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OP02 oral candidosis Flashcards

(46 cards)

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1
Q

What is candidosis?

A

Superficial mycosis (fungal infection) from commensal organisms but increase in some systemic diseases (opportunistic pathogens)

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2
Q

Where is the main reservoir in candidosis?

A

Dorsum of the tongue

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3
Q

What is a dimorphic organism?

A

Fungi grows in both ways:
Ovoid: yeast
Elongated: ‘true hyphae’
Elongated and joined: ‘pseudohyphae’

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4
Q

What are the common candida species?

A

C albicans, C tropicalis, C glabrata, C krusei etc etc

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5
Q

Which candida species have been associated with increased malignant types?

A

C krusei

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6
Q

What are the generic protection and predisposing factors for candida infection?

A

Protection factors: non-specific, specific
Predisposing factors: local factors, age, drugs, xerostomia, systemic disease

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7
Q

What non-specific factors are there protecting from oral candida?

A
  • Shedding of epithelial cells
  • Salivary flow
  • Antimicrobial factors in saliva - histidine-rich polypeptides, lactoferrin lysozyme, sialoperoxidase
  • Phagocytic activity of macrophages and neutrophils
  • Presence of commensal bacteria
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8
Q

What specific factors are there protecting from oral candida?

A
  • Specific antibodies in serum - IgA
  • Secretory immunity IgA - inhibits adhesion
  • Antimicrobial peptides - defensin
  • Cell-mediated response - might be impaired in patients w/ candidosis - immunosuppression/deficiency?
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9
Q

What local factors predispose an individual to oral candidosis?

A
  • Mucosal trauma (easier for candida to proliferate and invade)
  • Denture wearing/hygiene
  • Tobacco smoking
  • Carb-rich diet
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10
Q

How does age predispose an individual to oral candidosis?

A

Extremes - neonates/infants - elderly
Immune system not developed enough

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11
Q

What drugs predispose people to oral candidosis?

A

Broad spectum antibiotics
Local or systemic steroids
Immunosuppressant therapy
Cytotoxic agents

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12
Q

What things cause xerostomia which can predispose to oral candidosis?

A

Drugs
Radiotherapy
Sjogren syndrome

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13
Q

What systemic diseases can predispose to oral candidosis?

A

Iron deficiency anaemia
Acute leukaemia
Other malignant diseases
Diabetes mellitus
HIV/AIDS
Other immunodeficiency states

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14
Q

How does iron-deficiency anaemia predispose to oral candidosis?

A

Epithelium reduces in thickness making it easier for fungus to attach

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15
Q

What are the mechanisms of infection of candida?

A
  • Proteinases and phospholipases made by the fungi break down cell membrane components allowing invasion
  • Nitrosamines produced by candida might cause carcinogenesis
  • Extracellular mannoprotein - allows candida adherence to epithelium and acrylic
  • Tubular (hyphae) form facilitates adhesion to epithelium
    Transition from yeast to hyphae form is a virulence factor
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16
Q

What are the primary oral and perioral candidosis classifications?

A

Acute pseudomembranous (thrush)
Acute erythematous (atrophic)
Chronic erythematous
Chronic hyperplastic (candidal leukoplakia)
Candida associated lesions

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17
Q

What candida associated lesions are there?

A

Denture stomatitis
Angular cheilitis
Median rhomboid glossitis

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18
Q

What are the secondary oral candidosis classifications?

A

Systemic chronic mucocutaneous candidosis (inherited/sporadic/systemic disorders).
Familial (FCMC)
Diffuse (DCMC)
Candidosis endocrinopathy syndrome (CES)
Late onset (LOCMC)
CMC associated with primary immunodeficiency

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19
Q

What is acute pseudomembranous candidosis?

Study These Flashcards
A

Thrush - thick white coating (pseudomembranes)
Can be wiped out, leaving a red raw base (necrotic parakeratotic epithelium layers and candidal hyphae and yeasts)

20
Q

What are local and systemic factors for acute pseudomembranous candidosis?

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A

Local: Antibiotics, corticosteroids (inhalers), salivary gland disease
Systemic: systemic steroids, DM, anaemia, leukaemia, malignancy, HIV

21
Q

How does acute/chronic erythmatous candidosis present

Study These Flashcards
A

Tongue dorsum
Red, painful, depapillated tongue. Palate is sometimes involved.

