Oral cavity candidiasis

Description:

Candidiasis (candidosis) - a disease which is caused by drozhzhepodobny mushrooms of the sort Candida.

On a mucous membrane of a mouth and integuments different types of drozhzhepodobny mushrooms in the form of saprophytes live. Pathological changes most often cause Candida albicans, Candida tropicalis, Candida pseudotropicalis, Candida krusei, Candida guilliermondi. Localization of Candida in an oral cavity various: various sites of a mucous membrane, carious cavities, root channels. Candida albicans is the representative of resident microflora of an oral cavity of the person and it is found in a small amount and an inactive state in 50-70% of persons in the absence of clinical signs of candidiasis. The activator is found also on the surface of healthy skin, in urine, to Calais, a phlegm, etc. Candida albicans consists of the oval budding cells of 3 - 5 microns. The mushroom loves the "acid" environment (рН 5,8-6,5) and produces numerous enzymes, proteolytic, lipids and carbohydrates. Getting in epithelium cells, sometimes to a basal layer, mushrooms breed in them.

Oral cavity Candidiasis symptoms:

Displays of candidiasis of a mucous membrane of a mouth are various and depend on age of the patient, a condition of immune system, existence of associated diseases, reception of medicines (antibiotics, corticosteroids) and other factors.

On a clinical current distinguish acute and chronic forms. Acute candidiasis can proceed in the form of the milkwoman (acute pseudomembranous candidiasis) or acute atrophic candidiasis. Chronic candidiasis also exists in two clinical forms: chronic hyperplastic and chronic atrophic. They can develop as independent forms or to be transformed one to another.

Acute pseudomembranous candidiasis, or the milkwoman (candidosis acuta, s. soor), is one of the most often found forms of candidiasis of a mucous membrane of a mouth. At children of chest age the milkwoman is observed often and proceeds rather easily. At adults acute pseudomembranous candidiasis often accompanies какимлибо to somatic diseases: to a diabetes mellitus, blood diseases, hypovitaminoses, malignant new growths, etc.

The mucous membrane of a back of the tongue, cheeks, the sky, lips is surprised most often. It is hyperemic, dry. Against the background of a hyperemia there is a white plaque reminding the turned milk or the cottage cheese towering over the level of a mucous membrane. At the beginning of a disease he easily acts at a poskablivaniye the pallet, under it smooth, slightly edematous, hyperemic surface is found. In the heavy, started cases the plaque becomes more dense and is removed hardly, under it the erosive mucosal surface of a cover of a mouth is bared.

Patients complain of burning in a mouth, pain at meal, especially acute.

The acute pseudomembranous glossitis should be differentiated from a desquamative glossitis at which on a back of the tongue there are sites of desquamation of an epithelium which are constantly migrating on a back of the tongue and surrounded with a nimbus of the exfoliated epithelium. Acute candidosis stomatitis is differentiated from a leukoplakia and red flat depriving. At the last whitish films and small knots on a mucosal surface of a cover are formed owing to a hyperkeratosis and therefore it is impossible to remove them at a poskablivaniye. Carry out differential diagnosis of candidiasis and a soft leukoplakia, or white spongy nevus at which defeat is localized preferential in the area of a smykaniye of teeth and on a mucous membrane of lips. Color of a mucous membrane at a soft leukoplakia in the field of defeat belovatosery, a surface its rough, uneven, there are multiple small superficial erosion (grazes). The final diagnosis is made on the basis of data of a bakterioskopichesky research.

Acute atrophic candidiasis (candidosis acuta atrophica) is characterized by considerable morbidity, burning and dryness in an oral cavity. Mucous membrane bright-red, dry. At defeat of language its back becomes malinovokrasny color, dry, brilliant, threadlike nipples are atrophied. The plaque is absent or remains in deep folds, is removed hardly and represents a conglomerate of the lowered epithelium and a large number of mushrooms of the sort Candida in a stage of active budding (a mycelium, a pseudo-mycelium).

Acute atrophic candidiasis should be differentiated from allergic reaction to plastic of removable prostheses. An important role is played in this case by clinical observation of dynamics of change of a mucous membrane of a mouth after elimination of a prosthesis and carrying out a bakterioskopichesky research.

The general condition of patients with acute candidiasis does not suffer.

