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Oral pathology exam 1 > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

which form of Candida Albicans is pathogenic? which form is commensal?

A

yeast form – commensal

hyphal form – pathogen

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2
Q

what is developed as C. Albicans converts from its yeast to hyphae form?

A

germinative or “germ” tubes

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3
Q

what 3 factors influence the development/progression of Candidiasis?

A

The host immune status

The oral mucosal environment

The virulence of the candidal strain

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4
Q

what are the 4 parts of the “spectrum of candidiasis infection”?

A

“Carrier” state

Superficial oral mucosal/cutaneous infection

Localized invasive candidiasis

Disseminated candidiasis

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5
Q

what 2 forms of Candidiasis are relatively rare/uncommon?

A

Localized invasive candidiasis

Disseminated candidiasis

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6
Q

what are the 3 types of ORAL candidiasis?

A

1) Pseudomembranous candidiasis
2) Erythematous candidiasis
3) Hyperplastic candidiasis

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7
Q

most oral candidiasis infections are of what type?

A

Erythematous candidiasis

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8
Q

what are some different examples of Erythematous candidiasis?

A 
Acute atrophic candidiasis (“antibiotic sore mouth”)
Central papillary atrophy
Denture stomatitis?
Angular cheilitis
Perioral candidiasis
Chronic multifocal candidiasis
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9
Q

_____________ Candidiasis is also known as “thrush”

A

Pseudomembranous

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10
Q

what are the characteristics of Pseudomembranous Candidiasis?

A

White, curdled milk or cottage cheese-like plaques

** plaques can be wiped-off

May be asymptomatic, but burning or unpleasant taste occasionally noted

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11
Q

what are the common sites of Pseudomembranous Candidiasis?

A

buccal mucosa, palate or tongue

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12
Q

what are the common sites of Erythematous Candidiasis infections?

A

tongue is common site; may involve palate, oral commissures, perioral skin

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13
Q

what form of candidiasis is defined as: “diffuse atrophy of dorsal tongue papillae, particularly after broad-spectrum antibiotics”

A

Acute atrophic candidiasis

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14
Q

Acute atrophic candidiasis is typically associated with a ________ sensation

A

burning

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15
Q

most cases of Central Papillary Atrophy are caused by what?

A

chronic candidiasis

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16
Q

Characteristics of central papillary atrophy:

A

Well-defined area of redness, mid-posterior dorsal tongue

Usually asymptomatic

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17
Q

____________ stomatitis is often referred to as “chronic atrophic candidiasis”

A

Denture stomatitis

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18
Q

T/F: the link between candidiasis and Denture stomatitis is well researched and consistent

A

False

Not much evidence to support this concept

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19
Q

what conditions are usually related to candidiasis, but may have other cutaneous bacterial microflora admixed

A

Angular Cheilitis

Perioral candidiasis

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20
Q

what are the characteristics of Angular chelitis?

A

Redness, cracking of corners of mouth

Often waxes and wanes

Typically responds well to topical antifungal therapy

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21
Q

what condition is often associated with lip-licking or chronic use of petrolatum-based materials?

A

Perioral Candidiasis

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22
Q

characteristics of Perioral candidiasis:

A

Redness, cracking of cutaneous surfaces around mouth

Typically responds well to topical antifungal therapy

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23
Q

what 3 conditions will be seen in someone with Chronic Multifocal Candidiasis?

A

Patient will have:

1) angular cheilitis
2) central papillary atrophy
3) a “kissing lesion” of the posterior hard palate

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24
Q

_____________ is also known as “candidal leukoplakia”

A

Hyperplastic Candidiasis

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25
Q

clinical features of Hyperplastic Candidiasis

A

White patch that CANNOT be rubbed off

Uncommon; generally anterior buccal mucosa

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26
Q

why can hyperplastic candidiasis be an especially problematic form of candidiasis?

A

because a true leukoplakia may have candidiasis superimposed on it

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27
Q

what condition is associated with specific immunologic defects related to how the body interacts with Candida albicans?

A

Chronic Mucocutaneous Candidiasis

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28
Q

under what conditions is Invasive Candidiasis usually seen

A

in situations of severe uncontrolled diabetes mellitus or immune suppression

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29
Q

how can a candidiasis infection be diagnosed?

A

A) Sometimes clinical signs and symptoms are sufficient

B) Exfoliative cytology

C) Biopsy - usually not necessary

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30
Q

what cellular host response can be seen during candidiasis?

A

Variable host response

  • Microabscesses may be seen in the superficial epithelium
  • Chronic inflammation of the C.T.
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31
Q

Acanthosis is often present during what types of infections?

