Candidiasis and Oral Epithelial Dysplasia

Abstract

Oral candidiasis is a relatively common opportunistic infection. There are numerous predisposing factors for candidiasis. It has been shown that 07 species are pathogenic out of 150 candidal species. Candida albicans is the commonest infection and it exists in several forms varying from yeast to hyphal form. Hyphal form is invasive and causes clinical candidiasis. There are no reported studies in Sri Lanka with regards to dysplasia and candidiasis.

The aims of this study are, to investigate the relationship between candidal infection and epithelial dysplasia and to assess the changes of epithelial dysplasia following antifungal treatment.

Twenty two patients were selected from the Maxillo- Facial unit, Matara. All these cases were clinically diagnosed as candidiasis. Incisional biopsies were taken from these patients and examined under light microscope with Haematoxalin and Eosin sections. Periodic acid schiff was performed for all the cases to identify candida. Two investigators assessed the degree of dysplasia separately.

All the patients were treated with antifungals 10- 20 days (Ketakonazole 200mg &/ or Fluconazole 50mg daily). A repeat biopsy was performed after one month and assessed in the similar manner as the first biopsy.

All twenty two patients showed the presence of candidial hyphae before the treatment and 95.4% of them had features of epithelial dysplasia. Sixteen cases showed no dysplasia (73%) and six cases showed mild epithelial dysplasia with candidal hyphae(27%) after the antifungal treatment. These results are statistically significant. In conclusion, epithelial dysplasia due to candida may reverse to normal and over treatment of dysplastic lesions can be avoided with antifungal treatment for the candida infected cases.