Chronic hyperplastic candidiasis (candidosis chronica hyper plastica) is characterized by education on a hyperemic mucous membrane of a mouth of a thick layer of a plaque, plotnospayanny with it, in a look a node of k or plaques. The plaque usually is located on a back of the tongue, in the sky. In language the area typical for a rhomboid glossitis is surprised more often.

Chronic hyperplastic candidiasis in the sky has an appearance of a papillary hyperplasia. In cases of the long, persistently proceeding disease the plaque becomes impregnated with fibrin, the zheltovatosery films which are densely soldered to the subject mucous membrane are formed. At a poskablivaniye the pallet the plaque is removed hardly, under it the hyperemic bleeding erosive surface is bared. Patients complain of dryness in a mouth, burning, and in the presence of erosion - on morbidity. This form of candidiasis should be differentiated from a leukoplakia and red flat depriving.

Chronic atrophic candidiasis (candidosis chronica atrophica) is shown by dryness in an oral cavity, burning, morbidity when carrying a removable prosthesis. The site of a mucous membrane corresponding to borders of a prosthetic bed, hyperemic, edematous, painful.

Chronic atrophic candidiasis at persons, it is long using removable plastinochny prostheses, it is characterized most often by damage of a mucous membrane of a mouth under prostheses (a hyperemia, erosion, a papillomatosis) in combination with a mycotic (barmy) perleche and a candidosis atrophic glossitis at which a back of the tongue of malinovokrasny color, dry, brilliant, threadlike nipples atrofichny. The Belovatosery plaque is available in a small amount only in deep folds and on side surfaces of language, is removed hardly. Under a microscope in a plaque find disputes and a mycelium of the sort Candida. This triad (an inflammation of the sky, language and corners of a mouth) is so characteristic of atrophic candidosis stomatitis that diagnosis it does not represent difficulties.

Oral cavity Candidiasis reasons:

Manifestation of pathogenic properties of mushrooms of the sort Candida depends mainly on a condition of a macroorganism. The major role in development of candidiasis is played by weakening of immune system. Candidiasis arises, as a rule, against the background of more or less expressed immunodeficiency or an imbalance of immune system.

Development of candidiasis can be promoted by serious associated diseases: malignant new growths, Vichinfektion, tuberculosis, endocrinopathies (diabetes mellitus, hypothyroidism, hypoparathyrosis, hypo and hyperfunction of adrenal glands). Diseases of a digestive tract, especially lowered acidity of a gastric juice and an akhiliya, often cause development of candidiasis of a mucous membrane of a mouth. Disturbance of carbohydrate metabolism at a diabetes mellitus is a favorable background for development of candidiasis. Candidiasis of a mucous membrane of a mouth it becomes frequent the first clinical sign asymptomatically of the proceeding diabetes mellitus. In all cases of chronic candidiasis, especially recurrent, it is necessary to conduct a blood analysis on the content of glucose for a diabetes mellitus exception.

Development of candidiasis of an oral cavity is promoted by prolonged treatment by corticosteroid drugs, cytostatics which suppress immune system of an organism and increase virulence of drozhzhepodobny mushrooms.

Owing to broad use of antibiotics in recent years the number of patients with candidiasis of a mucous membrane of a mouth considerably increased. Long reception of antibiotics breaks structure of resident microflora of an oral cavity therefore dysbacteriosis forms. There are an oppression of resident microflora of an oral cavity and sharp growth of virulence of uslovnopatogenny mushrooms of Candida causing a disease of a mucous membrane of a mouth (superinfection, autoinfection). Prolonged use of various antimicrobic drugs has similar effect (Trichopolum, хлоргексидин, сангвиритрин, etc.). Reception of antibiotics can cause also an intestinal dysbiosis, the investigation of what is hypo also avitaminosis In, B2, B6, C, PP that has in turn an adverse effect on a functional condition of a mucous membrane of a mouth (it becomes subject to influence of a candidosis infection).

Candidiasis can arise owing to beam influences, alcohol intake and drugs, oral contraceptives.

In some cases candidiasis develops owing to infection from the outside. A source of infection is the sick person, and infection can happen through a kiss, sexual contact, when passing the newborn in the infected patrimonial ways.