A

candidiasis infections

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32
Q

In almost all cases of candidiasis, the candidal hyphae never penetrate deeper than the _________ layer

A

keratin

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33
Q

how can candidiasis infections be treated?

A

A) superficial infeciton- milder topical or systemic antifungal agents

B) Life-threatening infections usually require intravenous amphotericin B

34
Q

list the features and disadvantages of Nystatin (Mycostatin)

A

A) Not absorbed systemically

B) Disadvantages: taste (bitter to many), multiple dosing schedule, patient compliance

35
Q

what type of Nystatin prescription is usually given as a “cleaning soak” for dentures?

A

Nystatin Oral Suspension (100,000 ug/ml)

  • soak denture overnight for 10 days in enough liquid to cover
36
Q

___________ is a type of Imidazole antifungal agent

A

Clotrimazole (Mycelex)

37
Q

what are the advantages/disadvantages of Clotrimazole (Mycelex)?

A
  • No significant systemic absorption or side effects
  • given as pleasant-tasting lozenges (troches)
  • Disadvantage = dosing schedule (should be dissolved in mouth 5 times per day)
38
Q

Fluconazole (Diflucan) is what type of antifungal agent?

A

Triazole antifungal agent

39
Q

what are the advantages/disadvantages of Fluconazole (Diflucan)?

A
  • Readily absorbed SYSTEMICALLY (drug interaction a worry)
  • Daily dosing is convenient
  • relatively expensive
40
Q

what conditions are treated with topical antifungal creams?

A

angular cheilitis or perioral candidiasis

41
Q

what are the 2 kinds of antifungal creams?

A

A) Mycolog II Cream- combination of nystatin and triamcinolone

B) Vytone Cream - combination of iodoquinol and hydrocortisone

42
Q

Histoplasma capsulatum is a fungi endemic to what regions?

how is it spread?

A

Ohio and Mississippi River valleys

spores spread thru bird or bat droppings

43
Q

what are the clinical features of ACUTE Histoplasmosis? Chronic? Disseminated?

A

Acute – may have flu-like illness

Chronic – cavitary pulmonary lesions

Disseminated – elderly, debilitated, or immunocompromised

44
Q

oral lesions are usually seen in what form of histoplasmosis?

A

disseminated form

45
Q

histoplasmosis oral lesions are usually seen in what areas of the mouth? what are their symptoms?

A

Affects tongue, palate, or buccal mucosa

Presents as a chronic variably painful ulcer or granular erythematous plaque

Clinically may be identical to malignancy

46
Q

what histological features are characteristic of Histoplasmosis lesions?

A

Granulomatous inflammation, with or without necrosis

1-2 micron yeasts, usually within macrophages

Best visualized by silver stain (GMS) or PAS

47
Q

how is histoplasmosis diagnosed?

A

Identification of characteristic small yeasts in tissue sections

Culture of the H. capsulatum organism from a suspected lesion

Serologic testing for antibodies or yeast-related antigens

48
Q

what kinds of histoplasmosis infections require treatment? which do not?

A

Acute – no treatment is usually necessary

Chronic or disseminated histoplasmosis – may require amphotericin B

49
Q

what 2 antifungals are used for mild cases of histoplasmosis?

A

Ketoconazole or itraconazole

50
Q

which form of histoplasmosis has a mortality rate of 90% if left untreated?

A

Disseminated form

mortality drops to 7-23% if treated

51
Q

Coccidioidomycosis is caused by what organism? where is it endemic to?

A

Coccidioides immitis

  • Endemic to desert Southwest U.S.
52
Q

Coccidioidomycosis, AKA “Valley fever”, represents what type of host reaction?

A

hypersensitivity reaction

53
Q

T/F: more people are infected with Coccidioidomycosis than with Histoplasmosis each year

A

FALSE

Histoplasmosis infections are 5X as high as C. immitis

54
Q

Clinical Features of Coccidioidomycosis infections:

A

Inhalation of spores

Flu-like illness in 40% of infected patients

Dissemination in less than 1% of those infected

55
Q

what are the histological findings of Coccidioidomycosis?

A
  • large (20-60 micron) spherules that contain endospores
  • Variable host response, ranging from acute to granulomatous inflammation
  • Diagnosis can be made by culture or biopsy
56
Q

what drugs are used to treat Coccidioidomycosis?

A

Amphotericin B for disseminated cases

Fluconazole or itraconazole for milder cases

57
Q

Cryptococcosis is caused by what organism? how is this organism spread?

