Pediatric fungal infection stomatitis
Introduction
Introduction to fungal infection stomatitis in children Candida albicans is the most pathogenic to Candida albicans infection. Childhood infection is often called thrush. Candida is a common parasite in human body. Its pathogenicity is weak, only in certain conditions. The infection is caused by the infection, so it is a conditional pathogen. In recent years, with the wide application of antibiotics and adrenocortical hormones, the infection of Candida has been increasing. basic knowledge The proportion of illness: 0.003% Susceptible people: children Mode of infection: non-infectious Complications: Candidiasis, pulmonary candidiasis, sepsis
Cause
Causes of fungal infection stomatitis in children
(1) Causes of the disease
For Candida albicans infection, the cause is malnutrition, diarrhea and long-term use of antibiotics, adrenocortical hormones, etc. These incentives combined with milk contamination can cause thrush.
(two) pathogenesis
Candida is a conditional pathogen, which can be found in the oral cavity, pharynx, intestines, vagina and skin of normal people. Normal oral carriers are 30% to 50%. When the systemic or local resistance decreases, white rosary The bacteria only multiply and cause disease. Under normal circumstances, Candida albicans is an oval (yeast-like) single cell, which is propagated in a sprouting manner. When suffering from candida albicans, oral Candida albicans multiply A large number of hyphae are formed, and the factors related to the pathogenesis of Candida albicans are:
1. Long-term application of antibiotics and adrenocortical hormones
Microorganisms, under normal conditions, between the host and the external environment, are in a relatively dynamic equilibrium state. After receiving certain antibiotic drugs, some of the normal symbiotic groups in the body are inhibited, while others are proliferating, and the flora is activated. Disorders, especially the rapid proliferation of certain pathogenic bacteria, can cause a double infection in the host and cause disease. The combination of broad-spectrum antibiotics or multiple antibiotics is the main factor in inducing fungi, especially Candida infection. Experiments have shown that chlortetracycline, oxytetracycline and tetracycline can directly stimulate the growth of Candida. The chlortetracycline preparation contains factors that promote the growth of Candida, which can promote the growth of Candida. Antibiotics can enhance the virulence of Candida and strengthen The invasiveness of Candida, hormones can weaken the function of the reticuloendothelial system, reduce inflammation and reduce antibody production. On the other hand, hormones can also enhance the toxicity of fungi, thus causing the conditions for the proliferation of fungi.
2. The patient is chronically ill
Patients with low resistance, lack of nutrition, conditional pathogens are prone to clustering and induce new infections, patients with chronic wasting diseases such as malignant tumors, diabetes, burns, trauma and post-surgical patients can reduce local or systemic immunity , leading to clustering, proliferation and infection of Candida.
3. Local factors
Such as smoking, dry mouth syndrome or oral radiation therapy, saliva reduction, active dentures or other active prosthesis caused by local mucosal trauma, such as denture stomatitis caused by denture design errors or improper use of methods, denture stomatitis Most of them wear full dentures, especially those who wear day and night, and those who wear dentures for a long time have a higher rate of attack.
Prevention
Pediatric fungal infection stomatitis prevention
Remove bad factors, clean and disinfect children's feeding utensils, pay attention to prevent cross-infection caused by feeding staff, try to remove the cause, stop using antibiotics and other induced drugs, patients with denture should pay attention to the cleaning of dentures, take dentures before going to bed Next, soak in 2% ~ 4% sodium bicarbonate solution or 0.12% clonidine solution to remove local trauma, denture retention is not good cause the wound should be re-lined or re-repaired, smoking patients should quit smoking, nutrition Poor children, seriously ill, children with chronic illness should strengthen oral care.
Complication
Pediatric fungal infection stomatitis complications Complications Candidiasis Lung Candidiasis Septicemia
If the treatment is not timely, the lesion can spread to the back of the mouth to the pharynx, trachea, esophagus, esophageal candidiasis and candidosis of the lungs, and dysphagia occurs. In a few cases, the bacteria can enter the blood circulation and become Candida albicans sepsis. Critically ill, occasionally can cause serious diseases such as endocarditis and meningitis.
Symptom
Pediatric fungal infection stomatitis symptoms common symptoms stomatitis refused to eat oral mucosal leukoplakia edema dyspnea mucosal dry congestion
Acute pseudomembranous candidiasis
Also known as thrush, it occurs in newborns, small babies, patients who have long-term use of antibiotics or hormones, and patients who have been in bed for a long time. It is characterized by white milk clots on the oral mucosa, which can be distributed in any part of the mouth. Tongue, cheek, soft palate, mouth and so on are more common. First, there are mucosal congestion, edema, burning, dryness, irritation and other symptoms in the mouth. After 1 to 2 days, scattered white spots appear on the mucous membrane, showing small spots and small pieces. Shape, such as curd, is slightly elevated in semi-adhesion. Then, the small points gradually merge and expand to become patches of different shapes. Finally, the patches merge with each other. After several days, the color of white patches turns yellowish. It can turn into a yellowish brown color for a long time. The white patch adheres to the mucous membrane and is not easy to peel off. If it is forcibly ablated, it will expose the bleeding wound, local flushing, and there may be a hemorrhage, but it will soon be covered by the new patch. The patient has Dry mouth, burning sensation and mild pain, generally good, does not affect the feeding, sometimes the child may be irritated, refusing to eat, crying, etc., generally the systemic reaction is not obvious, some patients may have body temperature High, sometimes involving the individual because of the digestive tract, respiratory tract and vomiting, hoarseness or difficulty in breathing, smear and culture can help diagnose.
