International Journal of Dental and Health Sciences

Case Report Volume 02, Issue 02

A CASE REPORT OF: PSEUDOMEMBRANOUS

CANDIDIASIS INDUCED BY LONG TERM SYSTEMIC
CORTICOSTEROIDS THERAPY
Ziad Salim Abdul Majid1, Elsanousi M.Taher2.
1. BDS, Department of Oral Medicine, Surgery, and Diagnosis.Faculty of Dentistry, Libyan
International Medical University.
2.BDS, MSc Ireland, FFDRCSI, Head Of the Department of Oral Medicine, Surgery, and Diagnosis,
Dean of the Faculty of Dentistry/ Libyan International Medical University.

ABSTRACT:

Oral candidiasis is a common opportunistic infection of the oral cavity caused by an

overgrowth of Candida species, the commonest being the Candida albicans. It is one of the
common side effect associated with long term use of systemic corticosteroids. The purpose
of this case report is to discuss the Acute Pseudomembranous Candidiasis in 24 Negroid
Female Libyan patient on long term use of systemic corticosteroids therapy who came to
the department of Oral Medicine, Surgery, and Diagnosis at the Faculty of Dentistry, Libyan
International Medical University with the clinical appearance of Acute Pseudomembranous
Candidiasis.
Proper patient management with successful treatment protocol, and follow up were
performed to overcome the patient presenting symptoms, and to eliminate the
corticosteroids therapy related problems.
Key words: Acute Pseudomembranous Candidiasis, Candida albicans, Systemic
Corticosteroids, Ketoconazole, Chlorhexidine gluconate.

INTRODUCTION: A change from the harmless commensal

existence of Candida to a pathogenic state
Oropharyngeal candidiasis is a common
can occur following alteration of the oral
opportunistic infection of the oral cavity
cavity environment to one that favors the
caused by commensal Candida species.
growth of Candida. The causes of such
the Candida genus is comprised of over
changes most often related to a
150 species of asporogenous ‘yeast-like’
weakening of host immune defenses [1].
fungi [1]. Since the majority of healthy
The implicated predisposing factors are
individuals have an intraoral candida
classified into local factors which includes:
species, it is shown that some individuals
Impaired salivary gland function, inhaled
exposed to oral candidial lesions. The
steroids, dentures, oral
most commonly implicated species is
cancer/leukoplakia, and high
Candida albicans which is isolated in over
carbohydrate diet. The systemic factors
80% of lesions [2].
includes: Drugs such as long term use of
broad spectrum antibiotics,

*Corresponding Author Address: Ziad Salim Abdul Majid BDS, Department of Oral Medicine, Surgery, and Diagnosis, Faculty
of Dentistry, Libyan International Medical University, Benghazi - Libya. Email: [email protected].
 Abdul Majid. et al., Int J Dent Health Sci 2015; 2(2): 454-458

Immunosuppressives , corticosteroids, CASE DETAIL:

