Fungal infections

Question 1

… is a very common dimorphic yeast, its yeast form is … and its hyphal form is …

Answer 1

candida albicans

comensural

pathogen

Question 2

when candidiasis develops and the severity of the disease itself appears to depend on these 3 factors

Answer 2

host immune status

oral mucosal environment

virulence of the strain

Question 3

3 ways oral candidiasis can present

Answer 3

pseudomembranous

erythematous

hyperplastic

Question 4

… candidiasis is the most well recognized and is also known as “thrush”. It is white, curdled milk or cottage cheese- like plaques that can be wiped off .

Answer 4

pseudomembranous

Question 5

common sites for pseudomembranous candidiasis

Answer 5

buccal mucosa, palate or tongue

Question 6

pseudomembranous may be asymptomatic but … or … is usually noted

Answer 6

burning

unpleasant taste

Question 7

most common type of canidiasis?

Answer 7

erythematous

Question 8

… is diffuse atrophy of dorsal tongue papillae (“bald tongue”), particularly after broad-spectrum antibiotics. Acute onset and typically associated with “burning” sensation.

Answer 8

acute atrophic candidiasis aka “antibiotic sore mouth”

Question 9

what is the most common type of erythematous candidiasis?

Answer 9

central papillary atrophy

Question 10

… presents as a well defined area of redness in the mid-posterior tongue, usually asymptomatic and most are due to chronic candidiasis. Probably referred to as “median rhomboid glossitis” in the past

Answer 10

central papillary atrophy

Question 11

… is when there is erythema of the palatal denture bearing area, typically asymptomatic. Often referred to as “chronic atrophic candidiasis” but not much evidence to support this concept because usually only the denture is contaminated and there is no invasion of the mucosa (not a true infection)

Answer 11

denture stomatitis

Question 12

… presents as redness and cracking of corners of the mouth usually related to candidiasis but may have other cutaneous bacterial microflora admixed. often waxes and wanes and typically responds well to topical antifungal therapy

Answer 12

angular chelitis

Question 13

… is often associated with lip-licking or chronic use of petroleum-based materials. usually related to candidiasis but may have other bacterial microflora admixed. responds well to topical antifungal

Answer 13

perioral candidiasis

Question 14

…. is when a patient presents with at least 2 of the following: angular cheilitis, central papillary atrophy, “kissing lesion” of the posterior hard palate

Answer 14

chronic multifocal candidiasis

Question 15

…. is also known as candidal leukoplakia” and presents with a white patch that CANNOT be rubbed off. It is uncommon and usually found on the anterior buccal mucosa. It may be problematic because a true leukoplakia may have candidiasis superimposed on it (should resolve with antifungal if it doesnt)

Answer 15

hyperplastic candidiasis

Question 16

…. is a rare candidal infection associated with specific immunologic defects related to how the body interacts with candida albicans

Answer 16

chronic mucocutaneous candidiasis

Question 17

… is a rare candidal infection seen in situations of severe uncontrolled DM or immune suppression

Answer 17

invasive candidiasis

Question 18

histopath. features of candidiasis (3)

Answer 18

1. variable response from host
2. acanthosis usually present
3. in almost all cases, the candidal hyphae never penetrate deeper than keratin layer

Question 19

life threatening infections of candidiasis usually require

Answer 19

IV ampho B

Question 20

…. is an imidazole antifungal agent with no significant systemic absorption or side effects and comes in pleasant tasting lozenges. disadvantage is that dosing should be 5x per day for 10 days

Answer 20

Clotrimazole (mycelex)

Question 21

… is a med that was developed in the 1950s and is most commonly used today. It is NOT absorbed systemically and must be in contacct with organism to work. Distadvantage- multiple dosing schedule and tastes bitter

Answer 21

Nystatin (mycostatin)

Question 22

Soak dentures in …. and soak RPDs in …

Answer 22

mild bleach solution

Nystatin (100k u/ml)

Question 23

…. is a triazole antifungal agents that is readily absorbed systemically with no significant side effects but it does have drug interactions with antihyperlipidemics like lipitor. daily dosing is convenient but it is expensive

Answer 23

Fluconazole (diflucan)

Question 24

2 creams used for the treatment of angular chelitis or perioral candidiasis

Answer 24

Mycolog II cream

Vytone cream

Question 25

Mycolog cream is a combo of ... and ...

Answer 25

Nystatin | Triamcinolone (corticosteroid)

Question 26

Vytone cream is a combo of .... and ...

Answer 26

Iodoquinol (antifungal and antibacterial) | Hydrocortisone

Question 27

drawback of vytone cream?

Answer 27

iodine allergy

Question 28

.... is endemic to Ohio and Miss. River valleys, it is spread by spores in bird or bat droppings

Answer 28

Histoplasmosis

Question 29

histoplasmosis- most cases are ... | .... lymph nodes are seen coincidentally

Answer 29

asymptomatic | calcified hilar

Question 30

clinical presentation of acute histoplasmosis?

