Candidiasis and other fungal diseases of the mouth

Abstract

The advent of the human immunodeficiency virus (HIV) and the increasing prevalence of immunocompromised individuals due to surgical and medical advances have resulted in a resurgence of opportunistic infections including oral candidiasis and other rare mycoses which were once considered exotic. It is now recognized that oral candidiasis may present in many clinical guises that may confound the unwary clinician. Other mycotic diseases such aspergillosis, cryptococcosis, histoplasmosis, and mucormycosis may manifest intraorally both as primary lesions and as secondary manifestation of systemic disease. The primary oral pathology of most of the latter mycoses is ulcerations that respond well to systemic therapy with the polyene, amphotericin B. In general, the management of oral fungal infections has been revolutionized by the triazole group of drugs, fluconazole and itraconazole, although recent reports indicate an alarming increase of resistant organisms in particular to fluconazole. The first part of this review attempts to provide an overview of clinical variants of oral candidiasis and current therapeutic techniques, while the latter part outlines the rare oral mycoses and their management.