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Acute pseudomembranous candidiasis on buccal mucosa.  

Acute pseudomembranous candidiasis on buccal mucosa.  

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The incidence of oral fungal infections has increased in recent years as a result of factors such as increased number of solid organ transplantations and the widespread use of immunosuppressive drug therapies. This article reviews the diagnosis and treatment of oral fungal infections. At one time oral fungal infections were a relatively uncommon ev...

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... Many other general pathologies favor the increase of C. albicans in the oral cavity: HIV/AIDS [158], cancer treatments [159], dental caries [160], and oral lesions (ulcerations, nodules, or granulomas) [161]. In these patients, the presence of a removable denture creates new niches for microbial colonization. ...
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Denture-related Candida stomatitis, which has been described clinically in the literature, is either localized or generalized inflammation of the oral mucosa in connection with a removable prosthesis. During this inflammatory process, the mycobacterial biofilm and the host’s immune response play an essential role. Among microorganisms of this mixed biofilm, the Candida species proliferates easily and changes from a commensal to an opportunistic pathogen. In this situation, the relationship between the Candida spp. and the host is influenced by the presence of the denture and conditioned both by the immune response and the oral microbiota. Specifically, this fungus is able to hijack the innate immune system of its host to cause infection. Additionally, older edentulous wearers of dentures may experience an imbalanced and decreased oral microbiome diversity. Under these conditions, the immune deficiency of these aging patients often promotes the spread of commensals and pathogens. The present narrative review aimed to analyze the innate and adaptive immune responses of patients with denture stomatitis and more particularly the involvement of Candida albicans sp. associated with this pathology.
... Symptoms include headache, fever, lethargy, painful eyes, nasal or sinus congestion, ophthalmoplegia, meningoencephalitis, proptosis, facial swelling, partial loss of vision, coughing, shortening of breath, and altered mental status. In the oral cavity, the infection is manifested as necrotizing ulceration of the palate, blackish slough formation and exposure of bone, tenderness over the maxillary sinus area, tooth loss, etc. (12). Imaging aids and histopathology are used to diagnose mucormycosis. ...
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Coronavirus infectious disease-19 caused by Severe acute respiratory distress syndrome-coronavirus-2 has emerged to be an emergency global health crisis for more than a year. And, as the disease has spread, a number of new clinical features have been observed in these patients. Immunosuppression caused by this disease results in an exacerbation of pre-existing infections. While corticosteroids are considered a life-saving therapeutic intervention for this pandemic, they have proved to be a double-edged sword and their indiscriminate use has produced some deleterious results. Recently, in the backdrop of this expression, a notable rise in invasive fungal infections has been identified even in the post-remission phase. Mucormycosis, Aspergillosis, and Candidiasis are the three most common opportunistic fungal infections among those observed. COVID-19 patients with diabetes mellitus are already at a higher risk of developing such secondary infections due to impaired immunity. Here we present a rare case report of a 50-year old male diabetic mellitus patient diagnosed with dual fungal infections (Aspergillosis along with Mucormycosis) leading to maxillary sinusitis as a post-COVID manifestation. To our knowledge, this is the first such case reported till date.
... Using the spike proteins (S) virus binds to specific cell membrane proteins named angiotensin-converting enzyme 2 (ACE2) [3,10] or glucose-regulated protein 78. [11] ACE2 is an important enzyme of renin-angiotensin system [12] which regulates blood pressure, blood volume, etc., ACE2 expresses on almost all the tissue but the highest expression was found on endothelium cells, [13] heart, tongue, pneumocytes and enterocytes cells of respiratory system. [13][14][15] After S-ACE2 interaction, E protein and M protein interact with cell membrane, and the whole structure (virus with ACE2 receptor) is endocytosis. ...
... On May 26, 2021, there were 11,717confirmed cases of mucormycosis in India, which has more people living with diabetes than any other country in the world except China. [11] Even before the pandemic, the prevalence of mucormycosis may have been 70 times higher in India than the overall figure for the rest of the world. The fungus blocks blood flow, which kills infected tissue, and it is this dead or necrotic, tissue that causes the characteristic black discoloration of people's skin, rather than the fungus itself. ...
... Mucormycosis is caused by saprophytic fungi such as Rhizopus, Mucor, Cunninghamella, Rhizomucor, Apophysomyces or Lichtheimia. [10][11][12] ...
