Chapter 26 : Mucosal Candidiasis

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Mucosal candidiasis is extremely common and vastly more common than invasive, systemic candidiasis, although the latter receives far more attention due to the accompanying mortality. Although considerable progress has been made in the understanding of pathogenesis of mucosal candidiasis, considerable deficits in our knowledge persist, accompanied by dynamic changes in microbiology of the responsible species and antifungal drug susceptibility, including drug resistance. Mucosal candidiasis involving the oral, gastrointestinal, and vaginal mucosae represents the commonest forms of superficial candidiasis and contrasts significantly with systemic and visceral candidiasis and disease. Although involving widely different anatomical sites with profoundly divergent physiological influences, the forms of mucosal candidiasis at the various sites have much in common with regard to pathophysiology, diagnostic principles, clinical manifestations, and therapy. Oral candidiasis (OC) is a commonly encountered condition in clinical practice, almost invariably associated with underlying disease or risk factors. Esophageal candidiasis (EC) is seen less commonly than OC, though usually in more immuno-compromised patients. The hormonal dependence of vulvovaginal candidiasis (VVC) is illustrated by the facts that is seldom isolated from premenarchial girls and the prevalence of vaginitis is lower after menopause, except in women taking hormone replacement therapy. In spite of progress in understanding the pathogenesis of mucosal candidiasis, there continues to be significant defects in one's knowledge of normal mucosal host defense mechanisms, both innate and acquired, effective in preventing symptomatic mucosal candidiasis.

Citation: Revankar S, Sobel J. 2012. Mucosal Candidiasis, p 419-427. In Calderone R, Clancy C (ed), and Candidiasis, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817176.ch26

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Citation: Revankar S, Sobel J. 2012. Mucosal Candidiasis, p 419-427. In Calderone R, Clancy C (ed), and Candidiasis, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817176.ch26
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1. Achkar, J. M., and, B. C. Fries. 2010. Candida infections of the genitourinary tract. Clin. Microbiol. Rev. 23: 253273.
2. Ally, R.,, D. Schürmann,, W. Kreisel,, G. Carosi,, K. Aguirrebengoa,, B. Dupont,, M. Hodges,, P. Troke,, A. J. Romero, and the Esophageal Candidiasis Study Group. 2001. A randomized, double-blind, double-dummy, multicenter trial of voriconazole and fluconazole in the treatment of esophageal candidiasis in immunocompromised patients. Clin. Infect. Dis. 33: 14471454.
3. Arathoon, E. G.,, E. Gotuzzo,, L. M. Noriega,, R. S. Berman,, M. J. DiNubile, and, C. A. Sable. 2002. Randomized, double-blind, multicenter study of caspofungin versus amphotericin B for treatment of oropharyngeal and esophageal candidiasis. Antimicrob. Agents Chemother. 46: 451457.
4. Bensadoun, R. J.,, J. Daoud,, B. El Gueddari,, L. Bastit,, R. Gourmet,, A. Rosikon,, C. Allavena,, P. Céruse,, G. Calais, and, P. Attali. 2008. Comparison of the efficacy and safety of miconazole 50-mg mucoadhesive buccal tablets with miconazole 500-mg gel in the treatment of oropharyngeal candidiasis: a prospective, randomized, single-blind, multicenter, comparative, phase III trial in patients treated with radio-therapy for head and neck cancer. Cancer 112: 204211.
5. Cassone, A.,, F. De Bernardis, and, G. Santoni. 2007. Anticandidal immunity and vaginitis: novel opportunities for immune intervention. Infect. Immun. 75: 46754686.
6. Challacombe, S. J., and, J. R. Naglik. 2006. The effects of HIV infection on oral mucosal immunity. Adv. Dent. Res. 19: 2935.
7. Cheng, S. C.,, L. Y. Chai,, L. A. Joosten,, A. Vecchiarelli,, B. Hube,, J. W. Van Der Meer,, B. J. Kullberg, and, M. G. Netea. 2010. Candida albicans releases soluble factors that potentiate cytokine production by human cells through a protease-activated receptor 1- and 2-independent pathway. Infect. Immun. 78: 393399.
8. de Wet, N.,, A. Llanos-Cuentas,, J. Suleiman,, E. Baraldi,, E. F. Krantz,, M. Della Negra, and, H. Diekmann-Berndt. 2004. A randomized, double-blind, parallel-group, dose-response study of micafungin compared with fluconazole for the treatment of esophageal candidiasis in HIV-positive patients. Clin. Infect. Dis. 39: 842849.
