The frequency of fungal infection in biopsies of oral mucosal lesions.

OBJECTIVE

To determine the frequency of fungal infection in biopsies of oral mucosal lesions.

MATERIALS AND METHODS

Histopathology reports issued between 1991-1995 inclusive were reviewed. During this period, a single section of each mucosal biopsy had been stained using the periodic acid-Schiff (PAS) technique.

RESULTS

A total of 223 (4.7%) biopsies contained PAS-positive fungi: 191 individuals were affected, 124 (64.9%) of whom were male. There was a significant (P < 0.01) positive association of fungal infection with moderate and severe epithelial dysplasia, median rhomboid glossitis and squamous papillomas. Where a subsequent biopsy was available, 21.9% dysplasias which were infected with fungi worsened in histological severity, as compared with 7.6% of dysplasias which were not infected at any stage. There was a significant negative association of fungal infection with benign fibrous overgrowths (P < 0.01), benign hyperkeratoses, lichenoid reactions and pyogenic granulomas (P < 0.05). The difference in frequency of infection between the tongue and other sites was also significantly higher (P < 0.01).

CONCLUSIONS

There is a statistically significant association between histologically-determined fungal infection and epithelial dysplasia, and we recommend that a PAS stain be performed whenever oral epithelial dysplasia is diagnosed, especially in male patients. On histological confirmation of dysplasia, anti-fungal therapy should be considered in the management of these lesions.