COVID-19 was declared a pandemic outbreak by the World Health Organization, creating a significant impact on health care system. Realizing the high risk associated with this disease and its high rate of transmission, dentists were instructed by health authorities, to stop providing treatment which includes aerosols and droplets and only except emergency complaints. This was mainly for protection of dental healthcare personnel, their families, contacts, and their patients from the transmission of virus. Hence, this review focuses on the life cycle of COVID-19, its clinical symptoms and several issues concerned directly to dental practice in terms of prevention, treatment, and orofacial clinical manifestations.
... The fungal spores germinate into hyphae on entering the tissues of hosts initiating clinical symptoms and causing infection in immunocompromised individuals with defective phagocytic functions [29] Impaired phagocytic function and increased hyphae levels cause thrombosis, ischemia, infarction, and tissue necrosis. Fungal spores, in patients with diabetic ketoacidosis, severe burns, tumours, organ transplants or those on corticosteroids, can germinate in nasal cavity, paranasal sinuses to palate, orbit and even the brain, leading to death sometimes [30] There are six clinical forms of mucormycosis, most common being the rhino-cerebro-orbital form (44-48%) followed by the cutaneous variety (10-19%), then pulmonary (10-11%), disseminated (6-10%) and last being the gastrointestinal form (2-11%) [31,32] In the present review, we observed 21 cases of rhino-cerebro-orbital mucormycosis in COVID-19 patients. Majority of cases were reported in patients who had history of diabetes or were on corticosteroid therapy [16][17][18][19][20]. Incidence of mucomycosis is independent of age-or gender-related factors, though in this study a greater number of males were reportedly affected which could have been due to more prevalence of COVID-19 amongst males [17,20] Signs and symptoms reported by majority of the patients included in this review were fever, headache, orbital cellulitis with palpebral edema, ptosis, ophthalmoplegia, unilateral facial swelling and swelling in premaxillary, malar and retrobulbar region [16][17][18][19][20]. Delay in treatment of mucormycosis for even a week doubles the mortality rate from 35 to 66% and makes the prognosis poorer [19]. ...
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With the advent of coronavirus disease (COVID-19) pandemic, a wide range of life-threatening maxillofacial fungal coinfections have also been observed in patients. We conducted this systematic review to collate and evaluate the data to enable clinicians to understand the disease pattern and types of mycosis and provide meticulous management of these infections in COVID-19 patients. The review was carried out in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. A systematic electronic literature search was conducted on major databases using keywords in combination with Boolean Operators. Manuscripts discussing cases of maxillofacial fungal infections in COVID-19 patients were included. A total of 11 studies were systematically reviewed to assess the fungal coinfections in COVID-19 patients. Twenty-one cases of mucormycosis, 58 of candidiasis, and 1 each of aspergillosis and mixed infection were observed in the region of head and neck. Significant increase in invasive fungal infection is evident in patients suffering from COVID-19 which could be due to immunosuppression and other pre-existing comorbidities. Early diagnosis and intervention like systemic antifungals or surgical debridement is mandatory to reduce morbidity and mortality.
... Oral mucormycosis occurs usually in paranasal sinuses or nasal areas. Serious involvement of paranasal sinuses leads to palatal necrosis and/or ulceration [57,58]. ...
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The frequency of fungal infections is increasing due to immunodeficiency viruses and immunosuppressive drugs. The most common fungal infection of the oral cavity is candidiasis. The existence of Candida can be a part of normal commensal; hence, the isolation of Candida in the absence of clinical symptoms should exclude candidiasis. The pathogenicity of Candida is witnessed as opportunistic when immune status is compromised. Oral fungal infections are uncommon, but when identified, these infections are associated with greater discomfort and are sometimes destruction of tissues. Cytology and tissue biopsy are helpful in confirming the clinical diagnosis. The management of oral fungal infections must strategically focus on signs, symptoms, and culture reports. This article reviews information on diagnosis and therapeutic management of aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, mucormycosis, and geotrichosis.
