Brainscape's Knowledge GenomeTM

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


See full index

Oral Medicine > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

General predisposing factors to opportunistic infection?

A

1) Broad-spectrum Antibiotics

2) Corticosteroids (Immunomodulators)

3) Cytotoxics

4) Poorly Controlled Diabetes Mellitus

5) Xerostomia

6) Nutritional Deficiencies

7) Immunosuppression (e.g. extremes of age or HIV)

8) Haematological

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

Local predisposing factors to opportunistic infection?

A

1) Trauma (e.g. ill-fitting prostheses)

2) Tobacco Smoking

3) Reduced Salivary Flow

4) Carbohydrate-rich Diet
-> Increased Candida adherence to epithelial cells

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

2 acute forms of fungal infection?

A

Pseudomembranous candidosis
Erythematous candidosis

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

3 chronic forms of candidosis?

A

Hyperplastic
Erythematous (denture stomatitis)

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

Chronic secondary forms of fungal infection?

A

Median rhomboid glossitis
Angular cheilitis
Chronic mucocutaneous candidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Clinical presentation of thrush?

A

Detachable confluent-white or yellow patches (milk curds) on oral mucosa (often palate)

Wiped away to leave erythematous, bleeding base

Often asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Histology of white plaques?

A

Desquamated epithelial cells
Necrotic material
Fibrin
Fungal hyphae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors of thrush?

A

Immunocompromised pt (extremes of age, poorly controlled diabetes, malignancy, HIV, leukaemia or immunosuppressant drug users)

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

Thrush is often associated with…

A

Angular cheilitis
Oesophageal candidosis (particularly in HIV pts) -> odynophagia, dysphagia & chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Management of thrush?

A

Improve OH

Identify & treat systemic predisposing factor (e.g. immunosuppression, deficiencies, diabetes etc)

Live active yoghurt (encourages return to normal microflora)

Topical agents:
- CHX m/w (antibacterial & antifungal)
- Nystatin suspension
- Miconazole oral gel (avoid with warfarin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Clinical presentation of acute erythematous candidosis?

A

Painful erythematous patches

Commonly on dorsum of tongue & palate

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

What is acute erythematous candidosis associated with?

A

LT broad-spectrum antibiotic use (antibiotic sore mouth)

LT corticosteroid use

HIV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical presentation of chronic hyperplastic candidosis?

A

White-erythematous raised lesions which do not rub off

Usually asymptomatic & found bilaterally on buccal mucosa (towards commissures)

Nodular/speckled = more prone to malignant change OR homogenous plaque-like

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

What is CHC associated with?

A

Middle-aged male smokers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the risk associated with CHC?

A

Malignant transformation to OSCC

If left untreated, 5-10% show dysplasia & may transform to OSCC

Angular cheilitis

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

How to manage CHC?

A

Biopsy (as it is a premalignant lesion)

FBC (vitamin, iron, folate, glucose levels) & thyroid tests

Remove predisposing factors (e.g. smoking)

Topical antifungals not effective => 2-4+ weeks oral (systemic) fluconazole

17
Q

What is denture stomatitis (chronic erythematous candidosis)?

A

Chronic erythema of mucosa below fit surface of acrylic upper denture or ortho appliance

18
Q

Aetiology of denture stomatitis?

A

Denture or appliance fit => saliva excluded from supporting mucosa & commensal candida overgrowth occurs

19
Q

Clinical presentation of denture stomatitis?

A

Marked erythema of palatal mucosa with margins corresponding to appliance

‘Relief areas’ of denture may have underlying spongy granular change

Usually asymptomatic or angular cheiiltis present

20
Q

What is denture stomatitis associated with?

A

Poor OH
Poor denture design (non-hygienic design OR poorly fitting denture => trauma)

21
Q

Newton’s classification of denture stomatitis

A

Type
1 = Pin-point hyperaemia
2 = Diffuse erythema limited to fit surface of denture
3 = Nodular appearance of palatal mucosa

22
Q

Management of denture stomatitis?

A

Improve denture cleaning:
- Regular cleaning instruction +/- antiseptic soak (e.g. CHX)
- Eliminate tissue trauma (tissue conditioners)
- Improved design (more hygienic or less traumatic)

Antifungal - miconazole gel (applied to denture fit surface) except warfarin & statin pt

Review - if lack of resolution consider systemic issue or lack of compliance

23
Q

Clinical presentation of median rhomboid glossitis?

A

Asymptomatic diamond-shaped smooth erythematous area at junction between anterior 2/3rd & posterior 1/3rd of tongue (anterior to circumvallate papillae)

Localised candida infection leading to filiform papillae atrophy

‘Kissing lesion’ = similar patch on palate

24
Q

What is associated with median rhomboid glossitis?

A

Smoking & corticosteroid use (asthmatics)

25
Q

Aetiology of angular cheilitis?

A

Multi-factorial infection with C. albicans, S. aureus & B-haemolytic streptococci

26
Q

Clinical presentation of angular cheilitis?

A

Symmetrical erythematous fissuring at commissures +/- yellow crusting

27
Q

What is the main demographic associated with angular cheilitis?

A

Elderly edentulous pts with denture stomatitis

Decreased vertical dimension => maceration of underlying skin by saliva

28
Q

Risk factors of angular cheilitis?

A

Lip morphology

Malnutrition
- Reduced haematinic levels (iron, B12, folate)
- Malabsorption disorders (e.g. Crohns, OFG)

Immunosuppression (e.g. HIV)

Diabetes

Broad-spectrum antibiotics

Xerostomia (e.g. age, medication related or Sjogren’s)

29
Q

Management of angular cheilitis?

A

Correct predisposing factor (e.g. increase denture OVD)

Treat candida infection
- I/O = topical antifungal
- E/O = miconzaole gel applied to corners of mouth

30
Q

How to treat chronic angular cheilitis?

A

Trimovate cream application
(Triad: antifungal, antibacterial & steroidal)

31
Q

Why take a microbial sample?

A

Identify candida species & their antifungal resistance

Identify candida quantity

32
Q

Sampling methods & advantages & disadvantages?

A

Whole saliva culture
+ Gives fungal load
- Not suitable in xerostomia

Concentrated oral rinse
+ Gives fungal load

Swab
+ Site specific
- Not quantitative

Smear
+ No lengthy culture required
- Candida species not identified

Sponge imprint culture
+ Gives fungal load
+ Site specific

Biopsy
+ Indicated for CHC
- MOS procedure

33
Q

How to polyenes work & give example?

A

Fungicidal - generate pores in cell membrane => leakage

Not absorbed by gut

e.g. Nystatin

34
Q

How do azoles work & give example?

A

Fungostatic - interfere with ergosterol fungal cell membrane synthesis

e.g. Miconazole, fluconazole

35
Q

When do you give topical antifungal agents?

A

Superficial infections

e.g. Denture wear, antibiotic drug use or diabetics

36
Q

How is miconazole gel applied & what risks?

A

To affected area or fit surface of denture (can be left in)

GIT absorption => serious interactions with warfarin & statins

37
Q

When do you use systemic antifungals?

A

Immunosuppressed
Candidal leukoplakia

Oral Medicine (9 decks)

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