GI as a portal of entry

O. Nicolatou-Galitis

Author address: 

University of Athens, Athens, Greece

Abstract: 

Systemic candidiasis in patients with haematological malignancies and solid cancers is a disease with poor prognosis, which has, at times, been related with delays in the diagnosis. Candida carriage precedes the opportunistic infection. The oral cavity is an important site for Candida carriage. In patients with haematological malignancies, who receive cytotoxic chemotherapy and in patients with head and neck cancers, who undergo radiotherapy or chemoradiotherapy, Candida carriage ranges between 52% to 80%. Oral/oropharyngeal candidiasis is the second most common lesion during antineoplastic chemotherapy and head and neck radiotherapy, following oral mucositis and bleeding. During antileukemic chemotherpapy oral candidiasis develops with an incidence of 20% to 60%, while one out of three to one out of two patients with head and neck cancer will develop oral candidiasis during radiotherapy, superimposed on chemotherapy- or radiation- induced oral ulcerative mucositis, according to literature data and from our patient cohorts in Athens. The oral mucosal barrier damage is an important portal of entry for fungi in the immunocompromized setting, particularly when an infection has already developed on the chemotherapy- or radiation- induced ulcerations of the dry (xerostomic) mucosa. Oral candidiasis presents in different, relatively well described clinical forms, including erythematous candidiasis, often combined with angular cheilitis and pseudomembranous candidiasis. Dysphagia, difficulty in swallowing and xerostomia are common complaints, reported by the patients. The Clinicians should be aware of these clinical forms and presentations of oral / oropharyngeal candidiasis to early recognize and treat the infection before dissemination. The differential diagnosis of the fungal infection from the mucosal erythema and pseudomembranous ulcerations of oral mucositis and other oral pseudomembranous/ulcerative and erythematous lesions is also necessary. In this lecture, the different clinical forms of oral/oropharyngeal candidiasis will be presented, since early recognition may lead to an early diagnosis and, hence, appropriate antifungal treatment, minimizing the risk of regional and systemic dissemination in the cancer patient setting.
2009

abstract No: 

M12

Full conference title: 

4th Trends in Medical Mycology
    • TIMM 4th (2012)