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osomop 4th > candidal infections > Flashcards

candidal infections Flashcards

1
Q

what is the definition of oral candidiasis?

A

> Infection of the oral/perioral tissue with candida species

  • Commonest oral fungal infection in human
  • Many species, most common is C. albicans
  • Present as commensal organism in up to 50% of general population
  • Opportunistic pathogen
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2
Q

what is the general features of oral candidosis?

A

> Very common clinical problem

  • Wide variety of clinical patterns
  • Often multifactorial aetiologies
  • May indicate serious systemic disease
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3
Q

what is the microbiology of oral candidosis?

A

> Dimorphic yeast-like fungus

  • Blastospore
  • Hyphae
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4
Q

what local factors are predisposing to oral candidosis?

A

> Epithelial changes

> Xerostomia

> High carbohydrate diet

> Smoking

> Broad spectrum antimicrobials

> Corticosteroids

> Dental appliances

> Head and neck irradiation

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5
Q

what systemic factors are predisposing to oral candidosis?

A

> Physiological

> Malnutrition

> Endocrine

> Malignancy

> Primary immunodeficiency

> Secondary immunodeficiency

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6
Q

what is the HPC of oral candidosis?

A

> HPC can be varied case by case, some include -

  • asymptomatic
  • xerostomia
  • taste disturbance “yeast”
  • abnormal sensation “slimy”
  • burning sensation
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7
Q

what are the clinical features of oral candidosis?

A

> clinical features vary case by case

> mucosa may be white, red or both

> may be evidence of predisposing factors

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8
Q

what is oral candidosis classifications?

A
  1. Primary oral candidosis - which is confirmed to oral and perioral tissues
  2. candida associated lesions
  3. secondary oral candidosis which is distributed in other parts of the body as well as the oral cavity
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9
Q

what is pseudomembranous candidosis also referred to as?

A

Thrush

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10
Q

what is the age and sex demographic of pseudomembranous candidosis?

A

> neonates and adults

> M=F

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11
Q

what is the clinical presentation of pseudomembranous candidosis?

A

> semi adherent white/creamy drop like or confluent patches

> Wiped off to reveal an erythematous base

> tend to Recur

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12
Q

what is the difference between acute and chronic pseudomembranous candidosis?

A

> acute appears on - palate, dorsum of
tongue, buccal mucosa

> chronic appears on - palate, OROPHARYNX, tongue dorsum

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13
Q

what causes erythematous candidosis?

A

> corticosteroid use

> antibiotic therapy

> HIV

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14
Q

where are the common sites of erythematous candidosis?

A

> dorsum of the tongue

> and the opposing palate

> erythematous stands for red patch - inflamed areas of mucosa

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15
Q

what is chronic hyperplastic candidosis also referred to as?

A

> candida leukoplakia

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16
Q

what is the age and sex demographic of chronic hyperplastic candidosis?

A

> middle aged

> M=F

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17
Q

what is the clinical features and key sites of chronic hyperplastic candidosis?

A

> adherent plaques
white speckled lesions

> commissures of mouth
buccal mucosa
palate
tongue

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18
Q

what classification does angular cheilitis fall into?

A

candida associated lesions

19
Q

what is angular cheilitis?

A

> inflammation, fissuring and pain of the skin at commissure
mixed infection

20
Q

how many people does angular cheilitis effect? and what is its sex demographic?

A

> 2% of adults

> M=F

21
Q

what classification does median rhomboid glossitis fall into?

A

> candida associated lesions

22
Q

describe median rhomboid glossitis?

A

> Papillary atrophy, occasionally hyperplastic or exophytic (growth outwards)

> Midline of tongue

> Elliptical or rhomboid in shape

> Asymptomatic

> linked to predisposing factors

23
Q

what is the age and sex demographic of median rhomboid glossitis?

A

> middle aged and older

> M>F

24
Q

what classification does denture associated erythematous candidosis fall into?

A

> candida associated lesions

25
Q

describe denture associated erythematous candidosis?

A

> asymptomatic

> erythema and oedema of the oral mucosa in contact with a dental prosthesis

26
Q

what is the age and sex demographic?

A

> F>M

> older patients

27
Q

what classification does chronic mucocutaneous candidosis fall into?

A

> secondary oral candidosis

28
Q

what is chronic mucocutaneaous candidosis?

