Mucocutaneous candidiasis

Figure 3.1. (A) Acute pseudomembranous candidiasis. Note the white plaques, which consist of hyphae, desquamated epithelial cells, and polymorphonuclear leukocytes. (B) Cytological smear from pseudomembranous candidiasis showing hyphae, desquamated epithelial cells, and polymorphonuclear leukocytes (Periodic acid Shiff stain). (C) Acute atrophic candidiasis (antibiotic sore tongue) showing generalised depapillation of the dorsum of the tongue secondary to Candida overgrowth. (D) Chronic atrophic candidiasis. Chronic atrophic candidiasis in a patient who wears a cobalt chrome partial upper denture. The mid-portion of the palate is of normal color, but the mucosa under the denture is very erythematous. (E) Chronic hyperplastic candidiasis. Mixed red and white plaques inside the buccal mucosa in the commissure areas. These are often slightly raised and histologically show hyphal invasion. (F) Section from chronic hyperplastic candidiasis showing invading hypha forms of Candida (PAS stain). (G) Median rhomboid glossitis, a form of chronic hyperplastic candidiasis of the tongue, usually found at the junction of the anterior two thirds and posterior third of the tongue. (H) Erythematous candidiasis. The central portion of this tongue is very erythematous as well as depapillated. This patient has AIDS. (I) Erythematous candidiasis. The central portion of the palate is very erythematous. No white plaques are seen. This patient has AIDS.

from Candida colonization of the surface of the denture, usually in patients who wear their prostheses continuously day and night. There is no evidence of invasion by Candida hyphae.

Chronic hyperplastic candidiasis (CHC) (Fig. 3.1E) is a speckled or nodular chronic leucoplakia usually found in middle-aged or elderly patients. It is an invasive form of candidiasis with hyphae present often throughout the depth of the epithelium (Fig. 3.1F). There is a significant risk of malignant transformation. One form of CHC, which affects the dorsum of the tongue, is known as median rhomboid glossitis (Fig. 3.1G).

A more recently recognised entity, ery-thematous candidiasis, is often found associated with HIV infection. It presents as areas of erythema in the absence of white plaques (Challacombe, 1991), usually of the tongue (Fig. 3.1H) or palate (Fig. 3.1I).

Angular cheilitis is probably not a condition that occurs in the absence of intraoral increases in Candida, which probably acts as the reservoir for infection. There are a number of cofactors such as iron deficiency and inadequate denture construction involved in the pathogenesis of the disease although it is highly likely that the frequently cracked, macerated, thin, moist atrophic epithelium would be a key predisposing factor.

Chronic oral hyperplastic candidiasis may occur as part of chronic mucocutaneous candidiasis (CMCC), often with identifiable immunological or endocrine abnormalities as major factors. Endocrine disorders such as hypothyroidism, hypoparathyroidism, and adrenal insufficiency, have a familial incidence and are found in children and young adults, particularly in girls. The most frequently associated endocrine manifestations include idiopathic hyperparathy-roidism and hypoadrenocorticism, but candidiasis follows only where there is an immune defect (Kostiala et al., 1979).

Thus there are several different forms of oral candidiasis with a varying preponder ance of yeast or hyphal forms, and with or without invasion of the host tissues. It is certainly possible or even likely that immune mechanisms for protection vary with the different clinical forms.

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