Fungal Infections

Question 1

very common dimorphic yeast that has the ability to undergo transformation to hyphal form under appropriate conditions, producing germinative or “germ” tubes

Answer 1

candida albicans

Question 2

yeast form of candida albicans

Answer 2

commensal

Question 3

hyphal form of candida albicans

Answer 3

pathogen

Question 4

whether candidiasis develops, and the severity of the disease itself, appears to depend on at least what three factors?

Answer 4

• host immune status
• oral mucosal environment
• virulence of the candidal strain

Question 5

what is the spectrum of the candida disease?

Answer 5

• “carrier” state
• superficial oral mucosal/cutaneous infection
• localized invasive candidiasis
• disseminated candidiasis

*last two are uncommon

Question 6

what are the three presentations of oral candidiasis

Answer 6

• pseudomembranous
• erythematus
• hyperplastic

Question 7

type of candidiasis that is known as “thrush” that is whic, curled milk or cottage cheese-like plaques that CAN BE WIPED OFF

Answer 7

pseudomembranous candidiasis

Question 8

what are the common sites of pseudomembranous candidiasis

Answer 8

• buccal mucosa
• palate
• tongue

Question 9

type of candidiasis that has an area of redness, variable borders

Answer 9

erythematus candadiasis

*tongue is a common site

Question 10

diffuse atrophy of dorsal tongue papillae, particularly after broad spectrum antibiotics

Answer 10

acute atrophic candadiasis (antibiotic sore mouth)

Question 11

typically associated with “burning” sensation

Answer 11

acute atrophic candadiasis

Question 12

well-defined area of redness in mid-posterior dorsal tongue that is usually asymptomatic

Answer 12

central pappillary atrophy

median rhomboid glossitis in the past

Question 13

what is central papillary atrophy most commonly due to?

Answer 13

chronic candadiasis

Question 14

denture is often contaminated with candidal organisms but NO invasion of mucosa is seen. shows erythema of palatal denture-bearing area - typically asymptomatic

Answer 14

denture stomatitis
(chronic atrophc candidiasis)

*found many colonies on antaglio surface of denture but NONE on the mucosal surface

Question 15

redness, cracking corners of the mouth that often waxes and wanes

Answer 15

angular chelitis

Question 16

what causes angular chelitis

Answer 16

usually related to candadiasis but may have other cutaneous bacterial microflora admixed

Question 17

how do you tx angular chelitis?

Answer 17

typically responds well to topical antifungal therapy

Question 18

redness, cracking of thte cutaneous surface that is often associated with lip-licking or chronic use of petrolatum-based materials

Answer 18

perioral candidiasis

Question 19

what causes perioral candadiasis?

Answer 19

lip-licking

-usually related to candidiasis, but may have other cutaneous bacterial microflora admixed

Question 20

how do you treat perioral candidiasis

Answer 20

topical antifunal therapy

Question 21

when the pt has angular chelitis central papillary atrophy and a “kissing lesion” of the posterior hard palate

Answer 21

chronic multifacial candidiasis

Question 22

also known as “candidal leukoplakia” that has white patches that CANNOT be rubbed off. may be problematic because a true leukoplakia may have candidiasis

Answer 22

hyperplastic candidiasis

Question 23

where is hyperplasitc candidiasis usually found?

Answer 23

generally anterior buccal mucosa

Question 24

what is the tx for hyperplatic candidiasis?

Answer 24

antifungal therapy

Question 25

RARE candidal infection associated with specific immunologic defects related to how the body interacts with candida albicans

Answer 25

chronic mucocutaneous candidiasis

Question 26

RARE candidal infection seen in situations of severe uncontrolled diabetes mellitus or immune supression

Answer 26

invasive candidiasis

Question 27

what are some histological features of candidiasis?

Answer 27

- microabscesses may be seen in the superficial epithelium - chronic inflammation of the connective tissue - acanthosis is often present

Question 28

in almost all cases, candidal hyphae never penetrate deeper than what layer?

Answer 28

keratin layer

Question 29

the prognosis for treating oral candidiasis in normal pts is what?

Answer 29

good

Question 30

the prognosis for treating oral candidiasis in immune suppressed pts is what?

Answer 30

fair to poor

Question 31

what does candidiasis tx depend on?

Answer 31

severity of the infection

Question 32

what can superficial oral mucosal infections usually be treated with?

Answer 32

one of the milder topical systemic antifungal angents

Question 33

life threatening infections usually require what for treatment?

