Yamamoto Tetsuya
Department of Oral and Maxillofacial Surgery, Kochi Medical School, Kochi University, Nankoku 783-8505, Japan.
Rinsho Byori. 2010 Oct;58(10):1027-34.
Candidiasis is the most commonly encountered fungal infection, and oral candidiasis is often observed as a local opportunistic infection. Oral candidiasis is clinically divided into three types: acute forms, chronic forms, and Candida-associated lesions. Candida adhesion and multiplication are largely regulated by the local and systemic factors of the host. The local factors include impairment of the oral mucosal integrity, which is usually impaired by hyposalivation, anticancer drugs/radiation for head and neck cancers, denture wearing, a decrease in the oral bacterial population, and poor oral hygiene. Among Candida species, oral candidiasis is mostly caused by Candida albicans (C. albicans), C. glabrata, or C. tropicalis. Oral Candida induces a variety of symptoms, such as oral mucosal inflammation manifesting as an uncomfortable feeling, pain, erythema, erosion, taste abnormalities, and hyperplasia of the oral mucosa. Candida overgrowth in the oral cavity may disseminate to distant organs. Therefore, in order to avoid the sequelae of systemic candidiasis, oral candidiasis should be rapidly controlled. Oral candidiasis is usually treated by the local application of antifungal drugs. However, oral candidiasis occasionally escapes the control of such local treatment due to the development of multi-drug resistant Candida strains and species or due to the suppression of salivation or cellular immune activity. When drug-resistant strains are suspected as the pathogens and when the host is generally compromised, the oral administration of combinations of antifungal drugs, enhancement of cellular immune activity, and improvement of the nutritional condition are recommended.
念珠菌病是最常见的真菌感染，口腔念珠菌病常被视为一种局部机会性感染。口腔念珠菌病在临床上分为三种类型：急性型、慢性型和念珠菌相关病变。念珠菌的黏附和增殖在很大程度上受宿主局部和全身因素的调节。局部因素包括口腔黏膜完整性受损，这通常是由唾液分泌减少、头颈部癌症的抗癌药物/放疗、佩戴假牙、口腔细菌数量减少以及口腔卫生不良引起的。在念珠菌属中，口腔念珠菌病大多由白色念珠菌、光滑念珠菌或热带念珠菌引起。口腔念珠菌会引发多种症状，如口腔黏膜炎症，表现为不适感、疼痛、红斑、糜烂、味觉异常以及口腔黏膜增生。口腔内念珠菌过度生长可能会扩散到远处器官。因此，为避免全身性念珠菌病的后遗症，应迅速控制口腔念珠菌病。口腔念珠菌病通常通过局部应用抗真菌药物进行治疗。然而，由于多重耐药念珠菌菌株和种类的出现，或者由于唾液分泌抑制或细胞免疫活性降低，口腔念珠菌病偶尔会逃避这种局部治疗的控制。当怀疑耐药菌株为病原体且宿主一般状况较差时，建议口服抗真菌药物联合使用、增强细胞免疫活性并改善营养状况。
