|Rautemaa R, Ramage G.
Manchester Academic Health Science Centre, School of Translational Medicine,
The University of Manchester, Manchester, UK.
This review summarizes the impact of biofilms in oral
candidosis with special emphasis on medically compromised patients. The
concept of oral candidosis as a mixed candidal-bacterial biofilm infection
has changed our understanding of its epidemiology and diagnosis as well as
approach to its treatment. Candida albicans is the most common causative
agent of oral candidosis although Candida species other than C. albicans are
often seen in medically compromised patients with a history of multiple
courses of azole antifungals. Although C. albicans is usually susceptible to
all commonly used antifungals when tested in vitro, their biofilm form are
highly resistant to most antifungals. Therefore, treatment consists of
mechanical destruction of the biofilm in combination with topical drugs.
Azole antifungals should be avoided for patients suffering from recurrent
oral yeast infections due to a risk of selection and enrichment of resistant
strains within the biofilm. Oral candidosis can also be a symptom of an
undiagnosed or poorly controlled systemic disease such as HIV infection or
diabetes. If the response to appropriate treatment is poor, other causes of
oral mucositis should be excluded. Oral candidosis arises from the patient's
mixed candidal-bacterial biofilm, i.e., dental plaque, whereby good
self-care is important for successful therapy.