Answer 33

intravenous amphotericin B

Question 34

imidazole antifungal agent with no significant absorption or side effects

Answer 34

clotrimazole (mycelex) *pleasant tasting lozenges

Question 35

what is the disadvantage to clotrimazole?

Answer 35

dosing schedule (should be dissolved in mouth 5 times per day)

Question 36

antifungal developed during the 1950s that is NOT absorbed systemically and must be IN CONTACT with the organism in order to be effective

Answer 36

nystatin (mycostatin)

Question 37

what is the disadvantage to nystatin

Answer 37

taste, bitter to many | -multiple dosing schedule, pt compliance

Question 38

triazole antifungal angent that is readily absorbed SYSTEMICALLY and no significant degree of side effects

Answer 38

fluconazole (diflucan)

Question 39

what are the disadvantages to fluconazole?

Answer 39

-relatively expensive

Question 40

when do you use topical antifungal agents?

Answer 40

in treatment of angular cheilitis or perioral candadiasis

Question 41

combination of nystatin and triamcinolone

Answer 41

mycolog II cream

Question 42

combination of iodoquinol and hydrocodone

Answer 42

vytone cream

Question 43

deep fungal infection that is endemic to ohio and mississippi river valleys

Answer 43

histoplasmosis

Question 44

how many new cases of histoplasmosis are there annually?

Answer 44

500K

Question 45

how is histoplasmosis spread?

Answer 45

spores in bat or bird droppings in the soil

Question 46

most cases of histoplasmosis are what?

Answer 46

asymptomatic

Question 47

what might acute histoplasmosis have?

Answer 47

flu-like symptoms

Question 48

what might chronic histoplasmosis have?

Answer 48

cavitary pulmonary lesions

Question 49

what populations are most likely affected by disseminated histoplasmosis?

Answer 49

- elderly - debilitated - immunocompromised

Question 50

in what form of histoplasmosis are oral lesions uaually seen?

Answer 50

disseminated *affects tongue, palate, and buccal mucosa

Question 51

what do oral lesions of histoplasmosis look like?

Answer 51

chronic variably painful ulcer or granular erythematous plaque

Question 52

clinically, oral lesions of histoplasmosis may be identical to what?

Answer 52

malignancy

Question 53

histoplasmosis is what?

Answer 53

granulomatous inflammation with or without necrosis

Question 54

how big are the yeast cells for histoplasmosis?

Answer 54

1-2 micron yeast, usually within macrophages

Question 55

histoplasmosis is best visualized by what?

Answer 55

silver stain (GMS) or PAS)

Question 56

what are the three ways to dx histoplasmosis?

Answer 56

- ID of characteristic yeasts in tissue sections - culture of the H. capsulatum organism from a suspected lesion - serologic testing for antibodies or yeast related antigens

Question 57

what is the tx for acute histoplasmosis?

Answer 57

no tx necessary

Question 58

what is the tx for chronic or disseminated histoplasmosis?

Answer 58

amphotericin B *ketoconazole or itraconazole for mild cases or as maintenance therapy

Question 59

what is the prognosis of tx ACUTE histoplasmosis in an immunocompromised pt?

Answer 59

good

Question 60

what is the prognosis of tx CHRONIC histoplasmosis?

Answer 60

fair

Question 61

what is the prognosis of tx DISSEMINATED histoplasmosis?

Answer 61

poor *mortality rate of 90% if untreated, 7-23% if treated

Question 62

deep fungal infection endemic to desert southwest US known as the hypersensitivity rx

Answer 62

coccidioidomycosis

Question 63

how many ppl are infected with coccidioidomycosis annually?

Answer 63

100K

Question 64

how is coccidioidomycosis transferred?

Answer 64

inhalation of spores

Question 65

what is the illness like in 40% of coccidioidomycosis infected pts?

Answer 65

flu-like symtoms

Question 66

dissemination of coccidioidomycosis occurs in how many pts?

Answer 66

less than 1%

Question 67

where does infection of coccidioidomycosis usually occur on the human body?

Answer 67

skin of the central face may be affected, oral lesions are rarely described

Question 68

how is the dx of coccidioidomycosis made?

Answer 68

culture or biopsy

Question 69

what is the host response to coccidioidomycosis

Answer 69

ranges form acute to granulomatous infection

Question 70

what is the tx for disseminated coccidioidomycosis?