diabetes, Cushing’s syndrome, HIV
A 24 years old negroid female Libyan
infection, malignancies as leukemia,
patient, came to the department of Oral
nutritional deficiencies as vitamin B12,
Medicine, Surgery, and Diagnosis, at the
smoking, and stress [3].
Libyan International Medical University,
Candidiasis is categorized into primary with a complaint of roughness, peeling of
oral candidiasis in which the condition is oral tissue, burning sensation on the
only confined to the mouth where as in tongue and sore mouth since one and half
secondary oral candidiasis the condition is month ago. The patient medical, and drug
confined to other body parts in addition history revealed that she had surgical
to the mouth [4]. Primary oral candidiasis removal of intracranial cystic lesion since
has generally four forms are described three months ago, and since then she was
based on clinical presentation : Acute on systemic corticosteroids therapy
Pseudomembranous Candidiasis, Acute (dexamethasone 10mg/day) till a week
Erythematous Candidiasis, Chronic before her visit to the department.
Erythematous Candidiasis, and Chronic
On intraoral examination, almost all over
Hyperplastic Candidiasis [1].
her oral mucosa ( buccal, labial, palatal
Pseudomembranous candidiasis (oral mucosa) covered by elevated white
thrush) presents as creamy white lesions patches, diffuse erythema over the soft
on the oral mucosa and a diagnostic palate, uvula, and oropharynx (Fig.1
feature of this infection is that these A,B,C), with scrapable white patches. On
plaques can be removed by gentle gently rubbing these white patches , a
scraping leaving behind an underlying visible erythematous areas were seen.
erythematous mucosal surface.
The complete blood examination report
Histological examination of recovered
showed normal figures, a smear was
pseudomembranous reveals
made from scrapings of these lesions For
desquamated epithelial cells together
cytological evaluation, and the results
with yeast and filamentous forms of
indicated candidiasis, Culture Candida
Candida [1]. The infection has been
using a Sabouraud's dextrose agar was
demonstrated as an acute condition often
also done to aid the definitive
affecting newborns where the immune
identification of the fungal organism.
system is immature, in older individuals,
Based on both clinical examination , and
Acute Pseudomembranous Candidiasis
investigations; the diagnosis indicate
often occurs when there is a nutritional
Acute Pseudomembranous Candidiasis
limitation, immune suppression, or by an
due to prolonged use of systemic
underlying disease most notably HIV
corticosteroids. Following to that the
infection [5].
patient was treated with ketoconazole

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 Abdul Majid. et al., Int J Dent Health Sci 2015; 2(2): 454-458

tablet 200 mg once daily, chlorhexidine Systemic antifungals are usually indicated
gluconate 0.12% mouthwash 2 times/day in cases of disseminated disease and/or in
for 2 weeks. On the follow up visit, a one immunocompromised patients [3]. In
week after an improvement of the addition the use of Chlohexidine
presenting complaints was noticed , and gluconate mouthwash shows a significant
the oral lesions was completely improvement in the reduction, and
disappeared (Fig.2 A,B,C). prevention of the candidal infections [1].
"Chlorhexidine binds to negatively
DISCUSSION:
charged microbial cell surfaces leading to
Although, Candida albicans is the most a disruption of the cell membrane of the
frequently involved species in oral microorganisms (W Nittayananta et al,
candidiasis, other species are increasingly 2008)" [7]. Thus, antifungal activity of
being encountered. The unique virulence chlorhexidine due to both its fungicidal
factors of Candida albicans includes the activity and its mechanical effect inhibits
ability to adhere to host tissue surfaces, the fungal adhesion to mucosal epithelial
produce filamentous fungal growth, and cells [7].
release hydrolytic enzymes that cause
CONCLUSION:
damage to the host tissue.
Candida species are normal oral
Pseudomembranous candidiasis can be
commensals found in 17-75% of healthy
develop as a result of long term use of
individuals and most debilitated people.
systemic corticosteroids, or the case
The transition of this innocuous
where the individual being
commensal to the disease-causing
immunocompromised for long term.
associated with the virulence attributes of
Concurrent with their therapeutic
the microorganism.
properties subsist a plethora of adverse
effects, including the susceptibility to Long term use of systemic corticosteroids
infection [2]. They produce a multiple results in development of Acute
effects on different immunocytes, as Pseudomembranous Candidiasis due to
suppressing the dendritic cell activation, the fungal overgrowth in
reducing the release of macrophage immunosuppression status. Effective
cytokines, B lymphocytes and management of oral candidiasis demands
immunoglobulin/antibody production, the elimination of any identified
increasing in the number of circulating predisposing factors together with the
neutrophils, but delaying their apoptosis, administration of appropriate antifungal
and alter T-lymphocyte cytokine agents.
production [6] .

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FIGURES:

Fig. 1 A,B,C

A B C

B C

Fig. 2 A,B,C

A B C

A B C

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