22
Q

How does erythematous form usually occur?

Study These Flashcards
A

After prolonged corticosteroid or antibiotic therapy, they alter the oral flora balance so candida can flourish

23
Q

How does CHC present?

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A

Persistent white patch (leukoplakia), with sometimes red areas too (speckled) often in the buccal mucosa (palate and tongue_
Cannot be removed by scraping
Can be associated with angular cheilitis

24
Q

What is the histology of CHC?

Study These Flashcards
A
  • Epithelial parakeratosis
  • Acanthosis
  • Oedema and neutrophils causing microabscesses inside epithelium
25
Which layer of the epithelium do candidal hyphae invade in CHC?
The parakeratinised layer (not into prickle cell layer)
26
Which layers show inflammatory cells in CHC?
Prickle cell layer - acute and chronic inflammatory cells Lamina propria - chronic infl cells
27
What is the staining for Candida?
PAS (magenta) Wilder's silver method (black)
28
How many cases of CHC show epithelial dysplasia?
50% - premalignant!
29
Does candida get into the lamina propria?
No, cannot get through the basement membrane - the products of candida get transmitted through to recruit the inflammatory cells.
30
What is candida-associated denture stomatitis?
Usually symptomless chronic oedema and erythema of the denture covered mucosa (mostly upper)
31
What are causes of candida associated denture stomatitis?
Continuous use of ill-fitting dentures High carbohydrate diet
32
What are Newton's 3 types of denture stomatitis?
Pinpoint (localised erythematous areas Diffuse erythematous areas Erythema associated with granular/multinodular mucosa (chronic infl. papillary hyperplasia)
33
What mechanism can cause angular cheilitis?
Reduction in OVD, collapse in lower third of the face, so folds in corner of mouth are constantly invaded by saliva and fungi and bacteria Continuously occlusal height (old age, bad dentures) leads to continuously wet folds
34
What organisms cause angular cheilitis?
Candida, Staphylococcus aureus, Streptococcus beta-haemolytic sp. (occurs in 30% of patients with denture stomatitis)
35
What deficiencies put you at higher risk of angular cheilitis?
Iron, riboflavin, folic acid, B12
36
What is median rhomboid glossitis?
Located in the midline of dorsal (posterior) tongue - candidal hyphae present in many cases. Rhomboid shape devoid of papillae, nodular Usually asymptomatic At the foramen cecum/lingual V
37
What else can present with median rhomboid glossitis?
'Kissing' lesion on palate
38
Does the tongue repapillate after treatment of MRG?
No
39
What is the histology of median rhomboid glossitis?
Lack of filiform papillae, parakeratinised, acanthotic epithelium, neutrophil infiltration and superficial microabscess formation
40
What is systemic chronic mucocutaneous candidosis?
Rare conditions causing persisten candidal infections of the mucosa, nails and skin ORal lesions similar to CHC
41
What is candidosis endocrinopathy syndrome (CES)?
Enamel hypoplasia, autoimmune endocrinopathies, including hypoparathyroidism, adrenocortical hypofunction and diabetes mellitus.
42
What is the relationship between Candidosis and HIV/AIDS?
It is the most common oral manifestation of HIV. HIV - 20%, AIDS - 70%
43
What types of candida are more common in HIV/AIDS and where in the oral cavity?
Pseudomembranous and erythematous are most frequent - but may persist for months CHC common in cheeks, but rarely commissures (unlike HIV-negative)
44
What is the treatment for Candida?
Correction of underlying local causes after investigation Use of anti-fungals - nystatin, amphotericin, fluconazole
45
What should you do in the cases of chronic hyperplastic candidosis and epithelial dysplasia?
It means it is premalignant, so follow up: Treat the candida and see if the dysplasia and follow up. If it changes/gets worse then refer instantly to oral med.
46
Why do we treat CHC and epithlial dysplasia in this way?
Could be candida infection causing morphological changes in the tissue inducing epithelial dysplasia OR a premalignant lesion with a secondary infection by candida

Oral pathology (27 decks)

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