06 Fungal infections Flashcards
1
Q
A
candidiasis
- dimorphic (yeast, hyphal)
- opportunistic
- pseudomembranous, erythematous, hyperplastic, angular cheilitis, denture stomatitis, median rhomboid glossitis
- treat with clotrimazole
- use probiotics when taking antibiotics
2
Q
A
pseudomembranous candidiasis
- white plaques like cottage cheese
- tangled mass of hyphae, yeasts, debris
- scrapping to remove
- mild symptoms, burning sensation, unpleasant taste
- typically on buccal muccosa, palate, dorsal tongue
3
Q
A
erythematous candidiasis
- most common, but overlooked
- missing white component
- ‘antibiotic sore mouth’ following broad spectrum treatment
- loss of filliform papillae leads to red bald tongue
- higher incidence in xerostomic patients
4
Q
A
hyperplastic candidiasis
- not removed by scrapping
- least common
- possibly candidiasis over preexisting leukoplakia
- intermingled red/white areas
5
Q
A
angular cheilitis
- loss of vertical deminsion
- Vit. B deficient
- cheilocandidiasis - candidal infection at vermillion borders
- 20% candida, 60% candida + staph aureus, 20% staph aureus
- treat w/ mycolog II ointment, Vit. B complex
6
Q
A
central papillary atrophy
median rhomboid glossitis
7
Q
A
denture stomatitis
- form of erythematous candidiasis
- AKA chronic atrophic candidiasis
- poor denture hygiene
- treat candidiasis, remake denture, improve hygiene
8
Q
mucocutaneous candidiasis
A
- suspect when infections of mouth, nails, skin and other mucosal surfaces
- component of rare group of immunologic disorders
- mutations of autoimmune regulator gene
- increased oral/esophageal cancer
- control candida with antifungals
9
Q
candida histopathologic features
A
- PAS stain - bright magenta
- hyphae or pseudohyphae must be present to diagnose
- may be superimposed on LP, leukoplakia and squamous cell carcinoma
10
Q
candida treatments
A
- nystatin - bitter taste, sucrose, poorly absorbed
- clotrimazole - poorly absorbed, antibacterial/antifungal, elevates liver enzymes
- ketaconazole - need acid environment for absorption, liver issues
- fluconazole - more effective than ketacon., acid not needed, side effects with phenytoin/anticoagulants/hypoglycemic agents
- iodoquniol- antibacterial/antifungal, cream base effective for angular cheilitis
11
Q
histoplasmosis
A
most common systemic fungal infection in US
- humid areas
- bird or bat excrement
- spores inhaled, multiply in lymph nodes and spread systemically
- oral lesions on tongue, palate, buccal mucosa
- painful and mimic malignancy
- multinucleated giant cells with granulomatous inflammation
12
Q
histoplasmosis treatment
A
- acute cases self limiting requiring no treatment
- half chronic cases recover spontaneously
- amphotericin B in severe cases, kidney damage
- itraconazole for 3 months in nonimmunosuppressed
- disseminated form 80-90% death rate
13
Q
zygomycosis
A
- opportunistic
- ketoacidotic diabetics
- serum iron levels rise because ketoacidosis inhibits iron binding in transferrin
- fungal growth increased by iron
- AKA mucormycosis and phycomycosis
- spores found on decaying material
14
Q
zygomycosis symptoms and treatment
A
- nasal obstruction, bloody nasal discharge, facial swelling, cellulitis, visual disturbances
- facial paralysis with cranial nerve involvement
- blindness, lethargy, seizures, death in progressive cases
- histological necrosis with hyphae brancing at 90degrees
- surgical debridement
- high dose amphotericin B
15
Q
aspergillosis
A
- invasive or non-invasive forms
- invasive more in immunocompromised
- found in saprobic organisms, water and decaying debris
- spores released in air
- most aspergillus species can’t grow at 37degrees C, only pathologenic species
- allergic fungal sinusitis - infection of maxillary sinus forms mass fungal hyphae and may undergo dystrophic calcification (antrolith)
