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Oral candidiasis > 2. Oral candidosis > Flashcards

2. Oral candidosis Flashcards

1
Q

What structure is fungi? E or P?

A

Eukaryotic- contain nucleus, mitochondria and Golgi

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2
Q

What is the cell wall of fungi made of?

A

Chitin, mannan, glucan and structural proteins

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3
Q

What are the different types of yeast?

A

Mould like or yeast like, or dimorphic

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4
Q

What do yeast like fungi grow like?

A

They bud and detach, and behave like bacterial colonies

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5
Q

What do mould like fungi grow like?

A

They form hyphae, intertwining masses and fluffy colonies

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6
Q

What type of yeast does oral candida involve?

A

Dimorphic

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7
Q

What is dermatophyte fungi?

A

Superficial infections such as ring worm, athlete’s foot

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8
Q

What is opportunistic fungi?

A

Found in normal microflora but can cause disease in compromised host. Eg, candida, aspergillus spp

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9
Q

What are systemic fungi?

A

Cause disease in individual even if they are healthy, eg Blastomyces

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10
Q

What type of fungi is candida?

A

Dimorphic, opportunistic (commensal), superficial mycosis

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11
Q

Where is the main reservoir for candida?

A

Dorsum of tongue

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12
Q

What shape is yeast like fungi?

A

Ovoid

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13
Q

What shape is true hyphae?

A

Elongated tubes

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14
Q

What is pseudohyphae?

A

Elongated tubes which have constrictions along their length and attach together to form branching structures

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15
Q

What is the name of the most common candida species?

A

C.albicans

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16
Q

What candida is associated with malignant transformation?

A

C. Krusei

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17
Q

What are predisposing factors to candida?

A

Age, local factors, xerostomia, drugs, systemic disease

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18
Q

What are non-specific factors that protect from oral candida?

A
  • Shedding of epithelial cells
  • Salivary flow washing surface away
  • Phagocytic activity of macrophages and neutrophils
  • Commensal bacteria which keeps other bacteria in check
  • Saliva has antimicrobial properties including histidine rich polypeptides, lactoferrin, lysozyme, sialoperoxidase
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19
Q

What does saliva contain that creates non-specific protection?

A

Sialoperoxidase, lactoferrin, histidine rich polypeptides, lysozyme

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20
Q

What are specific factors protecting from oral candida?

A
  • IgA secreted in saliva prevents adhesion of fungi
  • specific antibodies in serum may end up in oral cavity through cervical fluid
  • antimicrobial peptides- defensing
  • cell mediated responses
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21
Q

What are local factors predisposing to candida?

A

Mucosal trauma
Denture wearing
High carbohydrate diet
Tobacco smoking

22
Q

What are age factors predisposing to oral candida?

A

Neonates and Elderly most affected

23
Q

What types of drugs predispose to candida?

A
  • broad spectrum antibiotics
  • immunosuppressant therapy
  • steroids
  • cytotoxic agents
24
Q

What can cause xerostomia?

A
  • Drugs
  • Radiotherapy to the head and neck
  • Sjogren’s syndrome
25
Q

What systemic diseases have a link to candida?

A

Iron deficiency anaemia
Acute leukaemia
Diabetes
HIV/AIDS
Immunodeficiency states

26
Q

What is the mechanism of infection of fungi?

A
  1. Proteinases and phospholipases help to break down phospholipid bilayer so fungi can invade
  2. Fungi metabolism produce nitrosamines which are linked to carcinogenic changes
  3. Fungi have extracellular mannoprotein which allows adherence to the acrylic and epithelium
  4. Tubular hyphae form adhesion to epithelium
27
Q

What are the 2 types of acute candidosis?

A

Pseudomembranous- white and erythematous (atrophic)- red

28
Q

What are the 2 types of chronic candida?

A

Erythematous (red)
Hyperplastic (Candida leukoplakia, CHC)- white

29
Q

What are 3 examples of candida associated lesions?

A

Denture stomatitis, Angular chelitis, median rhomboid glossitis

30
Q

Explain what acute pseudomembranous thrush looks like?

