Zegarelli D J
Columbia University College of Physicians and Surgeons, New York, New York.
Otolaryngol Clin North Am. 1993 Dec;26(6):1069-89.
Although several strains of Candida can infect the oral mucosa, the most commonly encountered oral fungal infection is Candida albicans, which may be highly infective because of its greater level of pathogenicity and adherence properties. C. albicans is an oral commensal in as many as 40% to 65% of healthy adult mouths. The papillated dorsal surface of the tongue and palatal mucosa beneath a maxillary denture are favored reservoir sites. Oral candidal infection almost always involves a compromised host. The compromise may be local or systemic. Local factors include decreased salivation and the weaning of dentures. Systemic factors include diabetes mellitus, pernicious anemia, and AIDS. Some have even implicated advanced age and the female gender as being mild predisposing factors. Furthermore, the C. albicans infection itself can depress a host's immune system. A patient with oral candidiasis can present with one or more of the following clinical forms: pseudomembranous, erythematous, hyperplastic, and denture erythematous. Many investigators accept median rhomboid glossitis as a form of chronic oral candidiasis. In some patients with angular cheilitis, genesis of the lesions is secondary to monilial infestation. Because C. albicans is a normal inhabitant in many mouths, diagnostic confirmation of infection often rests with successful response (i.e., resolution of lesions) to antifungal medications. This form of diagnostic confirmation can be further enhanced by culturing the offending microbe, preparing a fungal smear, or even incisional biopsy. The microscopic demonstration of fungal hyphae is highly diagnostic of the candidal infection, whether the hyphae are demonstrated on a PAS smear or on a biopsy within surface stratified squamous epithelium. Numerous medications exist for the treatment of oral candidiasis. They include the antibiotic nystatin as well as clotrimazole, ketoconazole, and fluconazole. Nystatin is safe and is used as a topical agent in rinse or pastille forms. Clotrimazole is used as a topical agent in lozenge form; it is highly effective but can cause liver enzyme changes. Ketoconazole, which is usually prescribed systemically, is highly effective but also capable of causing adverse liver changes. Chlorhexidine can be used as an oral rinse or as a disinfectant for dentures.
虽然几种念珠菌菌株均可感染口腔黏膜，但最常见的口腔真菌感染是白色念珠菌，因其致病性和黏附性更强，故具有较高的传染性。在40%至65%的健康成年人口中，白色念珠菌是口腔共生菌。舌背有乳头的表面以及上颌假牙下方的腭黏膜是其常见的滋生部位。口腔念珠菌感染几乎总是发生在宿主免疫力受损的情况下。这种损害可能是局部的，也可能是全身性的。局部因素包括唾液分泌减少和假牙停用。全身因素包括糖尿病、恶性贫血和艾滋病。甚至有人认为高龄和女性性别是轻度易感因素。此外，白色念珠菌感染本身会抑制宿主的免疫系统。患有口腔念珠菌病的患者可能会出现以下一种或多种临床症状：假膜型、红斑型、增生型和义齿性红斑型。许多研究人员认为正中菱形舌炎是慢性口腔念珠菌病的一种形式。在一些患有口角炎的患者中，病损的发生继发于念珠菌感染。由于白色念珠菌在许多人口腔中是正常居民，感染的诊断确认通常取决于对抗真菌药物的成功反应（即病损消退）。通过培养致病微生物、制备真菌涂片甚至进行切开活检，可以进一步加强这种诊断确认方式。真菌菌丝的显微镜显示对念珠菌感染具有高度诊断价值，无论菌丝是在PAS涂片上还是在表面复层鳞状上皮内的活检组织中显示。有多种药物可用于治疗口腔念珠菌病。它们包括抗生素制霉菌素以及克霉唑、酮康唑和氟康唑。制霉菌素安全，以漱口液或含片形式用作局部用药。克霉唑以含片形式用作局部用药；它非常有效，但会导致肝酶变化。通常全身给药的酮康唑非常有效，但也会引起肝脏不良反应。洗必泰可用作口腔漱口液或假牙消毒剂。