... Based on age and predisposing variables, multiple incidences were found (2,3). Predisposing factors for candidiasis include local ones, such as xerostomia, poor oral hygiene, chronic mucosal trauma, use of local antibiotics, chronic use of inhalational and topical steroids, radiotherapy to the head area, and systemic ones, such as iron deficiency anemia, diabetes mellitus, primary immunodeficiency, HIV infection and AIDS, leukemia and other malignancies, neutropenia, use of steroids and immunosuppressive medication, broad-spectrum antibiotics, hypoparathyroidism, cortical adrenal insufficiency, and other endocrine diseases (1,3,4). ...
... Oral candidiasis is prevalent and underdiagnosed in the elderly, especially in those wearing dentures, and can be avoided in certain instances with a proper mouth care regimen (5,6). A wide variety of clinical symptoms are found in oral mucosal candidiasis (3)(4)(5)(6)(7)(8)(9). The diagnosis is mainly based on the history and clinical features with further investigations required only for difficult cases. ...
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Candida infections are acute and / or chronic infections of the skin, mucosa, internal organs and systems which may be seen at any age. The purpose of this study is to present diagnostic and therapeutic approach for patients who applied to our clinic with the diagnosis of pseudomembranous candidiasis. Both of the patients who referred to our clinic were using inhaler due to Chronic Obstructive Pulmonary Disease (COPD). Intraoral examination revealed pseudomembranous candidiasis localized on both the border of soft palate and through pharynx of a 60 year-old female patient and on the midline of hard palate of a 70-year-old male patient. Cultures were taken for mycological evaluation of the patients after clinical examination. Antifungal treatment was administered to both patients for 10 days. Healing was observed as a result of the treatment. No recurrence was observed at monthly follow-up assessments performed for patients. In cases of oral candidiasis, antifungal agents should be used locally in the form of suspension or pomade, evaluation of mycological culture should be performed to support clinical diagnosis and the etiological factors that may cause the disease should be studied.
... It is associated with the presence of microorganisms, the most associated being the species of Candida spp., notably Candida albicans. However, other agents such as Staphylococcus and Streptococcus are also associated [36,37]. ...
... Its diagnosis is essentially clinical, based on the patient's anamnesis, clinical presentation of the lesions and response to antifungal therapy. However, it can be confirmed by performing complementary tests, such as exfoliative cytology and cell culture, in which the presence of Candida species can be determined [36,39,40]. Treatment should begin by controlling the predisposing factors identified during the clinical examination. ...
... In combination, topical antifungal therapies are effective in the treatment of ANC, including oral gel or cream miconazole and topical nystatin (mouthwash). Systemic antifungal agents, such as fluconazole, ketoconazole, and itraconazole, are appropriate against resistant infections, for patients unable to tolerate topical therapy, immunocompromised patients, or patients at high risk of systemic infection [36][37][38]40]. ...
Article
Objective To present a brief review of the literature on the different types of cheilitis, focusing on the clinical, histopathological and treatment characteristics. Methods Electronic databases were searched for studies assessing published researches and case reports on all types of cheilitis. Results Cheilitis is the term that refers to the inflammatory state of the lips, which may involve the perioral region, lip vermilion and/or labial mucosa, with lip vermilion being the most affected area. There are different types of cheilitis and amongst the most commonly reported in the literature there are: actinic, desquamative/factitious, glandular, contact/eczematous, angular, granulomatous, plasma cell, associated or secondary to skin or systemic diseases, drug-induced or drug reaction cheilitis. Conclusions The diagnosis of inflammatory conditions of the lips requires a complete clinical examination and, when necessary, complementary tests in order to achieve a correct diagnosis and satisfactory treatment for the different conditions. Dental surgeons and physicians must know the importance of the correct diagnosis to indicate the best therapy for each type of cheilitis, aiming patients’ well-being and better prognosis.
... This fungus produces spores deposited in the soil. Inhalation of the spores could result in a disseminated disease which could also affectthe oral cavity (Muzyka and Epifanio, 2013). ...
