Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OMPR > Candidiasis > Flashcards

Candidiasis Flashcards

1
Q

Candida Species

A

> Most common opportunistic fungal pathogen

> Causes mucosal infections, which are generally NON-INVASIVE are caused primarily by Candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

5 most common Candida Species causing invasive disease

A 
C. albicans
C. glabrata
C. tropicalis
C. parapsilosis
C. krusei
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Commensalism vs. Disease State

A

more than 50% of humans carry candida w/o harmful effects, but becomes an “infection” when environment changes and encourages growth

Usually defect in cell-mediated immune response

Ranges from mild superficial mucosal infection to fatal disseminated disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Causes for Candida Infection

A
  • A disrupted balance of the normal mucosal flora
  • Impaired barrier functions
  • Immunosuppression such as broad spectrum antibiotics, leukemia, HIV, cancer chemotherapy, diabetes, xerostomia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pathogenesis of Candidiasis

A
  • Fungal burden is increased and hyphae form
  • Immune cells are recruited by cytokines, chemokines
  • Neutrophils are recruited and kill fungus
  • Dendritic cells present antigen to T-cells
  • T-cells also decrease fungal burden (IL-22, IL-17)
  • Innate and acquired clear fungus to levels below threshold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does Candida overcome host defenses?

A
  • Dimorphism (two growth phases due to environmental changes; hyphal form associated with invasion and goes into the parakeratin layer)
  • Phenotypic switching (Can change into different shapes which prevent identification by neutrophils)
  • Adhesins/Invasins (Help the fungal organize attach to epithelial cells; invasin = endocytosis (inside cells))
  • Molecular mimicry of mammalian integrins (has integrin-like molecules which allow for adhesion to cells)
  • Secretion of hydrolytic enzymes (Break down epithelial cells)
  • Phospholipase B contributes to degradation of host tissues
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Candida Albicans Cell Wall

A
  • Protects against environmental stress
  • Antigenic determinants
  • Forms contact with host cells, plasma and body fluids
  • Mediates adherence of the pathogen to the host surface
  • Allows establishment of cross-talk with host
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Types of Candidiasis Infection

A

> Superficial and localized-more common (mild disease and often what we see in the oral cavity)

- Intertrigo    - Paronychia/Onychomycosis
- Diaper Rash
- Vulvovaginitis
- Esophageal candidiasis
- Oral Candidiasis (Candidosis)

> Invasive, disseminated and deep infection-rare (moderate-severe)
- Affects blood (candidemia-hospitalized), heart, brain,
eyes, bones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Invasive Candidiasis infects…

A 
bloodstream (candidemia)
heart (candida endocarditis) 
periosteum (peritonitis) 
bone (osteomyelitis) 
joints (candida arthritis) 
eyes (endophthalmitis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Candidal Sepsis

A
  • Very rare
  • Life-threatening event in individual with severely deficient cell-mediated immunity
  • C. albicans most common species
  • Most commonly involves urinary tract infection (women/men 4:1)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pseudomembranous (thrush)

A

Appearance/Symptoms:
-Creamy-white plaques, removable/wipeable; burning sensation, foul taste

  • Underlying mucosa is erythematous
  • Asymptomatic usually

Common Sites:

  • buccal mucosa
  • tongue
  • palate

Who gets it?
- HIV, broad-spectrum antibiotics, leukemia, infants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Erythematous Candidiasis

A

Appearance/Symptoms:

  • Red macules or patches
  • burning sensation

Subtypes:

  • atrophic candidiasis
  • median rhomboid glossitis
  • denture stomatitis

Common Sites:

  • posterior hard palate
  • buccal mucosa
  • dorsal tongue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Central papillary atrophy

median rhomboid glossitis

A

Appearance/Symptoms:

  • Red, atrophic mucosal areas
  • Asymptomatic
  • well demarcated erythematous zone
  • Loss of papillae
  • “Kissing” palatal lesion (when the tongue touches the palate, it transfers the fungal infection over)

Common Sites:
- Midline posterior dorsal tongue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Chronic multifocal

A

Appearance/Symptoms:
-Red areas, often with removable white plaques; burning sensation; asymptomatic

Common Sites:

  • posterior palate
  • posterior dorsal tongue
  • angles of the mouth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Angular chelitis

A

Appearance and Symptoms:
Red, fissured lesions; irritated, raw feeling

Seen with loss of vertical dimension/pooling of saliva

May be mixed bacterial/fungal infection

Common Sites:
-angles of the mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Denture stomatitis (chronic atrophic candidiasis, denture sore mouth)

A

Appearance and Symptoms:
Red, asymptomatic
petechiae may be noted
inflammatory papillary hyperplasia is associated with condition (not CAUSED but strongly associated)

Common Sites:
-confined to palatal denture bearing mucosa in maxilla

17
Q

Hyperplastic (candidal leukoplakia)

A

Appearance and Symptoms:
- white plaques that are not removable; asymptomatic

-increased frequency of epithelial dysplasia (theory of candida inf. over pre-existing leukoplakia?)

