Thrush in Sarcoidosis

3/05/2003

Question: Is mucosal thrush seen in sarcoidosis patients, in the absence of steroid therapy?

 [ NOTE: #1-#3 are only MEDLINE citations found pairing sarcoidosis with oral candidiasis. 

   #4 - #11 are general articles about immunocompromised patients (generally) and candidiasis. ]

<1>

Unique Identifier:8733504

Authors: Sinicco A. Maiello A. Raiteri R. Sciandra M. Dassio G. Zamprogna C. Mecozzi B.

Institution: Institute of Infectious Diseases, University of Turin, Italy.

Title: Pneumocystis carinii in a patient with pulmonary sarcoidosis and idiopathic CD4+ T lymphocytopenia.

Source: Thorax. 51(4):446-7: discussion 448-9, 1996 Apr.

Abstract: A case of pulmonary sarcoidosis and idiopathic CD4+ T lymphocytopenia is reported. Pneumocystis carinii was detected in the bronchoalveolar lavage fluid of a young homosexual man who was asymptomatic without any evidence of congenital or acquired immunodeficiency but with a low CD4+ cell count. A clinical and histological diagnosis of pulmonary sarcoidosis was made. During follow up the patient had oral candidiasis and a CD4+ cell count persistently below 300/microliters. This case is highly suggestive of concurrent pulmonary sarcoidosis and idiopathic CD4+ T lymphocytopenia.

<2>

Unique Identifier:8015560

Authors: Mateev G. Vassileva S. Kantardjiev T. Obreshkova E. Pramatarov K.

Institution: Institute of Dermatology, Sofia, Bulgaria.

Title: Candida granuloma and sarcoidosis.

Source: Mycoses. 36(9-10):295-7, 1993 Sep-Oct.

Abstract: Chronic mucocutaneous candidosis has been described in patients with impaired cell-mediated immunity. We describe a female patient with sarcoidosis who developed a Candida granuloma on her upper lip. Moderate impairment of the cell-mediated immunity was detected. Three months' treatment with ketoconazole was successful, but the lesion recurred at the same place after treatment was stopped. CAS Registry/EC Number 50-24-8 (Prednisolone).

<6>

Unique Identifier:2181814

Authors: Heimdahl A. Nord CE.

Institution: Department of Oral Surgery, Huddinge University Hospital, Karolinska Institute, Sweden.

Title: Oral yeast infections in immunocompromised and seriously diseased patients. [Review] [41 refs]

Source: Acta Odontologica Scandinavica. 48(1):77-84, 1990 Feb.

Abstract: The number of immunocompromised patients has increased during recent years. Most fungal infections in these patients are caused by Candida, Aspergillus, Mucor, and Cryptococcus species. Patients with low granulocyte count are at the highest risk of invasive candidal infection. The commonest type of granulocytopenia is observed in connection with malignant diseases of the hematopoietic system. Cytotoxic treatment and radiotherapy of large-body areas tend to produce a significant decrease in circulating granulocytes. Early diagnosis and adequate treatment of fungal infections are mandatory for a successful outcome. In the oral cavity it is important to differentiate between colonization and invasive infection. The optimal approach to diagnosis is a combination of histology and cultivation of specimens obtained from the same site of suspected infection. Prophylaxis of oral fungal infection in immunocompromised patients is generally aimed at preventing colonization. [References: 41] CAS Registry/EC Number 0 (Antifungal Agents).

<8>

Unique Identifier:2666442

Authors: Brawner DL. Cutler JE.

Institution: Department of Microbiology, Montana State University, Bozeman 57917.

Title: Oral Candida albicans isolates from nonhospitalized normal carriers, immunocompetent hospitalized patients, and immunocompromised patients with or without acquired immunodeficiency syndrome.

Source: Journal of Clinical Microbiology. 27(6):1335-41, 1989 Jun.

Abstract: A total of 128 human oral isolates of Candida albicans were collected from asymptomatic healthy carriers (64 isolates); asymptomatic, nonimmunosuppressed, hospitalized patients (25 isolates); immunosuppressed transplant patients (19 isolates); and human immunodeficiency virus-infected patients with symptoms of acquired immunodeficiency syndrome and oral candidiasis (20 isolates). Isolates were serotyped as A or B and tested for reactivity with an agglutinating immunoglobulin M monoclonal antibody (H9). Immunocompetent individuals colonized by oral C. albicans were almost equally likely to carry serotype A as serotype B cells, while immunocompromised individuals were at least twice as likely to be infected by serotype B than serotype A strains. The reactivity of isolates with H9 antibody followed a similar but more distinctive pattern. Approximately half of the strains from immunocompetent individuals reacted strongly with H9, and the remainder reacted weakly. However, up to 75% of the isolates from immunocompromised patients reacted weakly with H9, while the remainder reacted strongly. A correlation between H9 reactivity and the serotypes of these isolates existed (P = 0.16). The correlation between H9 reactivity and immune status was even stronger (P = 0.025). The monoclonal antibody activities described above were determined by agglutination tests during defined phases of C. albicans growth. Expression of antigen at various times during growth of several isolates was confirmed at the cellular level by analysis using fluorescence-activated cell sorting. Despite the correlation between serotype A and H9 reactivity, H9 antigen was not identical to the serotype A antigen because four serotype A strains reacted only weakly with H9 antibody, and one strain reacted strongly with H9 but was serotype B. These data indicate that oral strains of C. albicans from immunocompetent individuals differ as a group from C. albicans isolated from those who are immunosuppressed. CAS Registry/EC Number 0 (Antibodies, Monoclonal). 0 (Immunoglobulin M).