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OPath Block 2 > 4. Fungal infections > Flashcards

4. Fungal infections Flashcards

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1
Q

What is the most common oral fungal infection in humans?

A

Candidiasis

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2
Q

What is the most common Candida?

A

Candida albicans: yeast like fungal organism

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3
Q

How many forms do C. albicans exist in?

A

Dimorphic (Yeast form and Hyphal form)

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4
Q

Which C. albicans form invades the host tissue?

A

Hyphal form

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5
Q

What are common causes of oral candidiasis?

A

Broad spectrum antibiotics

Immunosuppression

Idiopathic

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6
Q

Clinical patterns of candidiasis?

A

Pseudomembranous

Erythematous

Chronic hyperplastic

Mucocutaneous

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7
Q

What is pseudomembranous candidiasis aka?

A

thrush

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8
Q

How does thrush clinically present?

A

Removable creamy white plaques

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9
Q

What patient population often gets pseduomembranous cadidiasis?

A

Immunocompromised pts

infants

patients on broad spectrum antibiotics

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10
Q

Symptoms of pseudomembranous candidiasis?

A

very mild

may have burning sensation and foul taste

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11
Q

Dx of thrush?

A

cytological smears

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12
Q

Tx of pseudomembranous candidiasis?

A

identify underlying cause and correct

antifungal antibiotics

no Tx needed for infants

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13
Q

Population that gets erythematous candidiasis?

A

Much more common

most patients are not immunocompromised

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14
Q

Symptom of erythematous candidiasis

A

Red mucosa

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15
Q

Common clinical presentations of erythematous candidiasis

A

denture stomatitis

acute atrophic candidiasis

median rhomboid glossitis

angular cheilitis

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16
Q

What is denture stomatitis?

A

Varying degrees of erythema localized to the denture wearing area

rarely symptomatic

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17
Q

Causes of denture stomatitis?

A

Reaction to denture material

Unusual pressure on the mucosa

Presence of candida (mostly on maxilla)

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18
Q

If candida seen on denture in denture stomatitis, what must we be concerned with?

A

Patient sleeping with denture on.

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19
Q

When is acute atrophic candidiasis often seen?

A

After broad spectrum antibiotics or suffer from xerostomia

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20
Q

S/S of acute atrophic candidiasis

A

Diffuse loss of filiform papillae of the dorsal tongue – loss of this keratin tissue leaves tongue very red

Burning tongue sensation

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21
Q

What is median rhomboid glossitis?

A

Well demarcated erythematous zone along the midline of the posterior dorsal tongue but anterior to terminal sulcus due to loss of filiform papillae

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22
Q

Does median rhomboid glossitis appear smooth or nodular?

A

Usually smooth but may be nodular

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23
Q

What is the kissing lesion?

A

It is a palatal lesion caused by contact with the dorsal tongue with median rhomboid glossitis

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24
Q

Tx for median rhomboid glossitis?

