Candida aids hiv

1. ACQUIRED IMMUNODEFICIENCY
SYNDROME (AIDS)
• More than 39.5 million cases worldwide.
• Considered almost 100% fatal and no known vaccine
developed so far.
ROUTES OF TRANSMISSION: -
1. Sexual contact
2.Infected blood / blood products
3.Intravenous drug abuse
4.Transplacental transfer
Dr. Adel Jumaan Binsaad 1
‫ميكرو‬
‫س‬1
L1

2. ‫المناعة‬ ‫نقص‬ ‫فيروس‬ ‫بنية‬
‫البشرية‬
Dr. Adel Jumaan Binsaad 2

3. PATHOGENESIS: -
• When virus enters the body, its DNA incorporated
into primary target cell i.e. CD4+ helper T
lymphocyte.
• Similar to other viral infections, antibodies to virus
are formed but are not protective.
• Virus can remain silent or cause cell death, as a
result, decrease in helper T- cells occurs, leading to
loss in immune function.
• There is an asymptomatic stage lasting for about 8
– 10 years after which the final symptomatic stage
develops.
Dr. Adel Jumaan Binsaad 3

4. CLINICAL FEATURES: -
• After infection, patient may be asymptomatic or
develop acute response similar to infectious
mononucleosis.
• Acute response – fever, generalized
lymphadenopathy, sore throat, myalgia, diarrhea,
maculopapular rash etc.
• Acute response (Acute syndrome) clears within a
few weeks and a variable asymptomatic phase
follows which may last for 8 – 10 years.
• Symptomatic phase – opportunistic infections
(pneumonia, CMV, HSV, TB etc) and neoplastic
processes (Kaposi sarcoma, Non-Hodgkin’s
lymphoma etc). Dr. Adel Jumaan Binsaad 4

