Serious forms of candida infections - invasive candidiasis and recurrent oral candidiasis refractory for therapy
Invasive candidiasis and candidaemia are the most serious forms of candidiasis, and the treatment of these infections is handled in hospitals. The incidence of candidaemia is signifi- cantly higher in Denmark than in the other Nordic countries. Calculation of the burden of fungal infections in Denmark has shown that about 900,000 Danes have a fungal infection per year, of which 800,000 are skin infections. In 2013, about 53,000 patients received prescribed antifungal agents for use in the oral cavity, which corresponds to approximately 1% of the population. About half the population is carrier of Candida albicans, and it is the carriers who develop oral can- didiasis. The dentist can carry out the treatment of uncom- plicated cases of oral candidiasis, i.e. cases where the cause is evident, for example, broad-spectrum antibiotic treatment, insufficient oral and/or denture hygiene, reduced salivary se- cretion, and smoking. Treatment becomes more complicated in cases when an underlying disease or condition causes re- current and often refractory oral candidiasis. In such cases a multidisciplinary approach and cooperation is necessary. In order to achieve an optimal response to therapy, it is important to identify factors that are important for therapy selection and duration of treatment. These factors include patient sensitive and infection sensitive parameters as it is important to address the predisposing factors and interven- tion approaches that are needed concurrently with antifungal therapy. Follow up on the therapeutic response is required to minimize resistance development. This article deals with the serious and intractable recurrent candida infections.