Common Sites:
-anterior buccal mucosa

18
Q

Mucocutaneous

A

Appearance and Symptoms:
-white plaques, some of which may be removable; red areas

Common Sites:

  • tongue
  • buccal mucosa
  • palate
19
Q

Endocrine-candidiasis syndromes

A

Appearance and Symptoms:
-white plaques, most of which are removable

Common Sites:

  • tongue
  • buccal mucosa
  • palate
20
Q

Predisposing factors to Candida

A

Local

  • denture wearing
  • smoking
  • atopic constitution
  • inhalation steroids
  • topic steroids
  • hyperkeratosis
  • imbalance of the oral microflora
  • quality of saliva

General

  • immunosuppressive diseases
  • impaired health status
  • immunosuppressive drugs
  • chemotherapy
  • endocrine disorders
  • hematinic deficiencies
21
Q

Atrophic Candidiasis

A

Erythematous areas on any mucosal surface

“Bald tongue”

Typically painful

Common with inhalation steroids; if they rinse after use though, it usually subsides

22
Q

Chronic Mucocutaneous Candidiasis

A

Group of rare disorders with immunologic pathogenesis

Clinical: Severe infection of mucosal surfaces, nails, and skin

Oral lesions-thick white plaques that do not rub off but may see other forms

May be associated with endocrine abnormalities (APECED)

Tx. Systemic antifungals

Increased risk for squamous cell carcinoma?

Ex. Tongue has formed a white and thickened plaque as well as skin, nails, and feet which cannot rub off

23
Q

APECED

A 
Autoimmune 
Polyendocrinopathy 
Candidiasis 
Ectodermal 
Dystrophy 
Syndrome
24
Q

Diagnosis of Oral Candidiasis

A

-Clinical signs
-Therapeutic diagnosis
-Cytologic smear
Periodic Acid Schiff Stain
(PAS stain)
KOH float (Immediate result but you can’t keep the
slide as a record and cannot evaluate epithelial cells
using Potassium hydroxide)

  • Biopsy (esp. hyperplastic candidiasis)
  • Culture
25
Q

Biopsy Results

A

Hyperplastic epithelium so it clinically appears WHITE

FUNGAL HYPHAE ALWAYS IN THE SURFACE PARAKERATIN LAYER (nuclei present in the keratin layer)

26
Q

Antifungal Drugs

A
  • Polyene-Nystatin, Amphotericin B
  • Imidazole-Clotrimazole, Ketoconazole (GI absorption)
  • Triazole-Fluconazole, Itraconazole, Posaconazole, Echinocandins
27
Q

Treatment of Mild Disease

A

Clotrimazole troches, 10 mg 5 times daily OR miconazole mucoadhesive buccal 50 mg tablet applied to the mucosal surface once daily for 7–14 days

Alt: Nystatin suspension (100 000 U/mL) 4–6 mL swished for >1min then swallow 4 times daily

28
Q

Treatment of Moderate to Severe Disease

A

Oral fluconazole, 100–200mg daily for 7–14 days is recommended

Pharmacokinetics: Fluconazole inhibits CYP2C9, CYP2C19, and CYP3A4 isoenzymes

Check for interactions with medications that are metabolized through this mechanism

For some medications fluconazole may be contraindicated

Alt: do exist but we would not prescribe reference slide if you care

29
Q

Fluconazole Adverse Reactions

A

Central nervous system: Headache/ dizziness

Dermatologic: Skin rash

Gastrointestinal: Nausea, abdominal pain, vomiting, diarrhea, dysgeusia, dyspepsia

Hepatic: Hepatitis, increased serum alkaline phosphatase, increased serum ALT, increased serum AST, jaundice

30
Q

Chronic Suppressive Therapy

A

Usually unnecessary in immunocompetent patients
Advise antiviral therapy to prevent opportunistic infections to begin with

Fluconazole, 100 mg 3 times weekly, is recommended

31
Q

Denture Stomatitis Treatment

A

The scope of treatment is broad and included strategies that targeted biofilm formation on the prosthesis as well as targeted approaches focused on treatment of a fungal infection of tissues.

disinfection methods could also considered as an adjunct or alternative to antifungal medications in the treatment of denture stomatitis. (bleach, polident, microwave??)

32
Q

Angular Cheilitis Treatment

A 
1. Topical Antifungal Agents
Rx: Clotrimazole cream 1% vs 
OR
Rx: Nystatin-Triamcinolone Acetonide ointment or cream
Disp: 15 g tube

Label: Apply to angles of mouth after meals and before bedtime

  1. Denture adjustment, reline, remake

OMPR (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions