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Oral Pathology Exam 2 > 7 Fungal Infections > Flashcards

7 Fungal Infections Flashcards

1
Q

organism that causes candidiasis

A

Candida albicans

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2
Q

a normal component of the oral microflora in 30-50% of the population

A

Candida albicans

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3
Q

the most common ORAL fungal infection in humans

A

candidiasis

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4
Q

not just an opportunistic infection!! develops in people who are otherwise healthy too

A

candidiasis

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5
Q

Three main factors that determine whether a candidiasis infection will occur:

A

1) immune status of pt
2) pt’s oral mucosal environment
3) pt’s particular strain of C. albicans

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6
Q

predisposing factors to candidiasis infection (5)

A
  • antibiotic use
  • wearing a denture or appliance
  • steroid inhaler use
  • xerostomia
  • immunosuppression
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7
Q

clinical patterns of candidiasis (4)

A

pseudomembranous candidiasis
erythematous candidiasis
angular cheilitis
chronic hyperplastic candidiasis

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8
Q

Name the candidiasis infection: aka thrush

A

pseudomembranous

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9
Q

Name the candidiasis infection: white plaques resembling cottage cheese that adhere to the oral mucosa

A

pseudomembranous

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10
Q

White plaques characteristic of pseudomembranous candidiasis consist of (3)

A

fungal hyphae, epithelial cells, and debris

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11
Q

Name the candidiasis infection: plaques CAN be scraped off, underlying mucosa may appear normal or erythematous

A

pseudomembranous

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12
Q

most common locations of pseudomembranous candidiasis

A

buccal mucosa, palate, dorsal tongue

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13
Q

Name the candidiasis infection: symptoms are mild (if present at all), unpleasant taste

A

pseudomembranous candidiasis

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14
Q

Common causes/situations of pseudomembranous candidiasis (4)

A
  • recent broad-spectrum antibiotic
  • impairment of the patient’s immune system
  • infants (underdeveloped immune system)
  • steroid inhalers for asthma
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15
Q

Name the candidiasis infection: very common but overlooked clinically

A

erythematous candidiasis

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16
Q

Several sub-categories of erythematous candidiasis:

A
  • dorsal tongue (acute atrophic candidiasis, central papillary atrophy)
  • palate
  • denture stomatitis
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17
Q 
Name the candidiasis infection: 
• focal redness and loss of the filiform papillae on the midline and posterior dorsal tongue
• chronic and asymptomatic 
• usually somewhat symmetric 
• smooth surface
A

central papillary atrophy (median rhomboid glossitis)

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18
Q

Name the candidiasis infection:
• aka “antibiotic sore mouth”
• typically occurs after broad-spectrum antibiotic therapy

A

acute atrophic candidiasis (erythematous candidiasis)

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19
Q

Name the candidiasis infection:
• pts complain that their mouth feels like they have “scalded” it
• diffuse loss of the filiform papillae on the dorsal tongue, while tongue looks red and smooth

A

acute atrophic candidiasis (erythematous candidiasis)

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20
Q

Name the candidiasis infection: erythema localized to the denture-bearing mucosa, may have petechial hemorrhages, usually asymptomatic

A

denture stomatitis (erythematous candidiasis)

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21
Q

Name the candidiasis infection: true candidal infection or just tissue response to microorganisms embedded in the denture acrylic? cultures usually show heavy colonization of the denture but not of the mucosa, consider the possibility of allergy or inadequately cured acrylic

A

denture stomatitis (erythematous candidiasis)

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22
Q

Name the candidiasis infection: erythema, cracking, and fissuring at the corners of the mouth

A

angular cheilitis

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23
Q

Angular cheilitis can occur in anyone, but especially in patients with?

A

decreased VDO—saliva pools in the accentuated folds keeping them moist

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24
Q

Angular cheilitis may be a combined infection:

A

20% C. albicans alone
20% Staph aureus alone
60% C. albicans and Staph aureus together

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25
Q
  • extension of angular cheilitis to involve the perioral skin
  • erythema, crusting, exfoliation, and swelling of the lips
  • associates with actions or habits that keep the lips and perioral skin moist
A

cheilocandidiasis

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26
Q

actions/habits that keep the lips/perioral skin moist and cause cheilocandidiasis (2)

A
  • chronic lip licking or sucking, thumb sucking

* chronic use of lip balms

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27
Q

Name the candidiasis infection: an uncommon form of candidiasis, often speckled red/white in appearance

A

chronic hyperplastic candidiasis

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28
Q

MC location of chronic hyperplastic candidiasis

A

anterior buccal mucosa (near commissures)

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29
Q

Name the candidiasis infection: CANNOT be scraped off!!!

A

chronic hyperplastic candidiasis

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30
Q

Name the candidiasis infection: should resolve completely after antifungal therapy

A

chronic hyperplastic candidiasis

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31
Q

dx of candidiasis (4)

A
  • clinical presentation may be characteristic
  • culture (Sabouraud’s agar slant)—organisms grow white colonies
  • exfoliative cytology—stained with PAS method
  • biopsy—hyphae are embedded in the parakeratin layer and induce a neutrophilic inflammatory infiltrate
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32
Q

tx of candidiasis

A
  • appropriate antifungal medications (nystatin, clotrimazole, fluconazole)
  • a patient’s dentures must be treated in addition to their mucosa
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33
Q

Tx for pseudomembranous and erythematous candidiasis? Angular cheilitis and cheilocandidiasis? Complete dentures? Partial dentures?

