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OPath Block 2 > 4. Fungal infections > Flashcards

4. Fungal infections Flashcards

1
Q

What is the most common oral fungal infection in humans?

A

Candidiasis

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2
Q

What is the most common Candida?

A

Candida albicans: yeast like fungal organism

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3
Q

How many forms do C. albicans exist in?

A

Dimorphic (Yeast form and Hyphal form)

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4
Q

Which C. albicans form invades the host tissue?

A

Hyphal form

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5
Q

What are common causes of oral candidiasis?

A

Broad spectrum antibiotics

Immunosuppression

Idiopathic

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6
Q

Clinical patterns of candidiasis?

A

Pseudomembranous

Erythematous

Chronic hyperplastic

Mucocutaneous

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7
Q

What is pseudomembranous candidiasis aka?

A

thrush

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8
Q

How does thrush clinically present?

A

Removable creamy white plaques

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9
Q

What patient population often gets pseduomembranous cadidiasis?

A

Immunocompromised pts

infants

patients on broad spectrum antibiotics

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10
Q

Symptoms of pseudomembranous candidiasis?

A

very mild

may have burning sensation and foul taste

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11
Q

Dx of thrush?

A

cytological smears

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12
Q

Tx of pseudomembranous candidiasis?

A

identify underlying cause and correct

antifungal antibiotics

no Tx needed for infants

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13
Q

Population that gets erythematous candidiasis?

A

Much more common

most patients are not immunocompromised

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14
Q

Symptom of erythematous candidiasis

A

Red mucosa

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15
Q

Common clinical presentations of erythematous candidiasis

A

denture stomatitis

acute atrophic candidiasis

median rhomboid glossitis

angular cheilitis

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16
Q

What is denture stomatitis?

A

Varying degrees of erythema localized to the denture wearing area

rarely symptomatic

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17
Q

Causes of denture stomatitis?

A

Reaction to denture material

Unusual pressure on the mucosa

Presence of candida (mostly on maxilla)

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18
Q

If candida seen on denture in denture stomatitis, what must we be concerned with?

A

Patient sleeping with denture on.

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19
Q

When is acute atrophic candidiasis often seen?

A

After broad spectrum antibiotics or suffer from xerostomia

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20
Q

S/S of acute atrophic candidiasis

A

Diffuse loss of filiform papillae of the dorsal tongue – loss of this keratin tissue leaves tongue very red

Burning tongue sensation

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21
Q

What is median rhomboid glossitis?

A

Well demarcated erythematous zone along the midline of the posterior dorsal tongue but anterior to terminal sulcus due to loss of filiform papillae

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22
Q

Does median rhomboid glossitis appear smooth or nodular?

A

Usually smooth but may be nodular

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23
Q

What is the kissing lesion?

A

It is a palatal lesion caused by contact with the dorsal tongue with median rhomboid glossitis

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24
Q

Tx for median rhomboid glossitis?

A

Can be treated causing redness/nodules to decrease in size

often after Tx, the condition will recur

uncurable

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25
Q

What is angular cheilitis?

A

Erythema, fissuring and scaling of the corners of the mouth

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26
Q

Causes of angular chelitis?

A
  • Bacteria infection
    • Often co-infection with candidiasis
  • Vit B deficiency
    • rare except alcoholic population
  • Candidiasis
    • MCC
    • May be co-infectoin with S. aureus
    • Occurs in conditions when saliva pool at the corners of the mouth
      • often a result of loss of vertical dimension or drooling
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27
Q

Tx of angular cheilitis?

A

Adress underlying cause

antibiotics

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28
Q

What is cheilocandidiasis?

A

type of exfoliative cheilitis that is usually periooral

caused by licking or sucking of lips on a regular basis

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29
Q

S/S of chronic hyperplastic candidiasis?

A

white plaque that is not removable

Background may be red and inflamed

usually asymptomatic

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30
Q

Dx of chornic hyperplastic candidiasis?

A

Biopsy is usualy necessary bc it clinically resembles pre-malignant lesions

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31
Q

histology of chronic hyperplastic candidiasis?

A

Candidal hyphae invade the surface epithelium

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32
Q

What is mucocutaneous candidiasis?

A

A genetic mutation causes patient to develop an immune disorder.

The disorder allows candida to infect multiple mucous membranes causing widespread infection

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33
Q

How does mucocutaneous candidiasis affect our endocrine system?

A

some mucocutaneous patients develop auto-antibodies against endocrine glands.

Will develop endocrine abnormalities later in life: hypothyroidism, hypoparathyroidism, Addison’s disease, DM, etc

These pts need to be evaluated periodically for endocrine fxn

These endocrine condiitons are called:

endocrine candidiasis syndrme; autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy

34
Q

Dx of oral candidiasis

A

Clinical presentation

&

Biopsy or Cytological smear

35
Q

Tx of oral candidiasis

A

Antifungal Tx may be necessary

underlying cause needs to be corrected

36
Q

How do histoplasmosis, coccioidomycosis and cryptococcosis infections differ from candidiasis?

A

they cause deep fungal infections while Candida infections are superficial

37
Q

How does an healthy patient deal with histoplasmosis, coccioidomycosis and cryptococcosis infections?

A

MAcrophages immediately come in and phagocytose the spores causing mild to no symptoms

38
Q

How does an immunocompromised patient deal with histoplasmosis, coccioidomycosis and cryptococcosis infections?

A

Their bodies cannot confine the spread of the infection and more macrophages are brought into the area of infection. This results in greater destruction of the lungs .

39
Q

S/S of histoplasmosis, coccioidomycosis and cryptococcosis infection?

