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The frequency of fungal infections is increasing due to immunodeficiency viruses and immunosuppressive drugs. The most common fungal infection of the oral cavity is candidiasis. The existence of Candida can be a part of normal commensal; hence, the isolation of Candida in the absence of clinical symptoms should exclude candidiasis. The pathogenicity of Candida is witnessed as opportunistic when immune status is compromised. Oral fungal infections are uncommon, but when identified, these infections are associated with greater discomfort and are sometimes destruction of tissues. Cytology and tissue biopsy are helpful in confirming the clinical diagnosis. The management of oral fungal infections must strategically focus on signs, symptoms, and culture reports. This article reviews information on diagnosis and therapeutic management of aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, mucormycosis, and geotrichosis.

BACKGROUND: Candida albicans is a commensal in the oral cavity of 40-65% of the adult human population. Diagnosis of oral candidiasis is usually based on clinical aspects, patients’ symptoms, and risk factors. The presence of Candida hyphae can be evaluated with staining or with the culture methods. VELscope® reveals natural tissues fluorescence produced by fluorophores of the oral mucosa is used for the screening of oral alterations. AIM: The aim of this study is to determine the sensitivity and specificity of VELscope® in the diagnosis of oral mycosis. MATERIALS AND METHODS: Oral cavity of 29 patients has been inspected evaluating the mucosa loss of fluorescence with VELscope®. The positive outcomes of VELscope® were compared to the positive outcomes of the microbiological oral swab and the cytological smear on slides. The study was approved by the Padua Hospital Ethical Committee. The Siemel method was used in the statistical analysis. RESULTS: VELscope® sensitivity was equal to 0.9167, CI95%=(0.6152- 0.9979), its specificity was equal to 0.1667, CI95%=(0.0209-0.4841). The likelihood positive ratio (LR+) was of 1.1 CI95%=(0.811-1.493) and LR- of 0.5 CI95%=(0.052-4.807). CONCLUSIONS: VELscope® sensitivity resulted higher than its specificity.

Degradation of natural ecosystems increases the risk of infections in wildlife due to microbiota dysbiosis. However, little is known about its influence on the development of fungal communities in predators and facultative avian scavengers. We evaluated the incidence of oral disease in wild nestling black kites (Milvus migrans) under contrasting environmental degradation conditions, and explored their oral fungal patterns using molecular methods and multivariate analysis. Oral lesions were found in 36.8% of the 38 nestlings examined in an anthropogenically altered habitat (southeastern Madrid, Spain), but in none of the 105 nestlings examined in a well-conserved natural area (Doñana National Park, Spain). In a subsample of 48 black kites, the composition of the oral fungal community differed among symptomatic nestlings from Madrid (SM) and asymptomatic nestlings from Madrid (AM) and Doñana (AD). Opportunistic fungal pathogens (e.g., Fusarium incarnatum-equiseti species complex, Mucor spp., Rhizopus oryzae) were more prevalent in SM and AM than in AD. Hierarchical clustering and principal component analyses revealed that fungal patterns were distinct between both study areas, and that anthropogenic and natural environmental factors had a greater impact on them than oral disease. Fungal signatures associated with anthropogenic and natural stresses harbored some taxa that could be used to flag oral infection (F. incarnatum-equiseti species complex and Alternaria), indicate environmental degradation (Alternaria) or provide protective benefits in degraded environments (Trichoderma, Epicoccum nigrum and Sordaria). Co-occurrence associations between potentially beneficial and pathogenic fungi were typical of AM and AD, hinting at a possible role in host health. This study shows that early-life exposure to highly degraded environments induces a shift towards a higher prevalence of pathogenic species in the oral cavity of black kites, favoring oral disease. Furthermore, our findings suggest potential ecological applications of the monitoring of oral mycobiome as a bioindication of oral disease and environmental degradation., This work was supported by projects CGL2009-12753-C02-01/BOS, CGL2010-15726 and PGC2018-095860-B-I00 of the Spanish Ministry of Science, Innovation and Universities, and FEDER funds and P18-FR-4239 of the Junta de Andalucía (Consejería de Conocimiento, Investigación y Universidad).

Introduction: Saprochete capitata is unusual etiologic agent in immunocompromised patients, particularly in those with hematologic malignancy and severe neutropenia. Most often, infections of the oral cavity are manifested clinically as oral candidiasis. Invasive forms are rarely described. Observation: a 63-year-old man consulted for pseudomembranous lesions associated with ulcero perforating lesion of the tongue and palatal region ulcerations. All evolving in a context of profound physical deterioration and severe neutropenia. Mycological examination showed Saprochaete capitata. The evolution was favorable with oral voriconazole. Comment: Saprochaete capitata invasive fungal infections have become an important cause of morbidity and mortality, particularly in hematology-oncology patients. Invasive or non-invasive, oropharyngeal involvement with this pathogen should not be underestimated in the neutropenic patient. They are the main starting point for fongemia of this pathogen, which is often fatal. Conclusion: Saprochete capitata is now recognized emerging etiologic agent in patients with hematological malignancy and severe neutropenia. Early detection and diagnosis of these fungal infections could lead to reduced morbidity and mortality, particularly in locally invasive infection.