9. Dinubile, M. J.,, R. J. Lupinacci,, R. S. Berman, and, C. A. Sable. 2002. Response and relapse rates of candidal esophagitis in HIV-infected patients treated with caspofungin. AIDS Res. Hum. Retrovir. 18: 903908.
10. Donders, G. G.,, O. Babula,, G. Bellen,, I. M. Linhares, and, S. S. Witkin. 2008. Mannose-binding lectin gene polymorphism and resistance to therapy in women with recurrent vulvovaginal candidiasis. BJOG 115: 12251231.
11. Duerr, A.,, M. F. Sierra,, J. Feldman,, L. M. Clarke,, I. Ehrlich, and, J. DeHovitz. 1997. Immune compromise and prevalence of Candida vulvovaginitis in human immunodeficiency virus-infected women. Obstet. Gynecol. 90: 252256.
12. Ferwerda, B.,, G. Ferwerda,, T. S. Plantinga,, J. A. Willment,, A. B. van Spriel,, H. Venselaar,, C. C. Elbers,, M. D. Johnson,, A. Cambi,, C. Huysamen,, L. Jacobs,, T. Jansen,, K. Verheijen,, L. Masthoff,, S. A. Morré,, G. Vriend,, D. L. Williams,, J. R. Perfect,, L. A. Joosten,, C. Wijmenga,, J. W. van der Meer,, G. J. Adema,, B. J. Kullberg,, G. D. Brown, and, M. G. Netea. 2009. Human dectin-1 deficiency and mucocutaneous fungal infections. N. Engl. J. Med. 361: 17601767.
13. Fichtenbaum, C. J.,, R. Zackin,, N. Rajicic,, W. G. Powderly,, L. J. Wheat,, B. S. Zingman, andAdult AIDS Clinical Trials Group Study Team 295. 2000. Amphotericin B oral suspension for fluconazole-refractory oral candidiasis in persons with HIV infection. AIDS 14: 845852.
14. Fidel, P. L., Jr. 2006. Candida-host interactions in HIV disease: relationships in oropharyngeal candidiasis. Adv. Dent. Res. 19: 8084.
15. Gantner, B. N.,, R. M. Simmons,, S. J. Canavera,, S. Akira, and, D. M. Underhill. 2003. Collaborative induction of inflammatory responses by dectin-1 and Toll-like receptor 2. J. Exp. Med. 197: 11071117.
16. Giraldo, P. C.,, O. Babula,, A. K. Gonçalves,, I. M. Lin-hares,, R. L. Amaral,, W. J. Ledger, and, S. S. Witkin. 2007. Mannose-binding lectin gene polymorphism, vulvovaginal candidiasis, and bacterial vaginosis. Obstet. Gynecol. 109: 11231128.
17. Goldman, M.,, G. A. Cloud,, K. D. Wade,, A. C. Reboli,, C. J. Fichtenbaum,, R. Hafner,, J. D. Sobel,, W. G. Powderly,, T. F. Patterson,, L. J. Wheat,, D. K. Stein,, W. E. Dismukes,, S. G. Filler, andAIDS Clinical Trials Group Study Team 323/Mycoses Study Group Study Team 40. 2005. A randomized study of the use of fluconazole in continuous versus episodic therapy in patients with advanced HIV infection and a history of oropharyngeal candidiasis. Clin. Infect. Dis. 41: 14731480.
18. Gonsalves, W. C.,, A. S. Wrightson, and, R. G. Henry. 2008. Common oral conditions in older persons. Am. Fam. Physician 78: 845852.
19. Gow, N. A.,, M. G. Netea,, C. A. Munro,, G. Ferwerda,, S. Bates,, H. M. Mora-Montes,, L. Walker,, T. Jansen,, L. Jacobs,, V. Tsoni,, G. D. Brown,, F. C. Odds,, J. W. Van der Meer,, A. J. Brown, and, B. J. Kullberg. 2007. Immune recognition of Candida albicans beta-glucan by dectin-1. J. Infect. Dis. 196: 15651571.
20. Hancock, P. J.,, J. B. Epstein, and, G. R. Sadler. 2003. Oral and dental management related to radiation therapy for head and neck cancer. J. Can. Dent. Assoc. 69: 585590.
