ORAL CANDIDIASIS AND HIV DISEASE !

Preventing And Treating Fungal Infection Of T!e "out! And T!roat

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ORAL CANDIDIASIS AND HIV DISEASE !
Preventing And Treating Fungal Infection Of T!e "out! And T!roat
Abstract
Oral candidiasis, which is also called thrush, is a fungal infection of the mouth and or
throat. Candidiasis of the throat i called esophageal candidiaisis While oral candidiasis can
sometimes occur without symptoms, the most common ones are discomfort and burning of
the mouth and throat and an altered sense of taste. Creamy white or yellowish spots on the
mouth and throat that can 3e re0oved by light scraping are also common. These may 3e
acco04anied by cracking, redness, soreness and swelling at the corners of the mouth. A bad
case can include mouth sores. Oral candidiasis is rare if CD4 cell counts are abo!e "##.
Outbreaks are more common as the count drops to $##. Oral candidiasis may be more
difficult to treat when CD4 cell counts fall below "#.
Cause
Oral candidiasis i caued by the fungus called Candida. %!eryone has small
&uantities of the fungus in the mouth, !agina, digesti!e tract and skin. 'n healthy persons,
(friendly) bacteria and the immune system pre!ent the fungus from causing disease.
*owe!er, a damaged or weakened immune system, as can be the case in *'+ disease, makes
it easier for Candida to grow and cause disease. Certain drugs can alter the natural organisms
in the mouth, which can then promote the growth of Candida. These include the e,tended use
of antibiotics, steroids and oral contracepti!es with a high estrogen content. Other factors that
may stimulate Candida growth include- diabetes, pregnancy, iron, folate, !itamin .$/ or 0inc
deficiency and using antihistamines. 1actors that may weaken the immune system2from
cancer chemotherapy to stress and depression2can also cause candidiasis.
Diagnosis
Oral conditions are usually diagnoed by appearance and symptoms. Diagnosis can
3e confir0ed by scraping a sore and e,amining it under a microscope. 1urther lab tests are
usually 4erfor0ed if the infection does not clear up after drug treatment. Candida infection
of the throat 3esophagus4 is a serious condition. 't is on the list of A'D56defining illnesses,
affecting up to /#7 of people with A'D5. 't often occurs together with oral candidiasis.
5ymptoms include chest pain, nausea and painful or difficult swallowing, causing people to
not want to eat. 'f symptoms do not impro!e with treatment, or problems with swallowing
occur without oral candidiasis, an endoscopy is usually 4erfor0ed. This procedure is where
a small tube i ued to look at the esophagus for signs of infection.
Side effects and drug interactions
Common side effects of oral a0ole drugs 3ketocona0ole, flucona0ole and itracona0ole4
are nausea, !omiting and belly pain. Others include headaches, di00iness, drowsiness, fe!er,
diarrhea, rash and changes in the sense of taste. The most serious problem is li!er to,icity, but
this is rare and usually re!erses after treatment when the drug i to44ed5 8e!ertheless, li!er
function should 3e 0onitored closely, particularly with ketocona0ole. 'ntra!enous
amphotericin . may pose serious side effects, including kidney to,icity. The most common
side effects are fe!er, shaking, chills, altered blood pressure, nausea, !omiting and headache.
These reactions are usually se!ere after the first few doses and lessen with subse&uent
treatment. 9iposomal !ersions of the drug 3like Abelcet4 are generally less to,ic and as
effecti!e than its earlier formula. 'ntra!enous amphotericin . should only 3e ued in cases
where there is a direct threat to life or all other treatments !ave failed. Oral a0ole drugs ha!e
similar drug interactions-: Anyone taking the antihistamines terfenadine 35eldane4 or
astemi0ole 3*ismanal4 or the anti6reflu, drug cisapride 3;ropulsid4 5*O<9D 8OT take
ketocona0ole or itracona0ole and should probably a!oid flucona0ole. These drugs can interact
to cause serious heart problems. A0ole drugs should not 3e ta-en with the sedati!es
tria0olam 3*alcion4 or mida0olam 3+ersed4 as this could lead to dangerous le!els of sedation.
: When ta-en with warfarin 3Coumadin4, a0oles can make the blood clot more slowly, so
clotting time should 3e 0onitored. : Taking a0oles with oral hypoglycemic drugs may result
in se!ere low blood sugar 3hypoglycemia4, so blood glucose le!els should 3e c!ec-ed
carefully. Amphotericin . has se!eral drug interactions- : =isk of kidney damage increases
when amphotericin . i ued with pentamidine 38ebupent4, cidofo!ir 3+istide4, adefo!ir
3;re!eon4, cyclosporine 38eoral4 or foscarnet 31osca!ir4. : Taking amphotericin . with
0ido!udine 3A>T, =etro!ir4, flucytosine 3Ancobon4 or ganciclo!ir 3Cyto!ene4 may result in
increaed bone marrow damage. Other drug interactions may occur. ?ore details can be
found in ;ro@ect 'nformAs publication, Drug 'nteractions, and from your pharmacist.
Prevention
=ecurrent oral candidiasis in people li!ing with *'+ is common, especially as CD4
cell counts decline. Thus, the most important method of pre!enting oral candidiasis may be
strengthening the immune system by stopping or slowing the course of *'+ infection. Other
pre!enti!e methods include use of antifungals, smoking cessation, good oral hygiene,
a!oidance of unnecessary antibiotics, alcohol, sugars and steroids. Topical therapy and
gentian !iolent may also be useful as a pre!enti!e measure. The benefits of pre!enti!e
antifungal therapy are unclear. This is partly because of the risk it poses in the de!elopment
of drug resistance, drug interactions and drug side effects. 'n general, long6term use of
antifungals should 3e reerved for people with fre&uent or se!ere recurrences of candidiasis,
particularly as the CD4 cell count declines. ;eople who e,perience occasional or infre&uent
recurrences of oral candidiasis 3no more than three episodes per year4 can 3e treated for each
episode. 'f recurrences are more fre&uent or se!ere, or if there is a history of esophageal
candidiasis, pre!enti!e therapy with flucona0ole may 3e reco00ended. According to the
need, daily, three times weekly or weekly flucona0ole at a dose of $##B/##mg is
recommended. Again, the potential risk of de!eloping a0ole resistance must 3e ta-en into
account when considering long6term use of systemic therapy for pre!enti!e purposes.
Source
'4df, Oral Candidiai And Hiv Dieae ! Preventing And Treating Fungal Infection Of
T!e "out! And T!roat http-CCimg.thebody.comClegacyAssetsC"DC$/Ccandida.pdf Taken $4
Eanuary /#$/. $D.4D W'.