PATHOGENS

• Candida albicans
  
  • Normal commensal of the mouth AND the most common cause of infection (~80% of colonizing isolates).
    • C. albicans may cause infection alone or in combination with non-C. albicans species.
  • Typically susceptible to azole antifungals, but resistance can develop.
• Non-albicans Candida spp
  • Most common non-C. albicans organisms: C. glabrata,C. tropicalis, C. dubliniensis and C. krusei.
  • C. glabrata may occur as part of a mixed infection (along with C. albicans) and can cause fluconazole-refractory infections, some of which can also prove resistant to other azoles.
  • C. auris is only very rarely found in the oral cavity.
• Host factors associated with conversion from commensal to local invasion (oral candidiasis)
  • Local: poor oral hygiene, salivary dysfunction (including due to radiation therapy), dentures, topical corticosteroids, smoking
  • Dietary: nutritional deficiencies (e.g., iron, folate and vitamin deficiencies), high-carbohydrate diet
  • Systemic immunodeficiency with local consequences: Cancer chemotherapy, HIV infection, poor glycemic control, immunosuppressive medications, age-related immune decline, other immune deficiencies states (e.g., chronic mucocutaneous candidiasis)
  • Broad-spectrum antimicrobial therapy