2. Acute atrophic candidiasis
Acute atrophic candidiasis can occur alone or in combination with pseudomembranous candidiasis. Patients often take a large amount of antibiotics and hormones, oral mucosa congestion, extensive red patches, irregular edges, and good Tongue, cheek and sputum mucosa, the tongue is usually at the midline of the back of the tongue, the local filamentous nipple is atrophy, and the filamentous nipple hyperplasia on both sides of the lesion forms a clear boundary with the lesion area. This performance is also called antibiotic glossitis. A small ulcer surface can be formed in the atrophic erythema area, and the corresponding sputum mucosa can have a hyperemic area of congestion, pain and obvious burning sensation.
3. Chronic atrophic candidiasis
Patients with lesions that occur in maxillary dentures and orthodontic appliances can also occur in the general patient's mouth, often accompanied by angular keratitis, chronic disease, which lasts for several months to several years, can recur, patients have mild dry mouth and Burning pain.
Examine
Examination of fungal infection stomatitis in children
Smear
Scrap the surface of the lesion area or the secretions, denture stomatitis scrape the tissue surface of the denture base, apply it on the slide, add 10% potassium hydroxide or sodium hydroxide solution to the spores of Candida albicans And hyphae, smear can also be stained with PAS (periodic acid Schiff staining) and then observed under the microscope. After staining, the spores and hyphae are reddish purple, easy to observe, and can be stored for a long time.
2. Cultivation
Collect 2 ml of non-irritating mixed saliva of the patient, take 0.5 ml and inoculate it on TTC agar medium (sand medium containing red tetrazolium), incubate at 35 ° C, and take out colony growth after 1 to 2 days to form yeast-like colonies. It can be used for smear and further identification. On the 7th day, the growth of aseptic fall is considered negative.
3. Identification
The thick-film spore formation experiment is one of the most important characteristics of the current identification of Candida albicans. The method is to inoculate the test bacteria in the corn tween medium, and culture at 22-25 ° C for 1-2 days, and the punctate gray-white colonies may appear. Microscopic spore growth at the top of the hyphae under the microscope.
4. Histopathological examination
The pseudomembrane of acute pseudomembranous candidiasis is a thick membrane composed of exfoliated epithelial cells, cellulose, food debris, white blood cells, bacteria and Candida albicans. Acute pseudomembranous candidiasis The hyphae can invade the keratinized layer of the mucosa, and the pathological examination of the lesion area of chronic proliferative candidiasis is characterized by epithelial incomplete keratinization. It can be seen that the hyphae of Candida albicans invade, polymorphonuclear leukocyte infiltration in the epithelium, and incomplete keratinization. In the layer, leukocytes accumulate to form tiny abscesses, sometimes with mild and moderate abnormal hyperplasia. Therefore, it is necessary to be vigilant against chronic proliferative candidiasis, and strive for early biopsy to confirm the diagnosis.
Generally, no auxiliary examination is needed. When the condition is serious and the infection spreads, chest X-ray, B-ultrasound, electrocardiogram, etc. should be taken accordingly.
Diagnosis
Diagnosis and diagnosis of fungal infection stomatitis in children
diagnosis
According to the clinical manifestations of various types, combined with Candida smear, culture and identification, it is generally easier to diagnose, chronic proliferative candidiasis should be combined with histopathological examination.
Differential diagnosis
The disease should be differentiated from herpes angina caused by Coxsackie A virus.
Herpetic angina is a self-limiting disease characterized by acute fever and pharyngeal herpes ulcer caused by many group A Coxsackie viruses or other enteroviruses, with fecal-oral or respiratory tract as the main route of transmission. It is more infectious, spreads quickly, is sporadic or popular, and is a high-season season in summer and autumn, mainly affecting children aged 1-7. The general course of disease is 4-6 days, and the severity is 2 weeks. The clinical manifestations are crying, refusing milk, persistent fever, pharyngeal pain, and salivation. The main symptoms are in the pharynx. At the beginning of the pharynx, the pharynx is congested. The pharyngeal isthmus (the tonsils, soft palate and uvula) can be seen scattered in the gray-white herpes of the size of the millet, surrounded by red blush, gradually enlarged after 2-3 days. Collapse, forming an ulcer.
