency of a cellular link of immunity. The angular cheilitis (candidiasis of corners of a mouth, a perleche) meets, as at physiological immunodeficiencies (at adults 45 years are more senior, than children), and at an immunopathology. In corners of a mouth there are erosion of crimson color covered with easily removed plaque of white color. Borders of erosion rather accurate, at close lips can be imperceptible. Process more often bilateral, has a chronic current. Morbidity when opening a mouth is characteristic. From 38 patients inspected by us in 4 stages of HIV infection (AIDS) (according to the WHO classification) the angular cheilitis is revealed at 29 (76%). At a bacteriological research at 21 (72%) from them candidosis process is revealed.

The ulitis can arise, both as a result of fungal process, and at bacterial infection. Allocate a marginal ulitis (a regional gingivalny erythema) at which the mucous membrane covering edge of a gum is hyperemic, edematous, strained. The ulcer and necrotic form of a disease is characterized by progressing of process with an ulceration and a necrosis of gingival nipples and a marginal gingiva. At survey the necrotic film (is more often gray-yellow color) covering edge of a gum comes to light. Bleedings as spontaneous, and when toothbrushing are possible. This state is noted at patients with the expressed immune suppression [15,23]. The ulcer and necrotic ulitis is revealed by us at 74%  of HIV-positive people in a stage AIDS.

Fungal tonsillitis (tonsillomycosis) rather seldom meets is isolated, in most cases accompanies candidosis stomatitis, a glossitis. On almonds there are whitish, curdled character plaques which are localized preferential in lacunas of almonds. Plaques easily are removed, however quickly arise again. The inflammatory phenomena on a mucous membrane insignificant. Pain when swallowing is absent more often.

Damage of a mucous membrane of an oral cavity (stomatitis) – one of the most often met forms of superficial candidiasis.

Reasons Orofaringealny candidiasis:

This kind of candidiasis occurs at a third of oncological patients who completed a chemotherapy course. Besides, strikes diseases to 90% of the people sick with AIDS. In this regard it is proved that the milkwoman is a bright indicator of weak immune system.

Treatment Orofaringealny candidiasis:

Treatment of oropharyngeal candidiasis has to be individual for each patient taking into account the immune status, existence of associated diseases, localization, prevalence and sharpness of process [6,26]. Sensitivity of the activator to in vitro and in vivo medicines sometimes does not match, however, researches showed the importance of allocation of culture and definition of resistance for the choice of the specific scheme of treatment [33].

The complex method of treatment of oropharyngeal candidiasis includes the following fundamental principles: topical administration of modern antifungal drugs, general use of antifungal drugs, recovery of a normal biocenosis of intestines.

In most cases treatment of candidiasis is begun with purpose of local therapy. Drugs for topical etiotropic treatment are divided into two groups: antiseptic agents and antimycotics. Duration of treatment of acute forms of a disease of drugs of local action averages two-three weeks. Treatment is continued before total disappearance of clinical displays of oropharyngeal candidiasis then usually carry out within one week.

Antiseptic agents with antifunginalny action are appointed in the form of rinsings and greasings. These drugs are rather eurysynusic and available: Lugol solution, solution of permanganate potassium (1:5000), 1 of % solution of boric acid, 0,2% of a hlorgeksidin of a biglyukonat, 0,1% solution of Hexetidinum, 2-3% of Natrii hydrocarbonas, 1% of Iodinolum, 2-3% of propolis, 2% of copper sulfate. Rinsings carry out not less than three times a day and, besides, after each meal. To local antiseptic agents stability of microorganisms therefore their weekly alternation is recommended quickly enough develops. Refer irritant action on a mucous membrane and rather low level of anti-mycotic activity to shortcomings of this group of drugs [5]. Antimycotics of topical administration (half-yen and imidazolny derivatives – nystatin, levorinum, Amphotericinum, натамицин, флуконазол, кетоконазол, Clotrimazolum, etc.) appoint in the form of solutions, aerosols, tablets for a rassasyvaniye and chewable tablets. At their appointment it is necessary to explain to the patient that drug for topical treatment has to be in an oral cavity as long as possible. At a bystry proglatyvaniye they have no due effect on mycotic pathological process.

At a candidosis cheilitis and an angular cheilitis of fabric process 1-2% solution of aniline dyes with the subsequent topical administration of antifungalny ointments (levorin, nystatin, ointments Clotrimazolum, a mikospor, etc.).