A

Coughing

Chest pain

Hemoptysis

40
Q

How do histoplasmosis, coccioidomycosis and cryptococcosis infections spread systemically?

A

When pulmonary infection reaches bronchus, fungi can implant into sputum. Sputum coughed into mouth then causes oral infection.

Can spread to anywhere in the body by hematogenous spread when cavitation involves blood vessels.

41
Q

How is histoplasmosis contracted?

A

Inhalation of spore

42
Q

What is the most common systemic fungal infection in US?

A

Histoplasmosis

43
Q

What is the most common deep fungal infection in HIV pts?

A

Histoplasmosis

44
Q

What is the endemic area of histoplasmosis?

A

Mississipi and Ohio River Valleys

45
Q

How is Coccidioidomycosis contracted?

A

Inhalation of spores

46
Q

What is the endemic area of Coccioidomycosis?

A

Central valley of CA

47
Q

how is cryptococcosis contracted?

A

inhalation of spores

48
Q

How is cryptococcosis distributed?

A

World wide distribution in pigeon dropping

49
Q

how does cryptococcosis affect HIV pts?

A

Used to be a significant cause of death in HIV pts before HAART

50
Q

S/S of histoplasmosis, coccioidomycosis and cryptococcosis oral lesions?

A

Chronic non healing ulcers, Base appears like granulation tissue

51
Q

Other diagnosis that may present similarly to histoplasmosis, coccioidomycosis and cryptococcosis oral lesion?

A

squamous cell carcinoma (must biopsy bc of this resemblance)

traumatic ulceration

deep fungal infections

oral TB

primary syphilis

52
Q

Dx of histoplasmosis, coccioidomycosis and cryptococcosis infection

A

Serology and cultures are needed to confirm diagnosis

Biopsy required due to resemblance to SCC

53
Q

Histology of histoplasmosis, coccioidomycosis and cryptococcosis infections?

A

granulomatous inflammation

special stains are used to demonstrate the fungus

54
Q

Tx of histoplasmosis, coccioidomycosis and cryptococcosis

A

antifungal agents

55
Q

What are the other two terms for zygomycosis?

A

Mucormycosis

phycomycosis

56
Q

What causes zygomycosis?

A

Caused by fungi in the class of zygomycetes

57
Q

What two populations are affected by zygomycosis?

A

Uncontrolled DM that develop ketoacidosis

Immunocompromised pts

58
Q

Dx of zygomycosis

A

Biopsy/culture because clinical presentation mimics malignancy

histology

59
Q

Histology of zygomycosis

A

Extensive tissue necrosis from angiotropic action. fungi invades vessel wall resulting in ischemia, infarction and necrosis

Characteristic fungal hyphae

60
Q

What is the most important form of zygomycosis for us?

A

Rhinocerebral form

61
Q

What is rhinocerebral form zygomycosis?

A

Fungal infection that usually attacks the midface area resulting in extensive necrosis

62
Q

What is the primary site affected by rhinocerebral form zygomycosis?

A

Nose

  • Spores are inhaled into nasal cavity and settle in nose
63
Q

Nasal S/S of rhinocerebral zygomycosis

A

Nasal obstruction

Epistaxis

Facial pain

Diffuse tissue destruction involving the midface area

Infection spreads to adjacent areas (eyes, brain) leading to visual disturbances and neurologic symptoms

spread causes poor prognosis

64
Q

how can rhinocerebral zygomycosis extend to the oral cavity?

A

Spreading to the maxillary sinus

65
Q

How does the maxillary sinus involvement in rhinocerebral zygomycosis extend to the oral cavity?

A

Starts as swelling and ulceration of the maxillary alveolar process and palate

If not treated, lesion proceeds to develop palatal necrosis and perforation

66
Q

Rhinocerebral zygomycosis Tx

A

Tx based on histology and starts before obtaining culture results

Surgical debridement

systemic antifgunal Tx

management of underlying predisposing conditoin

Time is key!

67
Q

Rhinocerebral zygomycosis prognosis

A

poor; 60% death rate

68
Q

What are two forms of aspergillosis?

A

Non-invasive

Invasive

69
Q

What population fo pts develop non invasive aspergillosis?

A

healthy patients

70
Q

What population of pts develop invasive aspergillosis?

A

Immunocompromised

71
Q

What are the two types of non-invasive aspergillosis?

A

Mycetoma (aspergilloma)

Allergic fungal sinusitis

72
Q

S/S of mycetoma

A

Symptoms similar to sinusitis

Mass of fungal hyphae in sinus

No tissue invasion from mass

Mass can cause dystrophic calcification causing opacity on radiograph

73
Q

Mycetoma Tx

A

surgical debridement

74
Q

What kind of patients develop allergic fungal sinusitis?

A

Ectopic pts with allergic response to fungus

75
Q

Biopsy of allergic fungal sinusitis

A

scattered fungal hyphae

allergic mnucin

eosinophils

76
Q

Allergic fungal sinusitis Tx

A

debridement to get rid of fungus and corticosteroids to treat allergy

77
Q

What are the two forms of invasive aspergillosis?

A

Local invasive aspergillosis

Disseminated aspergillosis

78
Q

Characteristics of local ivasive aspergillosis?

A

Tissue invasion

may spread to adjacent structures (CNS)

prognosis and Tx depends on pts immune status

79
Q

Disseminated aspergillosis characteristics

A

Immunocompromised pts

Widespread infection

80
Q

Tx of disseminated aspergillosis

A

Surgical debridement

systemic antifungal agent

management of underlying predisposing condition

81
Q

Disseminated aspergillosis prognosis

A

Very poor

OPath Block 2 (10 decks)

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