Fungal Infection

Question 1

What % population harbour Candida

Answer 1

40-70%

Question 2

What is Candida-pseudomembraneous

Answer 2

Creamy non adherent white plaque like lesions
Soft palate with steroid inhaler

Question 3

What investigations for Candida

Answer 3

Swab
Identify systemic risk factors
Investigate for anaemia, diabetes, immunosuppression

Question 4

Management for Candida

Answer 4

Antifungal - fluconazole 50mg daily 7 days
HIV screen? (NICE guidelines)

Question 5

How does acute erythematous candidosis usually present from pt description

Answer 5

Antibiotics
Sore mouth

Question 6

Diagnosis of AEC

Answer 6

Erythematous area
Painful
Typically dorsum of tongue

Question 7

Investigations for AEC

Answer 7

Swab
Correct systemic risk factors
Investigate anaemia, diabetes, immunosuppression

Question 8

Management got AEC

Answer 8

Address cause
Systemic antifungal - fluconazole 50mg daily

Question 9

Diagnosis for chronic hyperplasticity candidosis

Answer 9

White adherent plaques (nodular/speckled)
Homogenous or heterogenous
Bilateral commissure region
Dorsum of tongue

Question 10

Investigations of CHC

Answer 10

Incisional biopsy for dysplasia
(Invasion of epithelium by Candida hyphae)

Question 11

Management for CHC

Answer 11

Systemic fluconazole (50mg daily)
Smoking cessation

Question 12

Risk factors for CHC

Answer 12

Smoker
COPD (steroid inhalers)
Dentures
Diabetes

Question 13

What is chronic erythematous candidosis also known as

Answer 13

Denture stomatitis

Question 14

How many denture wearers get denture stomatitis

Answer 14

65%

Question 15

Clinical diagnosis for CEC

Answer 15

Most frequent candidosis presentation
Erythematous area one denture bearing surface
Usually non painful unless severe

Question 16

Management of CEC

Answer 16

Topical antifungal
Miconazole gel
Denture hygiene instruction

Question 17

Angular cheilitis clinical diagnosis

Answer 17

Erythematous area at angle of mouth - bilateral
Painful and sore
May accompany intra oral candidosis

Question 18

Investigations for angular cheilitis

Answer 18

Swabs
Combination with staph or MRSA

Question 19

Management for angular cheilitis

Answer 19

Treat underlying cause (decreased vertical dimension, drooling)
Topical antimicrobial (miconazole)

Question 20

Clinical diagnosis for median rhomboid glossitis

Answer 20

Red depopulated area in dorsum of tongue
Painless
Corresponding kissing lesion
Steroid use, dentures, immunodeficiency, smokers

Question 21

What is median rhomboid glossitis a form of

Answer 21

Chronic erythematous candidosis

Question 22

Investigations for median rhomboid glossitis

Answer 22

Rule out underlying cause
Swabs

Question 23

Management for MRG

Answer 23

Antifungals
Treat underlying cause

Question 24

What factors predispose to oral candidosis

Answer 24

Physiological - age and pregnancy
Local trauma - denture
Antibiotics - broad spectrum
Corticosteroids - inhaler/ systemic
Endocrine - diabetes
Malignancy - SCC, leukaemia
Immune deficiency - HIV
Xerostomia - drug related, sjogrens
High carb diet
Anaemia

Question 25

Management for Candida

Answer 25

Correct local factors
Correct systemic factors
Antimicrobial - topical and systemic
Follow up

Question 26

What are topical antifungals

Answer 26

Nystatin QDS 1/52
Miconazole gel 2.5ml QDS

Question 27

What are systemic antifungals

Answer 27

Fluconazole caps 50mg 2/52 od

Question 28

What are antifungal MOA

Answer 28

Polyenes (nystatin)
Disrupt cell membrane
Fungicidal
Azoles
Inhibit eegosteril synthesis
Fungistatic

Interact with warfarin