Chronic muco-cutaneous candidiasis: new approaches to treatment

Abstract

SUMMARY Chronic muco‐cutaneous candidiasis may be associated with several defined syndromes of immunodeficiency or may be the predominant feature in a group of diseases, some of which are genetically determined. Current therapeutic approaches are discussed in relation to each clinical group, with particular reference to immunological reconstitution, correction of iron deficiency and other nutritional deficiencies. The effects of two new antifungal agents are considered, as well as the use of parenteral amphotericin B in a low dose. The possible use of combined therapy is outlined in patients who are more severely affected.

Perception of iron deficiency from oral mucosa alterations that show a high prevalence of Candida infection

“…The chronic mucocutaneous candidosis can be congenital but rare. 20 The vast majority of cases with chronic mucocutaneous candidosis in adult life nowadays is acquired and often associated with internal diseases with secondary immunodeficiency, such as diabetes, thymoma, endocrine disorders, HIV infection, and IDA. Fletcher et al 16 reported that saliva from ID patients with mouth lesions contained much Candida and supported the growth of Candida.…”

Iron deficiency and infection

“…Indeed the high prevalence of single-deletion α-thalassemia in many tropical areas may have a confounding effect in many studies of iron, anemia and morbidity because the mutation causes both anemia and protection against malaria and other infections. 19 In an another report, 16 patients with recurrent staphylococcal furunculosis also had nonanemic iron deficiency. Higgs and Wells (1973) noted that of 31 patients with chronic mucocutaneous candidiasis, 23 were iron deficient and 9 of 11 improved with oral and parenteral iron therapy alone, with a regression of oral lesions and development of delayed hypersensitivity to Candida.…”

“…There is a possibility that this protective effect on malarial infection in these infants may be due to homozygous single gene deletion α-thalassemia, which is present in >50% of this population. Higgs and Wells (1973) noted that of 31 patients with chronic mucocutaneous candidiasis, 23 were iron deficient and 9 of 11 improved with oral and parenteral iron therapy alone, with a regression of oral lesions and development of delayed hypersensitivity to Candida. 18 Only few observational clinical studies in iron-deficient humans convincingly relate such deficiency to substantial morbidity due to infections.…”

Relation between Iron Deficiency and Susceptibility to Bacterial Infections

“…This suggested that host defense against these infections was better during iron deficiency than during iron repletion. In contrast, an argument by Higgs and also Wells (35) comes with a comment that of the thirty-one patients who were suffering from chronic mucocutaneous type of candidiasis, only twenty-three were said to be iron deficient while nine of the eleven recorded an improvement by the application of only oral form of iron therapy and also the parenteral form of iron therapy (35). The Furunculosis recorded a resolution in all the patients apart from one after a period of 3 to 4 weeks of the iron form of therapy (36).…”