A

Thick white coating, milk curds
Can be wiped off with gauze leaving underlying red base

31
Q

What local factors can cause acute pseudomembranous thrush?

A

Antibiotics, corticosteroids (inhalers), salivary gland disease

32
Q

What systemic factors can cause acute pseudomembranous thrush?

A

Systemic steroids, diabetes, anaemia, leukaemia, malignancy, HIV

33
Q

What can be used to stain candida?

A
  • Periodic acid schiff- stains glycogen in cells and fungi as magenta
  • Wilder silver method- stains black
34
Q

What does acute erythematous candida look like?

A

Red, painful, depapillated tongue
Palate is sometimes involved
Where the mucosa touches the palate, you may get a kissing lesion

35
Q

What other disease can acute erythematous candida also look like?

A

Black hairy tongue- antibiotics can alter the oral flora balance, allowing candida to proliferate

36
Q

What does CHC look like?

A

Leukoplakia- persistent white patch that cannot be removed by scrapping.
Sometimes has red areas too-speckled.

37
Q

Where is CHC most often found?

A

Buccal mucosa, palate and tongue

38
Q

What is it called when there are multiple sites of CHC?

A

Chronic multifocal oral candidosis

39
Q

What is the histology of CHC?

A
  • Increase in thickness of the parakeratotic layer of epithelium
  • Acanthosis- increase in thickness of the prickle cell layer with neutrophils and chronic inflammatory cells
  • Oedema
  • Microabscesses in the epithelial layer
  • Lamina propria contains chronic inflammatory cells- lymphocytes, macrophages, plasma cells
40
Q

Is CHC premalignant?

A

50% of cases of CHC may show epithelial dysplasia. The dysplasia may go away after treatment.

41
Q

What layers do candidal hyphae invade in CHC?

A

The parakeratinised layer, but not the prickle cell layer so it is a superficial infection.

42
Q

What is the appearance of the nucleus in the parakeratinised layer in CHC?

A

Contains nuclei of epithelial cells- longest axis of the nucleus runs parallel to the surface of the epithelium. Nuclei are flat and dark.

43
Q

What is candida-associated denture stomatitis?

A

Due to wearing ill-fitting dentures
Usually asymptomatic
Not cleaning dentures- leads to accumulation of debris that can lead to candida proliferation
Chronic oedema and erythema of denture covered mucosa
Seen in pt’s with high carbohydrate diet

44
Q

What are Newton’s 3 types of candida-associated denture stomatitis?

A
  • Pinpoint (localised) erythematous areas
  • Diffuse erythematous areas
  • Chronic inflammatory papillary hyperplasia- erythema
45
Q

What is angular cheilitis?

A

Sore, erythematous fissured corners of the mouth

46
Q

What other diseases are associated with angular cheilitis?

A

Iron, riboflavin, folic acid, B12 deficiency
30% of patient’s with denture stomatitis have it

47
Q

What is angular cheilitis caused by?

A

Multifactorial- candida
Bacteria- Staphylococcus aureus, Streptococcus beta haemolytic sp

48
Q

What is median rhomboid glossitis?

A

Found in midline dorsal tongue- often has kissing lesion on the palate
- Type of candida infection

49
Q

What is the appearance and histology of median rhomboid glossitis?

A

Rhomboid shape, devoid of papillae, nodular
- Lack of filliform papillae, parakeratinised, acanthotic epithelium, neutrophil infiltration and superficial microabscess formation

50
Q

What is systemic mucocutaneous candidosis?

A

Persistent candida infection of mucosa, nails, skin
Oral lesions are similar to CHC

51
Q

What is candidosis endocrinopathy syndrome?

A

You see systemic mucocutaneous candidosis, enamel hypoplasia, autoimmune endocrinopathies, hypoparathyroidism, diabetes mellitus, adrenocortical hypofunction

52
Q

What is the treatment for candida?

A

Treat underlying cause
Antifungals- nystatin, fluconazole, amphotericin
If there is CHC and epithelial dysplasia, you need to follow up

Oral candidiasis (18 decks)

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