Answer 30

flu-like

Question 31

clinical presentation of chronic histoplasmosis

Answer 31

cavitary pulm. lesions

Question 32

clinical presentation of oral lesions due to histoplasmosis

Answer 32

- chronic painful ulcer OR granular erythematous plaque - usually seen in disseminated form - affects tongue,palate or buccal mucosa - may be identical to malignancy

Question 33

histoplasmosis presents as a ... inflammation with or without ... best visualized by ...

Answer 33

granulomatous necrosis silver stain (GMS) or PAS

Question 34

DX of Histoplas.

Answer 34

ID small yeasts in tissue sections culture H. capsulatum from lesion Sero. testing for antibodies or yeast related antigens

Question 35

tx for mild cases of histoplasmosis?

Answer 35

ketoconazole or itraconazole

Question 36

prognosis for actue histoplasmosis? chronic histoplasmosis? disseminated?

Answer 36

good fair poor (90% mortality with no tx, 7-23% with tx)

Question 37

.... is endemic to desert SW U.S., is termed "valley fever" and represents a hypersensitivity rxn

Answer 37

Coccidioidomycosis

Question 38

clinical features of Coccidioidomycosis?

Answer 38

- skin of central face may be affected (oral lesions are rarely described) - inhalation of spores - flu-like in 40% of patients - dissemination in less than 1%

Question 39

Coccidioisomycosis histopathologically shows .... that contain ....

Answer 39

``` large spherules (20-60 micron) endospores ```

Question 40

tx for Coccidioidomycosis

Answer 40

ampho B for disseminated cases fluconazole or itraconazole for mild cases generally good prognosis if patient is not immunocompromised

Question 41

Coccidioidomycosis may be more aggressive in

Answer 41

persons of color

Question 42

.... is an organism that lives in pigeon droppings and is transmitted by air-borne spores. affects immunocompromised patients almost exclusively

Answer 42

cryptococcus

Question 43

clinical presentation of crypto.

Answer 43

flu like with initial pulm. infection disseminates to meninges resulting in headache, vomiting and neck stiffness cutaneous lesions may develop in 10-20% oral lesions are rare

Question 44

histoplath of crypto

Answer 44

4-6 micron yeasts with a clear halo representing a mucopolysaccharide capsule

Question 45

tx of severe cases of crypto

Answer 45

ampho B and flucytosine

Question 46

tx for less severe cases of crypto

Answer 46

fluconazole

Question 47

prognosis for crypto

Answer 47

poor because most are immunocompromised

Question 48

... is also known as ... and there are several genera of molds including ...., ... and ...

Answer 48

zygomycosis mucormycosis Mucor, rhizopus and absidia

Question 49

zygomycosis affects ... and present with ...

Answer 49

severe diabetic or immunocompromised patient rhinocerebral form in oral region

Question 50

clinical presentation of .... is nasal obstruction, bloody nasal discharge, facial pain, swelling, palatal perforation, black/necrotic lesions, blindess is progresses superiorly and seizures and death occur with intrcranial invasion

Answer 50

zygomycosis

Question 51

Dx of zygomycosis is usually based on the ... because ... is too slow

Answer 51

histopath culture

Question 52

what is seen in the histopath of zygomycosis

Answer 52

large, branching, nonseptae hyphae with extensive tissue necrosis hyphae are usually seen plugging small blood vessels

Question 53

tx of zygomycosis

Answer 53

radical surgical debridement IV ampho B control of diabetes poor prognosis

Question 54

.... is common and second in frequency to candidiasis, spectrum of disease that included allergy, localized infection or invasive infection. Found in spores in soil, water, decaying organic debris. May be "nosocomial" infection

Answer 54

aspergillosis

Question 55

4 ways aspergillosis can present

Answer 55

allergic fungal sinusitis "aspergilloma" (maxillary sinus fungus ball) tissue damage- locally invasive disseminated (immunocomp pt.)

Question 56

biopsy of aspergillosis shows ... which contrasts with ...

Answer 56

branching septae hyphae mucormycosis/zygomycosis which doesnt have septae

Question 57

... is significant with standard ampho B but newer liposomal preparations are relatively non-toxic

Answer 57

nephrotoxicity

Question 58

... is the first oral antifungral agent that could be absorbed systemically but it requires an acidic stomach environment. single dose is convenient. there are some problems with drug interactions and idiosyncratic hepatotoxicity

Answer 58

ketoconazole (nizoral)

Question 59

... is approved for treating histoplasmosis and is well absorbed. daily dosing, minimal side effects but expensive

Answer 59

itraconazole (sporanox)

Question 60

... is the first line of therapy for invasive asperogillosis

Answer 60

voriconazole

Question 61

voriconazole is approved for treating ...

Answer 61

candida, aspergillus and several other species

Question 62

side effects of voriconazole

Answer 62

photosensitivity

Question 63

voriconazole- expensive?

Answer 63

yes