How are fungal infections started?
Usually opportunistic infections
What is the clinical presentation of fungal infections?
- Cottage cheese appearance
- Pseudomembranous appearance
- Atrophic tongue
- Hyperkeratotic appearance
- Symptomatic geographic tongue
- Angular cheilitis
What are the ways to treat fungal infections (therapy)?
Topical (local candidiasis) or Sytemic (chronic, extensive mucocutaneous candidiasis)
Which treatment of fungal infections is preferred?
Treat for a min of 48 hours after symptoms subside - re-evaluate at 14 days after therapy
What methods can be used to help topical antifungal therapy last longer in the mouth?
- Troches - sweetened vaginal preps with cocoa butter (caution with diabetes)
- Pastilles - lozenge-type delivery
- Consider - chlorhexidine and Listerine
In treating a patient with diabetes that has a funal infection in their mouth (oral candiasis) what type of topical method could be used?
Pastilles - Troches are sweetened with sugar which will be problematic with diabetes
What different "vehicles" do topical antifungals come in?
What is the mechanism of nystatin (Mycostatin)?
Binds to sterols in fungal cell membrane, changing cell wall permeability allowing for leakage of cellular contents
Does nystatin (Mycostatin) get absorbed very easily?
No it stays in the GI tract
What are some of the forms nystatin (Mycostatin) comes in?
- Oral suspension
Compliance will be low - a lot for people to do 4-5 times per day.
What is another topical antifungal when nystatin is not effective in the patient?
What is the main adverse effect of clotrimazole?
Abnormal liver function
How are systemic antifungal drugs named?
Why would we want to avoid systemic (azole) antifungals?
- They promote resistance of fungal organisms
- Many dangerous drug interactions
What antifunal was big in dentistry and is no longer FDA approved for treatment of candidiasis due to hepatotoxicity (July 2013)?
What antifungal is used to treat Valley Fever, that must be monitored very closely due to possible liver damage?
What is a parenterally (IV) administered antifungal drug, and is almost always used for fungal infections associated with HIV?
When treating angular cheilitis why is there two different medications to treat the fungal infection? And what are the drugs?
Combines an antifungal with a steriod - to promote healing
- iodoquinol and hydrocorisone cream
- nystatin and triamcinolone acetonide ointment