The great value in development of candidiasis is attached to a condition of a mucous membrane of a mouth and its immunity. Developing of candidiasis is promoted by a chronic injury of a mucous membrane of a mouth the keen edges of teeth, low-quality prostheses destroyed by crowns of teeth, etc. Decrease in resistance of a mucous membrane of a mouth owing to a chronic injury promotes easier penetration of sort Candida mushrooms into it and the subsequent disease. Allergenic action of prostheses from acrylic plastic at their long contact with a mucous membrane of a mouth is established. Besides, sort Candida mushrooms well grow on a surface of removable prostheses from acrylic plastic, supporting a chronic inflammation of a mucous membrane under a prosthesis.

Treatment of Candidiasis of an oral cavity:

Influence on the activator, hold treatment of associated diseases, events for increase in specific and nonspecific protection, sanitation of an oral cavity, recommend a balanced diet. Patients with persistently proceeding chronic forms of candidiasis have to undergo inspection at the therapist. Treatment of generalized and visceral forms of candidiasis is carried out by vrachimikolog.

Careful inspection and treatment of associated diseases, especially gastrointestinal pathology, diabetes mellitus, leukosis are important for successful treatment of the patient with candidiasis. At persistently current candidosis perleche prosthetics at which first of all it is necessary to recover bite height is necessary.

    * General treatment

Appoint inside antifungal drugs nystatin or levorinum on 1000000 PIECES of 4-6 times a day after food within 10 days. The daily dose has to be not less than 4000000 PIECES. Tablets are recommended to be crushed and, having put under language, to suck as they are badly soaked up in a digestive tract. It is better to appoint levorinum in the form of transbukkalny (zashchechny) tablets. (Each tablet contains 500 000 PIECES of levorinum.)

The good antifungal effect is observed at suction of Dekaminum in the form of caramel: on 1-2 caramel of 6-8 times a day (each 3 - 4 h). One caramel contains 0,00015 g of Dekaminum. To Odnudva of caramel place under language or for a cheek and hold to a full rassasyvaniye, without making whenever possible deglutitory movements that drug as long as possible was in contact with a mucous membrane of a mouth.

Amfoglyukamin appoint inside 200 000 PIECES 2 times a day after food. At the heavy and persistently proceeding forms of candidiasis of a mucous membrane of a mouth use Amphotericinum In at the rate of 250 PIECES on 1 kg of body weight (on a course to 2 000 000 PIECES) and locally in the form of ointment. Drug has good resorptive effect.

Diflucan has the expressed antifungal effect. It is appointed in capsules on 50-100 mg (depending on disease severity) 1 time a day. Diflucan has a long elimination half-life.

For reduction of dryness in oral cavities and impacts on fungal flora appoint 2-3% potassium iodide solution on 1 tablespoon in 2-3 times a day after food. Iodine shows the fungistatic properties during allocation through skin, a mucous membrane of a mouth and mucous glands. Besides, iodine well stimulates a sialosis. Sick candidiasis good high-quality nutrition with reduction of amount of digestible carbohydrates is necessary. Inside appoint group B vitamins (In, B2, B6), PP, C.

    * Topical treatment

To applications and greasing of a mucous membrane of a mouth apply 0,5% dekaminovy ointment, Amphotericinum ointment In (30 000 PIECES/g), 1% ointment and 1% Clotrimazolum solution (канестен). A mucous membrane of a mouth and a red border of lips process solutions of aniline dyes, first of all violet (1-2% solution a gene of cyanic violet, 2% methylene blue, solution of a fukortsin). The means alkalizing the environment in an oral cavity that perniciously affects fungal flora are effective. For this purpose apply rinsings of 2-5% borax solution (sodium тстроборат), 2% solution of Natrii hydrocarbonas, 2% solution of boric acid. For 1 time rinse not less than 1 glass, repeating the procedure of 5-6 times a day. For applications and greasing use 20% borax solution in glycerin, lyugolevsky solution in glycerin, etc.

At a barmy perleche and a cheilitis Unguentum Nystatini (on 100 000 PIECES on 1 g of a basis), 5% levorin ointment, 0,5% dekaminovy ointment, the I % ointment or cream of Clotrimazolum is effective. For topical treatment it is better to appoint several different drugs and to change them during the day or every other day.

Careful sanitation of an oral cavity, any exception of an injury of a mucous membrane are important. Sanitation of an oral cavity can be begun in 2-3 days after the beginning of antifungal treatment. At acute and chronic candidiasis careful processing of prostheses the same means (except for dyes) which use for processing of a mucous membrane of a mouth is necessary.