Rahmatia Djou1, Irna Sufiawati2

Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia

Oral Medicine Departement, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia

Abstract

Objective: Oropharyngeal candidiasis (OPC) is one of the first and most prevalent oral opportunistic infections to affect HIV-infected individuals. There are  a wide variety of risk factors that predispose to OPC. The aim of this case report was to identify the association of various predisposing factors to the development of OPC in treatment-naive HIV-infected patients.

Method: Two newly HIV-infected patients who had not yet received antiretroviral therapy (ART), aged 32-year-old and 25-year-old, were referred to Oral Medicine Clinic at Dr. Hasan Sadikin General Hospital, Bandung Indonesia, with a similar complaint of white patches in the oral cavity. Clinical findings revealed dry lips, creamy white plaques on most of the oral mucosa. The plaque could be wiped off leaving an underlying erythematous mucosal surface. The oral hygiene (OH) was poor.

Both patients had been diagnosed and treated for pulmonary tuberculosis. The first patient had received prolonged cotrimoxazole and the second patient had a history of repeated antibiotic self-medication. They both had severe depletion of the CD4+ T cells (17 cells/mm3 and 16 cells/mm3 respectively).  Blood test revealed  that the patients had low levels of haemaglobin or haematocrit as a sign of anemia. They both denied use of alcohol, drug abuse, and smoking. The diagnosis of OPC in both patients was made based on clinical symptoms. The patients were given fluconazole, chlorhexidine digluconate 0,2% mouthwash, vitamin B12, folic acid, petroleum jelly, and OH instruction. Their oral lesions healed within a week.

Conclusion: The risk factors for developing OPC in treatment-na1ve HIV-infected patients include are related to anemia, low CD4+ count, prolonged/repeated antibiotic use, and poor of oral hygiene. Identification of possible risk factors associated with OPC is helpful in guiding the diagnosis and therapy for HIV-infected patients.