Answer 70

amphotericin B

Question 71

what is the tx for mild cases of coccidioidomycosis

Answer 71

fluconazole or itraconazole

Question 72

coccidioidomycosis may be more aggressive in what population?

Answer 72

ppl of color

Question 73

generally, coccidioidomycosis has a good prognosis if the pt....

Answer 73

is not immunocompromised

Question 74

this deep fungal infection has organisms that liv in pigeon droppings and is treansmitted by air-borne sopores

Answer 74

cryptococcosis

Question 75

cryptococcosis affects what population almost exclusively?

Answer 75

immunosuppressed

Question 76

what are the clinical presentations of cryptococcosis?

Answer 76

- flu-like symptoms with initial pulmonary infection | - disseminates to meniges, resulting in headache, vomiting, neck stiffness

Question 77

4-6 micon yeasts with a clear halo (representing a mucopolysaccharide capsule)

Answer 77

cryptococcosis

Question 78

dx of cryptococcosis is based on what?

Answer 78

culture or ID of organsims in tissue secretions

Question 79

what are severe cases of cryptococcosis tx with?

Answer 79

- amphotericin B | - flucytosine

Question 80

what are less severe cases of cryptococcosis tx with?

Answer 80

fluconazole

Question 81

cryptococcosis what is the usual px for cryptococcosis

Answer 81

usually poor bc pts are immunocompromised

Question 82

also known as mucormycosis, it is several genera of molds, including Mucor, Rhizopus, and Absidia

Answer 82

zygomycosis

Question 83

what population does zygomycosis affect?

Answer 83

severe diabetic or immunocompromised pts

Question 84

what is zygomycosis in oral region

Answer 84

rhinocerebral

Question 85

what is the clinical presentation of zygomycosis ?

Answer 85

- nasal obstruction, bloody nasal discharge - facial pain, swelling, palatal perforation - black necrotic lesions - with progression superiorily, visual disturbances and blindness result - seizures and death occur with intracranial invasion

Question 86

what is the dx of zygomycosis based on?

Answer 86

- histopathologic findings bc culture is too low - large branching nonseptate hyphae with extensive tissue necrosis - hyphae often seen plugging small blood vessels

Question 87

what type of px does zygomycosis have?

Answer 87

poor

Question 88

very common deep fungal infection that is second in frequency to candidiasis

Answer 88

aspergillosis

Question 89

spectrum of disease that includes allergy, localized infection, or invasive

Answer 89

aspergillosis

Question 90

the clinical features of aspergillosis vary depending on what?

Answer 90

immune status and extent of tissue invasion

Question 91

maxillary sinus fungus ball

Answer 91

aspergilloma

Question 92

does aspergillosis cause tissue damage?

Answer 92

yes, it is locally invasive

Question 93

what is the extent of aspergillosis in immunocompromised pts?

Answer 93

disseminated

Question 94

a biopsy of aspergillosis shows what?

Answer 94

branching septate hyphae - occlusion of small blood vessels by hyphae - granulomatous inflammation if the host is NOT immune compromised

Question 95

if a pt is immunocompromised with aspergillosis, is there inflammation?

Answer 95

only a little (granulomatous if the host is NOT immune compromised)

Question 96

what is the tx of aspergillosis?

Answer 96

``` non-invasive = debridement invasive = voriconazole or itraconazole (with or without debridement) ```

Question 97

what is the px of aspergillosis pt with normal immune status?

Answer 97

good

Question 98

what is the px of aspergillosis pt with immunocompromised status?

Answer 98

poor

Question 99

was approved for topical use in the US, but tastes bitter and is no longer available

Answer 99

amphotericin B

Question 100

IV forms of this are used to tx life threatening diseases?

Answer 100

amphotericin B

Question 101

first oral antifungal agent that could be absorbed systemically

Answer 101

ketoconazole

Question 102

requires acidic stomach environment to work

Answer 102

ketoconizole

Question 103

drug that has a convenient single daily dose and has problems with drug interactions and idiosycratic hepatotoxicity (1 in 12,000)

Answer 103

ketoconizole

Question 104

drug that is approved for tx histoplasmosis - well absorbed, daily dosing - minimal side effects - quite expensive

Answer 104

itraconazole (sporanox)

Question 105

triazole compound; IV or oral - approved for tx candida, aspergillus and several others - side effects include PHOTOSENSITIVITY - 1rst line therapy for INVASIVE ASPERGILLOSIS - quite expensive

Answer 105

voriconazole