21. Harriott, M. M.,, E. A. Lilly,, T. E. Rodriguez,, P. L. Fidel, Jr., and, M. C. Noverr. 2010. Candida albicans forms biofilms on the vaginal mucosa. Microbiology 156: 36353644.
22. Henriques, M.,, J. Azeredo, and, R. Oliveira. 2006. Candida species adhesion to oral epithelium: factors involved and experimental methodology used. Crit. Rev. Microbiol. 32: 217226.
23. Hurley, R., and, J. De Louvois. 1979. Candida vaginitis. Postgrad. Med. J. 55: 645647.
24. Kartsonis, N.,, M. J. DiNubile,, K. Bartizal,, P. S. Hicks,, D. Ryan, and, C. A. Sable. 2002. Efficacy of caspofungin in the treatment of esophageal candidiasis resistant to fluconazole. J. Acquir. Immune Defic. Syndr. 31: 183187.
25. Kirkpatrick, C. H. 1994. Chronic mucocutaneous candidiasis. J. Am. Acad. Dermatol. 31: S14–S17.
26. Koks, C. H.,, P. L. Meenhorst,, A. Bult, and, J. H. Beijnen. 2002. Itraconazole solution: summary of pharmacokinetic features and review of activity in the treatment of fluconazole-resistant oral candidosis in HIV-infected persons. Pharmacol. Res. 46: 195201.
27. Krause, D. S.,, A. E. Simjee,, C. van Rensburg,, J. Viljoen,, T. J. Walsh,, B. P. Goldstein,, M. Wible, and, T. Henkel. 2004. A randomized, double-blind trial of anidulafungin versus fluconazole for the treatment of esophageal candidiasis. Clin. Infect. Dis. 39: 770775.
28. Laudenbach, J. M., and, J. B. Epstein. 2009. Treatment strategies for oropharyngeal candidiasis. Expert Opin. Pharmacother. 10: 14131421.
29. Lev-Sagie, A.,, P. Nyirjesy,, N. Tarangelo,, A. M. Bongiovanni,, C. Bayer,, I. M. Linhares,, P. C. Giraldo,, W. J. Ledger, and, S. S. Witkin. 2009. Hyaluronan in vaginal secretions: association with recurrent vulvovaginal candidiasis. Am. J. Obstet. Gynecol. 206: e1–e5.
30. Lynch, D. P. 1994. Oral candidiasis. History, classification, and clinical presentation. Oral Surg. Oral Med. Oral Pathol. 78: 189193.
31. Marot-Leblond, A.,, S. Nail-Billaud,, F. Pilon,, B. Beucher,, D. Poulain, and, R. Robert. 2009. Efficient diagnosis of vulvovaginal candidiasis by use of a new rapid immuno-chromatography test. J. Clin. Microbiol. 47: 38213825.
32. McClelland, R. S.,, B. A. Richardson,, W. M. Hassan,, S. M. Graham,, J. Kiarie,, J. M. Baeten,, K. Mandaliya,, W. Jaoko,, J. O. Ndinya-Achola, and, K. K. Holmes. 2009. Prospective study of vaginal bacterial flora and other risk factors for vulvovaginal candidiasis. J. Infect. Dis. 199: 18831890.
33. Milanese, M.,, L. Segat,, F. De Seta,, D. Pirulli,, A. Fabris,, M. Morgutti, and, S. Crovella. 2008. MBL genetic screening in patients with recurrent vaginal infections. Am. J. Reprod. Immunol. 59: 146151.
34. Mohammad, A. R.,, P. J. Giannini,, P. M. Preshaw, and, H. Alliger. 2004. Clinical and microbiological efficacy of chlorine dioxide in the management of chronic atrophic candidiasis: an open study. Int. Dent. J. 54: 154158.
35. Nacher, M.,, V. Vantilcke,, F. Huber,, A. Mahamat,, M. El Guedj,, A. Randrianjohany,, E. Clyti,, C. Aznar,, B. Carme, and, P. Couppié. 2007. Increased incidence of mucosal candidiasis after HAART initiation: a benign form of immune reconstitution disease? AIDS 21: 25342536.
36. Naglik, J. R.,, P. L. Fidel, Jr., and, F. C. Odds. 2008. Animal models of mucosal Candida infection. FEMS Microbiol. Lett. 283: 129139.
37. Netea, M. G.,, G. D. Brown,, B. J. Kullberg, and, N. A. Gow. 2008. An integrated model of the recognition of Candida albicans by the innate immune system. Nat. Rev. Microbiol. 6: 6778.
