Fungal Infections of the Oral Mucosa

Excerpt

The oral cavity provides a unique ecological site that harbors a dynamic microbiota. Candida, Aspergillus, and Rhizopus are commensal oral fungi species. However, they may become pathological and cause opportunistic infections under certain conditions. The incidence of fungal infections has been on the rise in recent years, especially in COVID-19 patients, due to several factors such as immunodeficiency, hyperglycemia caused by diabetes mellitus, prolonged hospitalizations, and prolonged use of steroids, and hematopoietic malignancies. The advent of newer therapies for several diseases has also influenced the incidence of fungal infections.

The diagnosis of oral fungal infection is mainly based on clinical presentation and histopathology of the lesional tissue. Characteristic features include a burning sensation and an unpleasant taste in the mouth, white plaques, ulcerations, erythema, and pain. The most common oral cavity fungal infections include candidiasis, aspergillosis, mucormycosis or zygomycosis, histoplasmosis, blastomycosis, cryptococcosis, paracoccidioidomycosis, and geotrichosis. The modalities to detect fungal organisms have also evolved to include rapid molecular tests like polymerase chain reaction (PCR). Prompt evaluation of oral lesions is essential to establish the diagnosis, initiate therapy, and monitor clinical progress. Management primarily involves maintaining proper oral and denture hygiene, evaluating and correcting predisposing factors, and selecting an appropriate antifungal agent. For some types of fungal infections, surgical debridement is indicated. Clinical assessment of oral lesions, recognizing and correcting the underlying predisposing factors, and administering appropriate antifungal agents are the cornerstones for managing oral mycoses.