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Poor oral hygiene practices which involve inappropriate use and storage of manual toothbrushes among others could significantly increase the prevalence of oral diseases. In this study, personal oral hygiene practices and microbial contaminants present in used toothbrushes by undergraduates resident in the hostels were ascertained. A close-ended questionnaire was issued to twenty (20) subjects randomly selected. New toothbrushes were distributed to the participants and were instructed to maintain standard oral hygiene practice for a period of four (4) weeks. A new toothbrush served as the control. All the toothbrushes were analysed using Standard microbiological methods. Our finding shows that majority of the students brushed their teeth twice daily, changed their toothbrushes monthly, store them inside lockers and fail to use plastic cap to cover their toothbrushes. The total heterotrophic bacterial count (THBC) of the toothbrush bristles and handles were within the range of 0-6.70 and 6.07-6.71log 10 CFU/mL, whereas the equivalent values for total fungal count (TFC) were 0-6.74and 0-6.85 log 10 CFU/mL, respectively. Meanwhile, THBC of the handle and bristles of the new toothbrush were 6.0 and 6.70 log 10 CFU/mL, while the values for TFC were 6.30 and 6.0 log 10 CFU/mL, respectively. Forty-six (46) bacterial isolates and thirty-three (33) fungal isolates were encountered in the toothbrush bristles and handles. The bacterial isolates identified were Streptococcus mutans, Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Bacillus sp., Lactobacillus sp., Klebsiella sp., Proteus sp., Enterobacter sp. And Citrobacter sp. while the fungal isolates were Saccharomyces sp., Penicillium chrysogenum, P. notatum, Candida albicans, Fusarium oxysporum, Blastomyces dermatitidis, Microsporium canis, Aspergillus niger, A. clavatus and A. flavus. Only Klebsiella sp. and Candida albicans were present in the new toothbrush. Since all the toothbrushes were contaminated with pathogenic microorganisms, the students are at risk of manifesting oral diseases. Consequently, the use of approved antimicrobial solutions to decontaminate toothbrushes, plastic covers for the toothbrushes, storage of the toothbrushes inside clean dry containers and implementing good oral hygiene practices are recommended as preventive measures.
... However, only certain diseases correlate with fungal colonisation of the oral cavity. These include, but are not limited to, HIV/AIDS (Cassone and Cauda 2012), cancer treatments (Silk 2014), dental caries (Falsetta et al. 2014) and oral lesions (ulcerations, nodules or granulomas) (Muzyka and Epifanio 2013). All of these conditions are linked either to the creation of novel niches that are not naturally present, or to perturbation of immune function. ...
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Candida albicans is a major fungal pathogen of humans. It exists as a commensal in the oral cavity, gut or genital tract of most individuals, constrained by the local microbiota, epithelial barriers and immune defences. Their perturbation can lead to fungal outgrowth and the development of mucosal infections such as oropharyngeal or vulvovaginal candidiasis, and patients with compromised immunity are susceptible to life-threatening systemic infections. The importance of the interplay between fungus, host and microbiota in driving the transition from C. albicans commensalism to pathogenicity is widely appreciated. However, the complexity of these interactions, and the significant impact of fungal, host and microbiota variability upon disease severity and outcome, are less well understood. Therefore, we summarise the features of the fungus that promote infection, and how genetic variation between clinical isolates influences pathogenicity. We discuss antifungal immunity, how this differs between mucosae, and how individual variation influences a person's susceptibility to infection. Also, we describe factors that influence the composition of gut, oral and vaginal microbiotas, and how these affect fungal colonisation and antifungal immunity. We argue that a detailed understanding of these variables, which underlie fungal-host-microbiota interactions, will present opportunities for directed antifungal therapies that benefit vulnerable patients.
... 23,24 It is caused by the dimorphic fungus Histoplasma capsulatum. [23][24][25][26][27] The soils of the Mississippi and Ohio river valleys are endemic with H. capsulatum. 23,24,28 Histoplasmosis occurs in 3 forms: acute, chronic, and disseminated. ...
... 23,24,[26][27][28][29] Oral lesions are present in 30% through 50% of patients with disseminated histoplasmosis. 24,25,29 Rarely, the lesions can occur as an isolated finding in patients without systemic involvement. [25][26][27] These oral lesions can occur in almost every part of the oral mucosa, with the tongue, palate, and buccal mucosa being the most common sites. ...
... 24,25,29 Rarely, the lesions can occur as an isolated finding in patients without systemic involvement. [25][26][27] These oral lesions can occur in almost every part of the oral mucosa, with the tongue, palate, and buccal mucosa being the most common sites. [23][24][25][26][27][28][29] Intraoral histoplasmosis typically appears as a chronic, solitary ulceration with a variable degree of pain. ...