A

> Rare, heterogeneous group of syndromes

> presents with a = Persistent, severe, and diffuse mucocutaneous candidal infections affecting skin, nails and mucous membranes

> possibly Due to impaired cell-mediated immunity against Candida species.

> complex classification

29
Q

when does chronic mucocutaneous candidosis usually present?

A

> usually presents in infancy

> delayed or adult onset of the disease may also occur

30
Q

what is chronic mucocutaneous candidosis usually in combination with?

A

> endocrine disorders

> Candidosis endocrinopathy syndrome (CES)
Autoimmune polyendocrinopathy candidosis ectodermal dysplasia (APECED)

31
Q

what is the diagnosis pathway for chronic mucocutaneous candidosis?

A

> Combination of history and clinical examination

> Predisposing factors - Often multi-factorial

> Special Investigation

32
Q

what investigation do you carry out for oral candidosis?

A

> microbiological

> smear

> tissue biopsy

> blood tests

33
Q

describe the 2 microbiological tests -

A
  1. swabs = high rate of false -ve, sent to lab promptly, inoculated onto agar and growth checked in 24hrs
  2. Oral rinse - more sensitive than swab, patient rinses in mouth with 10ml sterile water for 60s and then spits into container, semi quantitative assessment
34
Q

describe the smear test -

A

> Obtained from lesional tissue with (moistened) cotton roll

> Transfer scraping to glass microscope slide

> Stain Periodic Acid – Schiff or Gram’s

> Visualise hyphae or blastospores

35
Q

describe a tissue biopsy for oral candidosis -

A

> Epithelium may be thicker (white lesion) or thinner (red lesions) than normal

> Neutrophil infiltration in epithelium often forming micro abscesses

> Varying degrees of vasodilation and inflammatory cell infiltrate in connective tissues

> Fungal hyphae seen in superficial layers.

36
Q

what blood tests are carried out for oral candidosis?

A

> FBC
Iron
B12
Red cell folate * Glucose

37
Q

what is the management of oral candidosis?

A
  1. control predisposing factors -
    • local factors = dentures, diet, oral mucosal disease eg LP
    • systemic factors - poor control of DM, anaemia
  2. smoking cessation
  3. inhaled corticosteroids advice - rinse mouth out with water after use and spit out, use spacing device
  4. anti fungal therapy
38
Q

what are the two classification of antifungal therapy?

A
  1. topical = nystatin, chlorhexidine
  2. systemic = fluconazole, miconazole
39
Q

describe chlorhexidine as an anti Fungal treatment -

A

> Gel, mouth rinse or spray

> Biguanide antiseptic and disinfectant

> Effective in management of oral candidosis

40
Q

Describe Nystatin oral suspension as an anti fungal treatment -

A

> Polyene

> Topical effect

> Effective against C. albicans and other fungi

> Inhibits ergosterol formation in fungal cell membrane

> No known drug interactions

> 100 000 units qds 1-2 weeks

41
Q

describe azole anti fungal drugs? -

A

> Topically & systemic

> Risk of significant drug interactions even when used topically

> Examples include Miconazole and Fluconazole

> Inhibit fungal cytochrome P450 dependant enzyme 14α demethylase:
Inhibits synthesis of ergosterol
Results in:
* Depletion of ergosterol in cell wall
* Accumulation of toxic intermediate sterols
* Membrane permeability and inhibited fungal growth

42
Q

describe micocanzole gel as an anti fungal treatment -

A

> Antimicrobial properties

> 24mg/ml (80g tube)
5ml applied to mouth QDS for 7 days after lesion resolves

> After food, Dentures out, Do not eat or drink for 1 hour afterwards

> Resistance can develop
Risk of significant drug interactions

43
Q

describe fluconazole as an anti fungal treatment -

A

> 50mg capsules
50mg/5ml suspension

> 50mg OD for 1-2 weeks:
- After food
- Dentures out – if suspension
- Do not eat or drink for 1 hour afterwards – if suspension

> Risk of significant drug interactions

43
Q

describe fluconazole as an anti fungal treatment -

A

> 50mg capsules
50mg/5ml suspension

> 50mg OD for 1-2 weeks:
- After food
- Dentures out – if suspension
- Do not eat or drink for 1 hour afterwards – if suspension

> Risk of significant drug interactions

osomop 4th (18 decks)

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