Candida

Question 1

Risk factors for developing candidiasis?

Answer 1

Immunocompromised - drug, acquired, viral etc

Catheters

Broad spectrum antibiotics

Dialysis

Diabetes

Trauma / burn pt

Long term corticosteroid use

Question 2

Bio-volume comparison in fungi vs bacteria and its implications?

Answer 2

Fungi cells approx 25-50x the bio volume of bacteria

Fungi has mycofilm - protective scaffold
- allows for colonisation of bacteria on hyphae of fungi

Question 3

How can oral candidosis be classified?

Answer 3

Confined to mouth and commissure

• Pseudomembranous - oral thrush
• Erythematous - atrophic or denture related
• Hyperplastic - candidal leukoplakia
• Angular chelitis

Generalised candidosis with oral manifestations
- chronic mucocutaneous

Question 4

Give some signs and symptoms of denture stomatitis

Answer 4

Inflamed mucosa - particularly under upper denture

Burning sensation

Discomfort

Bad taste

Pt often unaware

Question 5

What is a hydrolytic enzyme? Examples, and how do they contribute to infection?

Answer 5

Enzyme that catalyses the. Hydrolysis of a substrate through addition of water

Phospholipase - lipid substrate - host cell penetration

Haemolysin - RBC substrate - facilitate hyphae invasion

Proteinase - protein substrate - adhesion to epithelial cels

Question 6

How might one test for fungi?

Answer 6

If pseudomembranous - take a smear and view under microscope
- hyphae = albicans

Smear and microscopy

Oral rinse, swab or foam pad followed by
- agar

Biopsy and histology

Question 7

MOA Azoles?

Answer 7

Fungostatic

Inhibit biosynthesis of ergosterol

Poorly synthesised cell membrane and cell lysis

Question 8

MOA POLYENES?

Answer 8

Fungicidal

Binds directly to ergestorol in cell membrane

Creates pores in cell membrane
Cell lysis

Question 9

Give an overview of candida treatment algorithm

Answer 9

Pt immunocompromised
- systemic antifungal + topical antifungal / chlorhexadine

Pt immunocompetent with good OH
- any topical / systemic antifungal

Pt immunocompetent with poor OH
- improve OH + chlorhexadine rinse

Pt immunocompetent with dry mouth
- topical antifungal

Pt immunocompetent with no dry mouth
- any topical / systemic antifungal

Pt immunocompetent with large erosive lesions
- systemic + topical / chlorhexadine

Pt immunocomprometent with no large erosive lesions
- any topical / systemic antifungal

Question 10

Which sample for which candida?

Answer 10

Pseudomembranous - swab / smear

Acute erythematous - swab

Chronic erythematous - swab

Angular chelitis - swab

Chronic hyperplastic - biopsy