En este articulo se describe un caso de paracoccidioidomicosis cronica (PCM) recurrente 11 anos despues del diagnostico inicial. La paciente una mujer blanca de Brasil de 51 anos de edad, que habia sido diagnosticada previamente con PCM. El examen fisico revelo la presencia de una lesion unica en el labio superior y una lesion elevada con apariencia de cicatriz fibrosa en la mucosa bucal derecha. No obstante el diagnostico de PCM, la ausencia de compromiso pulmonar llevo a la biopsia de la lesion localizada en la mucosa bucal y el analisis histopatologico no demostro cambios morfologicos indicativos de cualquier lesion. Sin embargo, la citologia exfoliativa tenida con Grocott-Gomori mostro la presencia de Paracoccidioides brasiliensis y la infeccion causada por este hongo fue probado. De esta manera, hacemos hincapie en la importancia de la evaluacion odontologica para el diagnostico de enfermedades que se manifiestan generalmente por via sistemica. Por lo tanto, el diagnostico correcto de las manifestaciones orales de PCM es esencial para asegurar la intervencion temprana y segura.

Paracoccidioidomycosis (PCM) is a deep mycosis with primary lung manifestations that may present cutaneous and oral lesions. Oral lesions mimic other infectious diseases or even squamous cell carcinoma, clinically and microscopically. Sometimes, the dentist is the first to detect the disease, because lung lesions are asymptomatic, or even misdiagnosed. An unusual case of PCM with 5 months of evolution presenting pulmonary, oral, and cutaneous lesions that was diagnosed by the dentist based on oral lesions is presented and discussed.

This article describes a case of recurrence of chronic paracoccidioidomycosis (PCM) 11 years following the initial diagnosis. The patient was a 51-year-old white Brazilian female, which had been previously diagnosed with PCM. The physical examination revealed the presence of a single crusted lesion in the upper lip and an elevated lesion with fibrous scar appearance on right buccal mucosa. Although the diagnosis of PCM, the absence of pulmonary involvement led to the biopsy of the lesion localized on the buccal mucosa and the histopathological analysis in H&E and PAS stains revealed no morphological changes suggestive of any lesion. However, the exfoliative cytology stained with Grocott-Gomori showed the presence of Paracoccidioides brasiliensis and the infection caused by this fungus was proven. Of this way, we emphasize the importance of stomatologic evaluation to the diagnosis of diseases that usually manifestssystemically. So, the correct diagnosis of oral manifestations of PCM, is essential to ensure early and safe intervention. En este artículo se describe un caso de paracoccidioidomicosis crónica (PCM) recurrente 11 años después del diagnóstico inicial. La paciente una mujer blanca de Brasil de 51 años de edad, que había sido diagnosticada previamente con PCM. El examen físico reveló la presencia de una lesión única en el labio superior y una lesión elevada con apariencia de cicatriz fibrosa en la mucosa bucal derecha. No obstante el diagnóstico de PCM, la ausencia de compromiso pulmonar llevó a la biopsia de la lesión localizada en la mucosa bucal y el análisis histopatológico no demostró cambios morfológicos indicativos de cualquier lesión. Sin embargo, la citología exfoliativa teñida con Grocott-Gomori mostró la presencia de Paracoccidioides brasiliensis y la infección causada por este hongo fue probado. De esta manera, hacemos hincapié en la importancia de la evaluación odontológica para el diagnóstico de enfermedades que se manifiestan generalmente por vía sistémica. Por lo tanto, el diagnóstico correcto de las manifestaciones orales de PCM es esencial para asegurar la intervención temprana y segura.

Obiettivi. Effettuare una revisione sistematica sui farmaci disponibili per il trattamento della candidosi orale in modo da scegliere la terapia più adeguata. Materiali e metodi. La candidosi orale rappresenta una causa sempre più frequente di infezione che può in taluni casi compromettere la qualità della vita del paziente. L’alta incidenza della candidosi orale può essere correlata con una molteplicità di fattori predisponenti che favoriscono la conversione della Candida da commensale a parassita. Alcuni fattori che contribuiscono a questo incremento sono rappresentati dai trattamenti antibiotici ad ampio spettro, dalla terapia con glucocorticoidi, dall’aumento dei pazienti severamente immunocompromessi, fra I quali soggetti affetti da AIDS, pazienti con neutropenia conseguente alla chemioterapia antineoplastica ecc. Risultati. Il trattamento della candidosi orale richiede l’identificazione dei fattori predisponenti, locali e sistemici, l’eliminazione degli stessi, un’accurata igiene orale e la somministrazione di farmaci antimicotici locali o sistemici. Discussione e conclusioni. Dalla letteratura si evince che un antimicotico ideale per il trattamento della candidosi orale non è ancora disponibile. OBJECTIVES. To carry out a systematic review of available drugs for the treatment of oral candidiasis in order to select the most appropriate treatment. MATERIALS AND METHODS. Oral candidiasis is a more and more frequent infection that in some cases can compromise patient's quality of life. The increasing frequency of oral candidiasis can be correlated to a number of predisposing factors favouring the conversion of Candida from a commensal to a parasite condition. These factors include treatment by broadspectrum antibiotics and glucocorticoids, the increasing of immuno-compromised patients, including subjects affected by AIDS, and neutropenia following chemotherapy. RESULTS. The treatment of oral candidiasis requires to identify both local and systemic predisposing factors, to eliminate them, to have good oral hygiene and to administer local or systemic antimycotic drugs. DISCUSSION AND CONCLUSIONS. The available literature shows that an ideal drug for the treatment of oral candidiasis is not yet available.