Fungal and Protozoal Disease

Question 1

What is the most common oral fungal infection in humans?

Answer 1

Candidiasis

*caused by candida albicans

Question 2

What are the two forms (dimorphism) or Candida?

Answer 2

1-Yeast form- innocuous

2-Hyphal form-invasion of host tissue

Question 3

What are the 4 main categories for Candidal manifestation?

Answer 3

1-Pseudomembranous
2-Erythematous (5 subcategories)
3-Chronic hyperplastic (does not rub off)
4-Mucocutaneous

Question 4

Which form of candidiasis is adherent white plaques that wipe off and typically called thrush?

Answer 4

Pseudomembranous Candidiasis

*Mild burning, Initiated by antibiotics, impaired immune system and inhalers

Question 5

Which form of candidiasis is often overlooked clinically, is more common that pseudomembranous and does not have major white lesions?

Answer 5

Erythematous Candidiasis

*5 subtypes

Question 6

What are the 5 clinical presentations of Erythematous candidiasis?

Answer 6

1-Median rhomboid glossitis
2-Chronic multifocal candidiasis
3-Angular cheilitis
4-Denture stomatitis
5-Acute atrophic candidiasis

Question 7

AKA Central papillary atrophy what presents as a well-demarcated erythematous zone affecting the midline, posterior dorsal tongue?

Answer 7

Median Rhomboid glossitis

*erythema due to loss of filiform papillae

Question 8

Median rhomboid glossitis plus signs of infection at other sites such as the hard or soft palate or angles of the mouth is called?

Answer 8

Chronic multifocal candidiasis

Question 9

What forms as a sore in the corners of the mouth where saliva can pool?

Answer 9

Angular cheilitis

Question 10

What are the 3 main causes of Angular cheilitis?

Answer 10

1-C albicans only 20%
2-Staph Aureus only 20%
3-Combo of both 60%

Question 11

Usually due to chronic lip licking, what is it called what angular cheilitis includes the whole lip?

Answer 11

Cheilocandidiasis

Question 12

AKA Chronic atrophic candidiasis, what condition is localized erythema due to denture-bearing areas of a maxillary removable denture?

Answer 12

Denture Stomatitis

*Remember to treat both denture and tissues

Question 13

What condition is called • “Antibiotic sore mouth” because it usually follows a course of broad-spectrum ABX and appears as a bald tongue?

Answer 13

Acute atrophic candidiasis

*loss of filiform papillae. mouth feels as though hot liquid scalded it

Question 14

AKA Candidal leukoplakia, what condition appears as white patches that cannot be removed and is the least common form of candidiasis?

Answer 14

Chronic hyperplastic candidiasis

*usually anterior buccal mucosa

Question 15

Which condition is a rare group of immunologic disorders and presents with oral white plaques that do not rub off?

Answer 15

Mucocutaneous Candidiasis

Question 16

What are the three types of mucocutaneous candidiasis that can be developed?

Answer 16

1-Endocrine-candidiasis syndrome
2-Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) syndrome
3-Iron-deficiency anemia

Question 17

What are three main treatments for Candidiasis?

Answer 17

1-Nystatin (antifungal)
2-Amphotericin B
3-Imidazole such as Clotrimazole

Question 18

Which candidiasis treatment should you not use in xerostomia-related cases due to added sugar?

Answer 18

Nystatin

*is bitter and comes as rinse or lozenge

Question 19

Which Candidiasis treatment is for life-threatening systemic fungal infection and is IV?

Answer 19

Amphotericin B

Question 20

Which candidiasis treatment has very few side effects, and is formulated as a troche (lozenge)?

Answer 20

Imidazole agents

Question 21

What is the most common systemic fungal infection in the US?

Answer 21

Histoplasmosis

*Caused by Histoplasma capsulatum. Mild flu-like symptoms usually

Question 22

What are the two forms of Histoplasma capsulatum?

Answer 22

1-Yeast at body temperature in human host

2-Mold in natural environment

Question 23

Histoplasma capsulatum is found in bird or bat excrement in what areas?

Answer 23

Ohio and Mississippi River Valley

Question 24

What uncommon disease is due to inhalation of spores after a rain and resembles pneumonia in its acute form and tuberculosis in its chronic form?

Answer 24

Blastomycosis

*Caused by Blastomyces dermatitidis. 9:1 male:female ratio

Question 25

What are the two forms of Blastomyces dermatitidis?

Answer 25

1-Grows as yeasts at body temperature

2-Grows as mold in rich, moist soil

Question 26

What is the histological term for the benign reaction of epithelium that blastomyces dermatitidis can cause?

Answer 26

pseudoepitheliomatous (pseudocarcinomatous) hyperplasia

*Can look like cancer

Question 27

Which disease is carried by the nine-banded armadillo, and resembles mickey mouse or a mariners wheel?

Answer 27

Paracoccidioidomycosis (South American Blastomycosis)

*Caused by Paracoccidioides brasiliensis. Associated with agriculture

Question 28

AKA San Joaquin valley fever, which disease is caused by inhaled spores southwestern US and Mexico?

Answer 28

Coccidioidomycosis

*Caused by Coccidioides immitis

Question 29

Affecting the legs, what is it called when a patient has a hypersensitivity reaction in conjunction with Coccidiodes immitis infection?

Answer 29

Erythema nodosum

Question 30

Which disease lives in pigeon excrement, has a mucopolysaccharide capsule and most often involves the meninges when dissemeninated?

Answer 30

Cryptococcosis

*Caused by Cryptococcus neoformans (yeast form in tissue and host)

Question 31

AKA mucormycosis, which disease can be found on decaying organic material, is enhanced by iron and may result in rhinocerebral zygomycosis?

Answer 31

Zygomycosis

*Radical debridement often necessary with high dose amphotericin B

Question 32

What 3 groups of patients are at risk for zygomycosis?

Answer 32

1-Diabetic patients who are uncontrolled (Ketoacidosis inhibits iron binding to transferrin, allowing serum iron levels to rise)
2-Patients taking deferoxamine (iron-chelating agent)
3-Immunocompromised patients

Question 33

Which disease has an invasive as well as non-invasive infective state and is the second most frequent infection?

Answer 33

Aspergillosis

*Surgical debridement

Question 34

What are the two most common species that cause aspergillosis?

Answer 34

1-A. fumigatus (90%)

2-A. flavus

Question 35

Which type of aspergillosis is an allergic reaction affecting the sinuses and may cause a large mass of fungal hyphae called aspergilloma?

Answer 35

Noninvasive infection

*Calcified aspergilloma is called antrolith

Question 36

Which type of aspergillosis is localized in normal host but extensive in immunocompromised patients?

Answer 36

Invasive infection