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6. ORAL MANIFESTATIONS
Group 1 (lesions strongly associated with
HIV):
1. Oral candidal infections
- Erythematous
- Hyperplastic
- Pseudomembranous
2. Hairy leukoplakia
3.HIV associated periodontitis
- HIV gingivitis
- HIV periodontitis
- Necrotizing ulcerative gingivitis
- Necrotizing ulcerative stomatitis
4. Kaposi sarcoma (READ)
5. Non-Hodgkin’s lymphoma (READ)
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7. ORAL
CANDIDIASI
S
HAIRY
LEUKOPLAKIA
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8. HIV
ASSOCIATED
PERIODONTITIS
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9. HIV ASSOCIATED GINGIVITIS
NECROTIZING ULCERATIVE
GINGIVITIS
NECROTIZING ULCERATIVE STOMATITIS
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10. CANCRUM ORIS
• Acute, rapidly progressing, localized, bacterial
infection of the orofacial tissues and jaws
• Causative organisms – Fusobacterium necrophorum,
Fusobacterium nucleatum and Prevotella intermedia.
• Predisposing factors: include poverty, malnutrition,
poor oral hygiene & sanitation, recent illness,
malignancy and immunodeficiency states like AIDS.
CLINICAL FEATURES: -
Age incidence: Predominantly children
between 1 – 10 years.
Sex incidence: Male
Site predilection:Usually begins on gingivae as ANUG,
then spreads facially / lingually to adjacent soft
tissues.
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12. Patch stage
Plaque stage
Nodular stage
KAPOSI
SARCOMA
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13. Kaposi's Sarcoma
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14. Group 2 (lesions less commonly associated
with HIV):
1. Aphthous ulcers (oropharyngeal region) (READ)
2. Idiopathic thrombocytopenia (READ)
3. Salivary gland disorders
- Dry mouth and decreased salivary flow
- Uni or bilateral swelling of major glands
4. Viral infections (apart from EBV)
- Cytomegalovirus
- Herpes simplex virus
- Human papilloma virus
- Varicella - zoster virus
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15. HIV ASSOCIATED APHTHOUS
ULCERS
HIV ASSOCIATED HPV
INFECTION
HIV ASSOCIATED HERPETIC ULCERS
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16. HAIRY LEUKOPLAKIA
• It is a chronic, localized infection.
• Caused by: Epstein-Barr virus (EBV).
CLINICAL FEATURES :-
 Asymptomatic, slowly spreading, non scrapable,
papillary, greyish white lesion.
 Usually in young age males and located bilaterally
at the lateral borders of the tongue.
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18. HISTOLOGICAL FEATURES
• Lesion is characterized by
hyperparakeratosis and
acanthosis.
• Epithelial cells are
infected by EBV which
appear as swollen cells
with ballooning
degeneration.
• Characteristic pattern of
peripheral margination of
nuclear chromatin is seen,
called nuclear beading.
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19. DIAGNOSIS
1. Screening test: ELISA is most commonly used
test. But it can show false positive results.
2. Western Blot test: It is a test to detect viral
antibodies. More accurate than ELISA.
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20. Candidiasis
• Candidiasis is the most
common type of yeast
infection.
• Candida ssp is an
opportunistic fungus
(yeast).
• It can infect the mouth,
vagina, skin, and urinary
tract.
• About 75% of women will
get vaginal yeast infection
during their life.
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21. Candidal virulent factors:Candidal virulent factors:
1. Ability to adhere to host tissues and prostheses
(e.g. dentures) and form biofilm.
2. Ability to form hyphae that helps in tissue
invasion.
3. Ability to modify the surface antigen.
4. Ability to produce extracellular phospholipase,
proteinase, and haemolysin which break down
physical defence barriers.
 Candida species rarely cause disease in absence
of predisposing factors (opportunistic organisms) .
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22. Predisposing factors
1.1.Heavy smoking.Heavy smoking.
2.2.Age (e.g. very young or very old).Age (e.g. very young or very old).
3.3.Malignant and chronic disease.Malignant and chronic disease.
4.4.Inadequate care of appliances.Inadequate care of appliances.
5.5.Immunological and endocrine disorders (e.g.Immunological and endocrine disorders (e.g.
diabetes mellitus).diabetes mellitus).
6.6.Radiation to the head and neck.Radiation to the head and neck.
7.7.Disturbed oral ecology by antibiotics,Disturbed oral ecology by antibiotics,
Corticosteroides.Corticosteroides.
8.HIV infection
9.Cancer
10.Dry mouth
11. Pregnancy.
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23. Signs and symptoms
Most candidial infections are treatable and result
in minimal complications such as redness, itching
and discomfort, though complication may be severe
or fatal if left untreated in certain populations.
Thrush is commonly seen in infants, elderly people,
and those with a weakened immune system.
Children, mostly between the ages of three and
nine years of age, can be affected by chronic
mouth yeast infections, normally seen around the
mouth as white patches.
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24. Thrush (pseudomembrane):
Acute infection but may persist intermittently
for many months or even years in HIV-infected
persons (Oropharyngeal thrush may spread into
esophagus), patients using corticosteroids,
neonates and in patients with leukaemia.
white patches on oral mucosa, tongue and
elsewhere. Lesions resembling milk curds.
Microbiology
patches consists of necrotic material and
desquamated parakeratotic epithelia, penetrated
by yeast and hyphae.
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25.  Thrush usually develops suddenly, but it may
become chronic, persisting over a long period of
time.
A common sign of thrush is the presence of creamy
white, slightly raised lesions in the mouth -usually
on the tongue.
The lesions, can be painful and may bleed slightly
when we scrape them or brush your teeth.
In severe cases, the lesions may spread into
esophagus, causing pain or difficulty swallowing.
Thrush can spread to other parts of the body,
including the lungs, liver, and skin.
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26. Oral Candidiasis (Thrush(
Thrush (pseudomembrane) is a yeast infection of
the mucus membrane lining the mouth and
tongue. Other oral manifestations include
erythematous and hyperplastic variants. 26

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28. Thrush
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31. Oral thrush
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32. Vulvovaginitis in women using
contraceptive and associated with yeasty-
smelling discharge, and vaginal itching.
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33. Cutaneous candidiasis
• Cutaneous candidiasis
include:
• Paronychia and
onychomycosis.
• Diaper candidiasis.
• Intertrigo candidiasis.
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34. Paronychia:-
•Paronychia of the finger nails may develop in persons
whose hands are subject to continuous wetting.
•In chronic cases the infection may progress to cause
onycho-mycosis with total detachment of the cuticle
from the nail plate.
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35. Paronychia
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36. Diaper (Nappy rash):-
•Diaper candidiasis is common in infants under
unhygienic conditions of chronic moisture and local
skin maceration due to irregular change of unclean
diapers.
• Caused by C.albicans derived from the lower
gastrointestinal tract.
• Scaly macules or vesicles,
associated with pruritus.
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37. Candidal intertrigo consists of vesicular
pustules that enlarge, rupture and cause
fissures.
• Seen especially in warm and moist surfaces
and in the obese.
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38. Mucocutaneous candidiasisMucocutaneous candidiasis
• Involve both the skin and the oral and /or vaginal
mucosae.
• Chronic mucocutaneous candidiasis is rare and
associated with T-cells deficiency.
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39. Systemic or deep candidiasisSystemic or deep candidiasis
•Involve the lower respiratory tract and urinary
tract, then lead to candidaemia; localization in
meninges, bone, kidney and eye is common.
• Susceptible settings include prosthetic
implantation, heart surgery, organ transplantation
and long-term treatment with steroid or
immunosuppressive drugs.
• Superficial infection rarely cause dissemination.
• Untreated disseminated disease is fatal.
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40. Diagnosis:Diagnosis:
1.Demonstration of yeasts in Gram – stained
smear, skin scraping (KOH), followed by culture.
2.Serology or PCR or blood culture ( candidaemia)
are helpful in diagnosis of disseminated
candidiasis.
3.Histopathological examination; helps to know the
causative agent (demonstration of hyphae) and in
chronic candidal leukoplakial lesions.
4.C.albicans C.dubliniensis differentiated from
other Candida species by their ability to produce
germ tubes.
5. Definitive identification based on fermentation
test and other biochemical tests.
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41. Treatment:Treatment:
1. Superficial mycoses1. Superficial mycoses::
• Correction ofCorrection of predisposing Factors.
• Topically with nystatin or amphotericin orTopically with nystatin or amphotericin or
miconazole.miconazole.
2. Systemic and disseminated candidiasis2. Systemic and disseminated candidiasis::
• Intravenous amphotericin, either alone or inIntravenous amphotericin, either alone or in
combination with flucytosine.combination with flucytosine.
• Fluconazole effective for both Superficial andFluconazole effective for both Superficial and
Systemic mycoses and itSystemic mycoses and it``s the drug of choice ins the drug of choice in
treating Candida infection in HIV disease ( C.treating Candida infection in HIV disease ( C.
krusei is resistant).krusei is resistant). Dr. Adel Jumaan Binsaad 41

42. `
Prevention:Prevention:
as infection is endogenous, therefore preventionas infection is endogenous, therefore prevention
include:include:
1.1. Correction ofCorrection of predisposing factors.
2. Compromised patients require long term
prophylactic treatment continuously or
intermittently with antifungal treatment.
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43. Candidal oral manifestations include three
variants.
Caused mainly by Candida albicans. Other
Candida spp. may also involved.
Considered as opportunistic infections.
Variants of oral candidiasis:
1.Pseudomembranous
2.Erythematous (atrophic) 3. Hyperplastic.
Erythematous (atrophic) candidiasis
Condition associated with corticosteroids, topical
or systemic broad-spectrum antibiotics or HIV
disease. May arise when pseudomembranes shed.
Erythematous candidasis of palate is commonly
seen in elderly people wearing full-denture
(candida associated denture stomatitis). 43

44. Clinical features
Erythematous area (s) is asymptomatic.
Lesions on the dorsum of the tongue present as
depapillated areas.
Red areas seen on the palate in HIV disease.
Erythematous candidiasis, dorsum of tongue44

45. Erythematous candidiasis, hard
palate
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46. Hyperplastic candidiasis (candidal leukoplakia)
Lesions: chronic, discrete raised areas,
asymptomatic and usually occur on the inside
surface of one or both cheeks.
Microbiology and histopathology
Includes parakeratosis and epithelial hyperplasia
with candida invasion restricted to the upper
layers of epithelium.
Associated with iron and folate deficiencies and
with defective cell-mediated immunity.
It is premalignant.
Treatment
Topical antifungals such as nystatin and
amphotericin B.
Fluconazole tablets _ useful in chronic infection.46

47. Candida associated lesions
1. Candida-associated denture stomatitis ( Denture
sore mouth)
•Chronic erythema and oedema of mucosa that
contacts the fitting surface of the upper denture.
•The mucosa below lower denture is rarely
involved.
•Due to accumulation of plaque with bacteria and
yeast on the fitting surface of denture and the
underlying mucosa.
•Mechanical irritation or allergic reaction to the
denture material.
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48. Denture stomatitis
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49. Treatment:
I.Removal of dentures at night.
II. Regular disinfection by steeping dentures in
e.g. chlorhexidine.
III. Review of denture fitness to relieve trauma.
IV. Diet with low content of fermentable
carbohydrates.
V.Nystatin or amphotericin.
2. Angular stomatitis (angular cheilitis)
Clinical feature:
Soreness, erythema and fissuring seen in one or
both angles of the mouth.
Commonly associated with inadequate denture.
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50. Condition seen in HIV disease.
Condition is occasionally a sign of anaemia or
vitamin B12 deficiency.
Microbiology
Yeast and Staph. aureus (yellow crusting).
Treatment
I.Topical antifungal therapy with nystatin,
amphotericin B or miconazole.
II.Neomycin and chlorhexidine.
III.Adjustment dimension of dentures to prevent
saliva retention, and moisture (encourage growth
of candida) at the angles of the mouth.
IV.Investigate for iron or vitamin B12 deficiency
or HIV.
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51. Angular stomatitis (angular cheilitis)
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