38. Niimi, M.,, N. A. Firth, and, R. D. Cannon. 2010. Antifungal drug resistance of oral fungi. Odontology 98: 1525.
39. Nokta, M. 2008. Oral manifestations associated with HIV infection. Curr. HIV/AIDS Rep. 5: 512.
40. Nurbhai, M.,, J. Grimshaw,, M. Watson,, C. Bond,, J. Mollison, and, A. Ludbrook. 2007. Oral versus intra-vaginal imidazole and triazole antifungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database Syst. Rev. 17: CD002845.
41. Ohmit, S. E.,, J. D. Sobel,, P. Schuman,, A. Duerr,, K. Mayer,, A. Rompalo,, R. S. Klein, andthe HIV Epidemiology Research Study (HERS) Group. 2003. Longitudinal study of mucosal Candida species colonization and candidiasis among human immunodeficiency virus (HIV)-seropositive and at-risk HIV-seronegative women. J. Infect. Dis. 188: 118127.
42. Ozcan, K.,, M. Ilkit,, A. Ates,, A. Turac-Bicer, and, H. Demirhindi. 2010. Performance of chromogenic Candida agar and CHROMagar Candida in recovery and presumptive identification of monofungal and polyfungal vaginal isolates. Med. Mycol. 48: 2934.
43. Pappas, P G.,, C. A. Kauffman,, D. Andes,, D. K. Benjamin, Jr.,, T. F. Calandra,, J. E. Edwards, Jr.,, S. G. Filler,, J. F. Fisher,, B. J. Kullberg,, L. Ostrosky-Zeichner,, A. C. Reboli,, J. H. Rex,, T. J. Walsh,, J. D Sobel, andthe Infectious Diseases Society of America. 2009. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin. Infect. Dis. 48: 503535.
44. Pirotta, M. V., and, S. M. Garland. 2006. Genital Candida species detected in samples from women in Melbourne, Australia, before and after treatment with antibiotics. J. Clin. Microbiol. 44: 32133217.
45. Rosenbach, A.,, D. Dignard,, J. V. Pierce,, M. Whiteway, and, C. A. Kumamoto. 2010. Adaptations of Candida albicans for growth in the mammalian intestinal tract. Eukaryot. Cell 9: 10751086.
46. Schuman, P.,, L. Capps,, G. Peng,, J. Vazquez,, W. el-Sadr,, A. I. Goldman,, B. Alston,, C. L. Besch,, A. Vaughn,, M. A. Thompson,, M. N. Cobb,, T. Kerkering, and, J. D. Sobel. 1997. Weekly fluconazole for the prevention of mucosal candidiasis in women with HIV infection. A randomized, double-blind, placebo-controlled trial. Terry Beirn Community Programs for Clinical Research on AIDS. Ann. Intern. Med. 126: 689696.
47. Sha, B. E.,, M. R. Zariffard,, Q. J. Wang,, H. Y. Chen,, J. Bremer,, M. H. Cohen, and, G. T. Spear. 2005. Female genital-tract HIV load correlates inversely with Lactobacillus species but positively with bacterial vaginosis and Mycoplasma hominis. J. Infect. Dis. 191: 2532.
48. Skiest, D. J.,, J. A. Vazquez,, G. M. Anstead,, J. R. Gray-bill,, J. Reynes,, D. Ward,, R. Hare,, N. Boparai, and, R. Isaacs. 2007. Posaconazole for the treatment of azole-refractory oropharyngeal and esophageal candidiasis in subjects with HIV infection. Clin. Infect. Dis. 44: 607614.
49. Sobel, J. D. 2007. Vulvovaginal candidosis. Lancet 369: 19611971.
50. Sobel, J. D. 1986. Recurrent vulvovaginal candidiasis: a prospective study of the efficacy of maintenance ketoconazole therapy. N. Engl. J. Med. 315: 14551458.
51. Sobel, J. D.,, S. Faro,, R. W. Force,, B. Foxman,, W. J. Ledger,, P. R. Nyirjesy,, B. D. Reed, and, P. R. Summers. 1998. Vulvovaginal candidiasis: epidemiologic, diagnostic and therapeutic considerations. Am. J. Obstet. Gynecol. 178: 203211.
