title: Perception of iron deficiency from oral mucosa alterations that show a high prevalence of Candida infection.
abstract: OBJECTIVE
  Iron deficiency (ID) is the most common cause of anemia. The aim of this study was to investigate patients with oral mucosa alterations as the initial manifestation of ID or ID anemia (IDA).
  
  
  METHODS
  Sixty-four patients (50 IDA and 14 ID) with a wide range of sore mouth were diagnosed and treated. The oral and physical manifestations as well as iron studies and anemia classification based on the mean and heterogeneity of red cell size were assessed.
  
  
  RESULTS
  ID predisposed 64 patients to a high incidence of Candida infection (85%) and showed a variety of oral manifestations including angular cheilitis (63%), atrophic glossitis (AG; 59%), pseudomembranous candidosis (44%), erythematous candidosis (41%), median rhomboid glossitis (5%), chronic mucocutaneous candidosis (5%), papillary hyperplastic candidosis (3%), and cheilocandidosis (3%). Others included pale oral mucosa (31%), burning mouth (28%), and recurrent oral ulcers (6%). Colorectal cancers in two patients were diagnosed. The values of hemoglobin (Hb) in 64 ID patients varied from normal to life-threatening levels, but none had developed advanced systemic symptoms except fatigue. All had low serum iron and ferritin. Sixty (94%) patients had transferrin saturation < 16%; however, 19 (30%) patients remained normocytic and 14 (22%) patients were nonanemic.
  
  
  CONCLUSIONS
  The study demonstrates that oral mucosa alterations accompanying oral candidosis are a sensitive indicator of ID. All oral changes can be successfully ameliorated by iron therapy plus antifungals when candidosis exists. Investigating the origin of IDA is necessary, because it may be the first sign of a more serious disease, particularly malignancy.
authors.affiliation: Oral Pathology and Family Dentistry Section, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. Electronic address: jasminelu@adm.cgmh.org.tw.
authors.forename: Shin-Yu
authors.initials: SY
authors.lastname: Lu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018798:Anemia, Iron-Deficiency / Q000150:complications*; D000935:Antifungal Agents / Q000627:therapeutic use; D002180:Candidiasis, Oral / Q000150:complications* / Q000188:drug therapy; D004909:Erythrocyte Indices; D005260:Female; D005293:Ferritins / Q000097:blood*; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D015994:Incidence; D007501:Iron / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000382:microbiology / Q000473:pathology*; D012720:Severity of Illness Index; D013624:Taiwan; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D006454:Hemoglobins; D005293:Ferritins; D007501:Iron
keywords: iron deficiency anemia; oral candidosis; oral mucosa alterations