A

Can be treated causing redness/nodules to decrease in size

often after Tx, the condition will recur

uncurable

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25
What is angular cheilitis?
Erythema, fissuring and scaling of the corners of the mouth
26
Causes of angular chelitis?
* Bacteria infection * Often co-infection with candidiasis * Vit B deficiency * rare except alcoholic population * Candidiasis * MCC * May be co-infectoin with S. aureus * Occurs in conditions when saliva pool at the corners of the mouth * often a result of loss of vertical dimension or drooling
27
Tx of angular cheilitis?
Adress underlying cause antibiotics
28
What is cheilocandidiasis?
type of exfoliative cheilitis that is usually periooral caused by licking or sucking of lips on a regular basis
29
S/S of chronic hyperplastic candidiasis?
white plaque that is not removable Background may be red and inflamed usually asymptomatic
30
Dx of chornic hyperplastic candidiasis?
Biopsy is usualy necessary bc it clinically resembles pre-malignant lesions
31
histology of chronic hyperplastic candidiasis?
Candidal hyphae invade the surface epithelium
32
What is mucocutaneous candidiasis?
A genetic mutation causes patient to develop an immune disorder. The disorder allows candida to infect multiple mucous membranes causing widespread infection
33
How does mucocutaneous candidiasis affect our endocrine system?
some mucocutaneous patients develop auto-antibodies against endocrine glands. Will develop endocrine abnormalities later in life: hypothyroidism, hypoparathyroidism, Addison's disease, DM, etc These pts need to be evaluated periodically for endocrine fxn These endocrine condiitons are called: endocrine candidiasis syndrme; autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy
34
Dx of oral candidiasis
Clinical presentation & Biopsy or Cytological smear
35
Tx of oral candidiasis
Antifungal Tx may be necessary underlying cause needs to be corrected
36
How do histoplasmosis, coccioidomycosis and cryptococcosis infections differ from candidiasis?
they cause deep fungal infections while Candida infections are superficial
37
How does an healthy patient deal with histoplasmosis, coccioidomycosis and cryptococcosis infections?
MAcrophages immediately come in and phagocytose the spores causing mild to no symptoms
38
How does an immunocompromised patient deal with histoplasmosis, coccioidomycosis and cryptococcosis infections?
Their bodies cannot confine the spread of the infection and more macrophages are brought into the area of infection. This results in greater destruction of the lungs .
39
S/S of histoplasmosis, coccioidomycosis and cryptococcosis infection?
Coughing Chest pain Hemoptysis
40
How do histoplasmosis, coccioidomycosis and cryptococcosis infections spread systemically?
When pulmonary infection reaches bronchus, fungi can implant into sputum. Sputum coughed into mouth then causes oral infection. Can spread to anywhere in the body by hematogenous spread when cavitation involves blood vessels.
41
How is histoplasmosis contracted?
Inhalation of spore
42
What is the most common systemic fungal infection in US?
Histoplasmosis
43
What is the most common deep fungal infection in HIV pts?
Histoplasmosis
44
What is the endemic area of histoplasmosis?
Mississipi and Ohio River Valleys
45
How is Coccidioidomycosis contracted?
Inhalation of spores
46
What is the endemic area of Coccioidomycosis?
Central valley of CA
47
how is cryptococcosis contracted?
inhalation of spores
48
How is cryptococcosis distributed?
World wide distribution in pigeon dropping
49
how does cryptococcosis affect HIV pts?
Used to be a significant cause of death in HIV pts before HAART
50
S/S of histoplasmosis, coccioidomycosis and cryptococcosis oral lesions?
Chronic non healing ulcers, Base appears like granulation tissue
51
Other diagnosis that may present similarly to histoplasmosis, coccioidomycosis and cryptococcosis oral lesion?
squamous cell carcinoma (must biopsy bc of this resemblance) traumatic ulceration deep fungal infections oral TB primary syphilis
52
Dx of histoplasmosis, coccioidomycosis and cryptococcosis infection
Serology and cultures are needed to confirm diagnosis Biopsy required due to resemblance to SCC
53
Histology of histoplasmosis, coccioidomycosis and cryptococcosis infections?
granulomatous inflammation special stains are used to demonstrate the fungus
54
Tx of histoplasmosis, coccioidomycosis and cryptococcosis
antifungal agents
55
What are the other two terms for zygomycosis?
Mucormycosis phycomycosis
56
What causes zygomycosis?
Caused by fungi in the class of zygomycetes
57
What two populations are affected by zygomycosis?
Uncontrolled DM that develop ketoacidosis Immunocompromised pts
58
Dx of zygomycosis
Biopsy/culture because clinical presentation mimics malignancy histology
59
Histology of zygomycosis
Extensive tissue necrosis from angiotropic action. fungi invades vessel wall resulting in ischemia, infarction and necrosis Characteristic fungal hyphae
60
What is the most important form of zygomycosis for us?
Rhinocerebral form
61
What is rhinocerebral form zygomycosis?
Fungal infection that usually attacks the midface area resulting in extensive necrosis
62
What is the primary site affected by rhinocerebral form zygomycosis?
Nose * Spores are inhaled into nasal cavity and settle in nose
63
Nasal S/S of rhinocerebral zygomycosis
Nasal obstruction Epistaxis Facial pain Diffuse tissue destruction involving the midface area Infection spreads to adjacent areas (eyes, brain) leading to visual disturbances and neurologic symptoms spread causes poor prognosis
64
how can rhinocerebral zygomycosis extend to the oral cavity?
Spreading to the maxillary sinus
65
How does the maxillary sinus involvement in rhinocerebral zygomycosis extend to the oral cavity?
Starts as swelling and ulceration of the maxillary alveolar process and palate If not treated, lesion proceeds to develop palatal necrosis and perforation
66
Rhinocerebral zygomycosis Tx
Tx based on histology and starts before obtaining culture results Surgical debridement systemic antifgunal Tx management of underlying predisposing conditoin Time is key!
67
Rhinocerebral zygomycosis prognosis
poor; 60% death rate
68
What are two forms of aspergillosis?
Non-invasive Invasive
69
What population fo pts develop non invasive aspergillosis?
healthy patients
70
What population of pts develop invasive aspergillosis?
Immunocompromised
71
What are the two types of non-invasive aspergillosis?
Mycetoma (aspergilloma) Allergic fungal sinusitis
72
S/S of mycetoma
Symptoms similar to sinusitis Mass of fungal hyphae in sinus No tissue invasion from mass Mass can cause dystrophic calcification causing opacity on radiograph
73
Mycetoma Tx
surgical debridement
74
What kind of patients develop allergic fungal sinusitis?
Ectopic pts with allergic response to fungus
75
Biopsy of allergic fungal sinusitis
scattered fungal hyphae allergic mnucin eosinophils
76
Allergic fungal sinusitis Tx
debridement to get rid of fungus and corticosteroids to treat allergy
77
What are the two forms of invasive aspergillosis?
Local invasive aspergillosis Disseminated aspergillosis
78
Characteristics of local ivasive aspergillosis?
Tissue invasion may spread to adjacent structures (CNS) prognosis and Tx depends on pts immune status
79
Disseminated aspergillosis characteristics
Immunocompromised pts Widespread infection
80
Tx of disseminated aspergillosis
Surgical debridement systemic antifungal agent management of underlying predisposing condition
81
Disseminated aspergillosis prognosis
Very poor

OPath Block 2 (10 decks)

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