52. Sobel, J. D.,, P. S. Kapernick,, M. Zervos,, B. D. Reed,, T. Hooton,, D. Soper,, P. Nyirjesy,, M. W. Heine,, J. Willems,, H. Panzer, and, H. Wittes. 2001. Treatment of complicated Candida vaginitis: comparison of single and sequential doses of fluconazole. Am. J. Obstet. Gynecol. 185: 363369.
53. Sobel, J. D.,, W. Chaim,, V. Nagappan, and, D. Leaman. 2003. Treatment of vaginitis caused by Candida glabrata: use of boric acid and flucytosine. Am. J. Obstet. Gynecol. 189: 12971300.
54. Sobel, J. D.,, H. C. Wiesenfeld,, M. Martens,, P. Danna,, T. M. Hooton,, A. Rompalo,, M. Sperling,, C. Livengood,, B. Horowitz,, J. Von Thron,, L. Edwards,, H. Panzer, and, T. C. Chu. 2004. A randomized, placebo-controlled trial of maintenance fluconazole therapy for management of recurrent vulvovaginal candidiasis. N. Engl. J. Med. 351: 876883.
55. Soysa, N. S.,, L. P. Samaranayake, and, A. N. Ellepola. 2008. Antimicrobials as a contributory factor in oral candidosis—a brief overview. Oral Dis. 14: 138143.
56. Trama, J. P.,, M. E. Adelson,, I. Raphaelli,, S. M. Stemmer, and, E. Mordechai. 2005. Detection of Candida species in vaginal samples in a clinical laboratory setting. Infect. Dis. Obstet. Gynecol. 13: 6367.
57. Vazquez, J. A., and, J. D. Sobel. 2002. Mucosal candidiasis. Infect. Dis. Clin. N. Am. 16: 793820.
58. Vazquez, J. A.,, D. J. Skiest,, H. Tissot-Dupont,, J. L. Lennox,, N. Boparai, and, R. Isaacs. 2007. Safety and efficacy of posaconazole in the long-term treatment of azole-refractory oropharyngeal and esophageal candidiasis in patients with HIV infection. HIV Clin. Trials 8: 8697.
59. Vazquez, J. A.,, J. A. Schranz,, K. Clark,, B. P. Goldstein,, A. Reboli, and, C. Fichtenbaum. 2008. A phase 2, open-label study of the safety and efficacy of intravenous anidulafungin as a treatment for azole-refractory mucosal candidiasis. J. Acquir. Immune Defic. Syndr. 48: 304309.
60. Villanueva, A.,, E. Gotuzzo,, E. G. Arathoon,, L. M. Noriega,, N. A. Kartsonis,, R. J. Lupinacci,, J. M. Smietana,, M. J. DiNubile, and, C. A. Sable. 2002. A randomized double-blind study of caspofungin versus fluconazole for the treatment of esophageal candidiasis. Am. J. Med. 113: 294299.
61. Villar, C. C.,, and A. Dongari-Bagtzoglou. 2008. Immune defense mechanisms and immunoenhancement strategies in oropharyngeal candidiasis. Expert Rev. Mol. Med. 10: e29.
62. Weerasuriya, N., and, J. Snape. 2008. Oesophageal candidiasis in elderly patients: risk factors, prevention and management. Drugs Aging 25: 119130.
63. Werneck-Silva, A. L., and, I. B. Prado. 2009. Role of upper endoscopy in diagnosing opportunistic infections in human immunodeficiency virus-infected patients. World J. Gastroenterol. 15: 10501056.
64. White, M. H. 1996. Is vulvovaginal candidiasis an AIDS-related illness? Clin. Infect. Dis. 22: S124–S127.
65. Wilcox, C. M.,, R. O. Darouiche,, L. Laine,, B. L. Moskovitz,, I. Mallegol, and, J. Wu. 1997. A randomized, double-blind comparison of itraconazole oral solution and fluconazole tablets in the treatment of esophageal candidiasis. J. Infect. Dis. 176: 227232.
66. Witkin, S. S. 1991. Immunologic factors influencing susceptibility to recurrent candidal vaginitis. Clin. Obstet. Gynecol. 34: 662668.
67. Young, G. L., and, D. Jewell. 2001. Topical treatment for vaginal candidiasis (thrush) in pregnancy. Cochrane Database Syst. Rev. 4: CD000225.


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Recommendations for prevention and treatment of mucosal candidiasis

Citation: Revankar S, Sobel J. 2012. Mucosal Candidiasis, p 419-427. In Calderone R, Clancy C (ed), and Candidiasis, Second Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817176.ch26

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