Oral Kandidozun Tanı Ve Tedavisi: Derleme
Özet
Ağız boşluğu, bakteri, virüs ve mantar gibi 700 farklı mikroorganizma türünü barındıran karmaşık bir ekosistemdir ve klinik açıdan en önemli mantar cinsi Candida, özellikle de C. albicans’tır. Oral kavitenin en sık karşılaşılan fırsatçı enfeksiyonu olan oral kandidoz, dünya genelinde sağlıklı bireylerde semptomsuz taşınabilirken; yenidoğanlarda, protez kullananlarda, kemoterapi hastalarında ve HIV pozitif bireylerde taşıyıcılık oranları ciddi artış göstermektedir. Mikroorganizmanın saprofit formdan patojenik forma geçmesinde sigara, hareketli protez, radyasyon, karbonhidrat ağırlıklı diyet gibi lokal faktörlerin yanı sıra diyabet, ileri yaş, antibiyotik kullanımı ve bağışıklık baskılanması gibi sistemik faktörler rol oynar. Hastalığın tanısında imprint kültür, sürüntü (smear), pamuk çubuk (swab), konsantre ağız gargarası, tükürük örneği ve biyopsi gibi yöntemlerden yararlanılır. Klinik olarak primer (akut/kronik psedömembranöz, eritematöz, kronik hiperplastik) ve sekonder formda sınıflandırılan oral kandidoz; protez stomatiti, angular şelit ve mediyan romboid glossit gibi lezyonlarla veya liken planus gibi keratinize lezyonlarla ilişkili gelişebilir. Dünya Sağlık Örgütü tarafından potansiyel premalign bozukluk olarak kabul edilen kronik oral kandidozun tedavisinde öncelikle predispozan faktörlerin ortadan kaldırılması gerekir; ardından nistatin, amfoterisin B, mikonazol, itrakonazol ve flukonazol gibi lokal veya sistemik azol ve polyen grubu antifungal ajanlar reçete edilir.
The oral cavity is a complex ecosystem harboring approximately 700 different microorganism species including bacteria, viruses, and fungi, with Candida, particularly C. albicans, being the most clinically significant fungal genus. Oral candidosis, the most common opportunistic infection of the oral cavity, can be carried asymptomatically by healthy individuals worldwide; however, carriage rates increase significantly in neonates, denture wearers, chemotherapy patients, and HIV-positive individuals. Local factors such as smoking, removable denture use, radiation, and a high-carbohydrate diet, alongside systemic factors including diabetes, advanced age, antibiotic use, and immunosuppression, play a major role in the transition of the microorganism from a commensal to a pathogenic form. Diagnostic methods include imprint culture, smear, swab, concentrated oral rinse, saliva sampling, and biopsy. Clinically classified into primary (acute/chronic pseudomembranous, erythematous, chronic hyperplastic) and secondary forms, oral candidosis can manifest in association with lesions like denture stomatitis, angular cheilitis, and median rhomboid glossitis, or superimposed on keratinized lesions such as lichen planus. In the treatment of chronic oral candidosis, classified as a potential premalignant disorder by the World Health Organization, eliminating predisposing factors is primary; subsequently, local or systemic azole and polyene group antifungal agents such as nystatin, amphotericin B, miconazole, itraconazole, and fluconazole are prescribed.
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