A

Cryptococcus neoformans

  • Organism lives in pigeon droppings
  • Transmitted by air-borne spores
58
Q

unlike other fungal infections, Cryptococcosis almost exclusively infects what group of people?

A

immunocompromised

59
Q

Clinical signs/symptoms of Cryptococcosis:

A

Flu-like symptoms with initial pulmonary infection

Disseminates to meninges, resulting in headache, vomiting, neck stiffness

Cutaneous lesions may develop in 10-20%

60
Q

T/F: Cryptococcosis rarely presents with oral lesions

A

true

61
Q

Histopathology of Cryptococcosis:

A

A) 4-6 micron yeasts with a clear halo

B) Organisms may be visualized with mucicarmine, PAS, or silver stain (GMS)

62
Q

what do the “clear halos” of cryptococcosis infections represent?

A

a mucopolysaccharide capsule

63
Q

how are cryptococcosis infections treated?

A
  • Severe cases- amphotericin B and flucytosine
  • Fluconazole for less severe cases and for maintenance
  • POOR PROGNOSIS because most patients are immunocompromised
64
Q

_____________ is Also known as Mucormycosis

A

Zygomycosis

65
Q

what genera of molds cause zygomycosis?

A

Mucor, Rhizopus, and Absidia

66
Q

what population groups does Zygomycosis effect? what form does it take in oral regions?

A

Affects severe diabetic or immunocompromised patient

Rhinocerebral form in oral region

67
Q

list the clinical features of Zygomycosis

A

Nasal obstruction, bloody nasal discharge

Facial pain, swelling, palatal perforation

Black, necrotic lesions

Seizures and death occur with intracranial invasion

68
Q

as a Zygomycosis infection progresses superiorly, what can result?

A

visual disturbances and blindness result

69
Q

how can Zygomycosis be diagnosed?

A
  • based on histopathologic findings because culture is too slow
  • Large, branching, nonseptate hyphae with extensive tissue necrosis
  • Hyphae are often seen plugging small blood vessels
70
Q

Treatments for Zygomycosis include what?

A

Radical surgical debridement

IV amphotericin B

If patient is diabetic, control of diabetes is important

Poor prognosis

71
Q

After candidiasis, what is the next most common fungal infection?

A

Aspergillosis

72
Q

what diseases can Aspergillosis cause? how is this organism transmitted?

A
  • Spectrum of disease that includes allergy, localized infection or invasive aspergillosis
  • Spores in soil, water, decaying organic debris
73
Q

T/F: Aspergillosis is a concern in hospital setting

A

TRUE

it is a “nosocomial” infection

74
Q

Clinical features of Aspergillosis infections:

A
  • features depend on immune status and extent of tissue invasion
  • Allergy- Allergic fungal sinusitis
  • “Aspergilloma” – maxillary sinus fungus ball
  • Tissue damage post-extraction or RCT
75
Q

how is Aspergillosis diagnosed?

A

Biopsy shows branching septate hyphae

Occlusion of small blood vessels by hyphae

Granulomatous inflammation if the host is not immune compromised

Little inflammation if immunocompromised

76
Q

Treatment options for Aspergillosis include what?

A

Non-invasive disease:
- debridement

Invasive disease:
- Voriconazole or itraconazole, with or without debridement

77
Q

what are the advantages/disadvantages of Amphotericin B (Fungizone)?

A
  • NOT for topical use anymore
  • IV form is used to treat life-threatening systemic candidal (and other fungal) infections
  • Nephrotoxicity is significant with standard amphotericin, but newer (expensive) liposomal preparations are relatively non-toxic
78
Q

what are the advantages/disadvantages of Ketoconazole (Nizoral)?

A
  • oral antifungal that can be absorbed systemically
  • Requires acidic stomach environment
  • Single daily dose is convenient
  • LIVER TOXICITY

Problems with drug interactions and idiosyncratic hepatotoxicity (1 in 12,000)

79
Q

what are the advantages/disadvantages of Itraconazole (Sporanox)?

A

Approved for treating histoplasmosis

Well-absorbed; daily dosing

Minimal side effects

Quite expensive

80
Q

what are the advantages/disadvantages of Voriconazole?

A

Triazole compound; IV or oral

Approved for treating Candida, Aspergillus and several other species

Side effects include photosensitivity

1st line therapy - invasive aspergillosis

Quite expensive ($460)

81
Q

what areas of the head/neck are Coccidioidomycosis lesions usually found?

A

Skin of central face may be affected

oral lesions are rarely described

Oral pathology exam 1 (5 decks)

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