A
  • Pseudomembranous and erythematous candidiasis—nystatin, clotrimazole, fluconazole
  • Angular cheilitis and cheilocandidiasis—clotrimazole cream 1%
  • Complete dentures (no metal)—diluted bleach
  • Partial dentures (with metal)—nystatin
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34
Q

Disp: 11
Sig: take 2 tablets on day 1, then 1/day until gone
Note: compliance is usually better compared to clotrimazole
Drug interactions: oral hypoglycemics, phenytoin, coumadin

A

fluconazole (100 mg tablets)

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35
Q

drug interactions of fluconazole

A

oral hypoglycemics, phenytoin, coumadin

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36
Q

Disp: 50
Sig: dissolve one in mouth 5x/day until gone
Note: effectiveness depends on direct contact with the mucosa (must be dissolved, won’t work if chew/swallow)
Drug interactions: won’t interact with other meds, more expensive than fluconazole

A

clotrimazole (10 mg oral troches)

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37
Q

Disp: 480 mL
Sig: use 2 tsp as a mouth rinse 5 qd for 10 days, hold suspension in mouth for 2 min then expectorate
Note: effectiveness depends on direct contact with mucosa, bitter taste of drug is disguised by sugary flavoring agents so may not be the best choice for pts with high caries risk

A

nystatin oral suspension 100,000 units/mL (for oral mucosa)

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38
Q

Disp: 250 mL
Sig: soak partial denture overnight for 10 days, refresh suspension every 3 days

A

nystatin oral suspension for partial denture (100,000 units/mL)

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39
Q

how to dilute bleach for complete denture

A

one tablespoon of bleach in 1 cup water, soak overnight for 10 days (make sure to rinse thoroughly before inserting back in mouth to avoid chemical irritation!!)

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40
Q

available OTC, marketed as athlete’s foot cream, apply to affected areas 3-4 times per day for 10 days to treat angular cheilitis/cheilocandidiasis

A

clotrimazole cream 1%

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41
Q

organism that causes histoplasmosis

A

Histoplasma capsulatum

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42
Q

the most common SYSTEMIC fungal infection in the US (500,000 new cases/yr)

A

histoplasmosis

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43
Q

suited to growth in humid areas

A

Histoplasma capsulatum

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44
Q

organisms common in bird and bat droppings

A

Histoplasma capsulatum

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45
Q

endemic to the Ohio and Mississippi river valleys, 80-90% of the population in endemic areas has been infected

A

Histoplasma capsulatum (histoplasmosis)

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46
Q

no person-to-person transmission, spores are inhaled from the environment then germinate into yeasts inside the lungs

A

Histoplasma capsulatum (histoplasmosis)

47
Q

Expression of histoplasmosis depends on (3):

A
  • amount of spores inhaled
  • immune status of patient
  • strain of Histoplasma capsulatum
48
Q

Name the type of histoplasmosis: a common, self-limited pulmonary infection

A

acute

49
Q

Name the type of histoplasmosis: the type that normal, healthy people get if they inhale a high concentration of spores

A

acute

50
Q

Name the type of histoplasmosis: calcification of hilar lymph nodes may be seen incidentally on chest films in the future

A

acute histoplasmosis

50
Q

Name the type of histoplasmosis: flu-like clinical presentation (for about 2 weeks)—fever, headache, body ache, non-productive cough

A

acute

51
Q

Name the type of histoplasmosis: much less common, also affects the lungs

A

chronic

52
Q

Name the type of histoplasmosis: typically occurs in older, emphysematous or immunocompromised patients

A

chronic

53
Q

Name the type of histoplasmosis: TB-like clinical presentation—fever, chest pain, dyspnea, cough, hemoptysis, fatigue

A

chronic

54
Q

Name the type of histoplasmosis: the least common type

A

disseminated

55
Q

Name the type of histoplasmosis: infection spreads to extrapulmonary sites

A

disseminated

56
Q

Name the type of histoplasmosis: old, debilitated, or immunocompromised pts

A

disseminated

57
Q

Name the type of histoplasmosis: oral cavity can be affected—a solitary, variably-painful ulcer with firm, rolled borders (mimics malignancy)

A

disseminated

58
Q

Oral appearance: a solitary variably-painful ulcer with firm, rolled borders (mimics a malignancy)

A

disseminated histoplasmosis

59
Q

dx of histoplasmosis

A
  • culture
  • serologic testing for H. capsulatum antibodies
  • biopsy specimen—granulomatous inflammation, organisms can usually be seen on H&E slides but are better visualized with special stains such as GMS or PAS
60
Q

Tx of acute histoplasmosis? Chronic? Disseminated?

A
  • Acute—no tx other than supportive care
  • Chronic—IV amphotericin B for immunocompromised pts, itraconazole for non-immunosuppressed patients (fewer side effects)
  • Disseminated—IV amphotericin B, followed by intraconazole for several months
61
Q

Prognosis of acute histoplasmosis? Chronic? Disseminated?

A
  • Acute—excellent
  • Chronic—20% mortality rate amongst untreated pts, amphotericin B can cause kidney damage
  • Disseminated—80-90% mortality rate in untreated pts, 7-23% mortality rate among treated patients
62
Q

organism that causes blastomycosis

A

Blastomyces dermatitidis

63
Q

overlaps same region as histoplasmosis, but also extends further north

A

blastomycosis

64
Q

Which is more common? histoplasmosis or blastomycosis

A

histoplasmosis is 10x more common

65
Q

male predilection? vs population bias

A

blastomycosis

66
Q

spores are inhaled from the environment, infection usually limited to the lungs, relatively rare in immunocompromised pts

A

blastomycosis

67
Q

acute vs chronic blastomycosis

A

Acute—resembles pneumonia

Chronic—resembles TB (more common than acute)

68
Q

If dissemination of blastomycosis occurs, ________ is usually involved.

A

skin

69
Q

oral lesions may represent dissemination or local inoculation

A

blastomycosis

70
Q

tx for blastomycosis

A

itraconazole for mild to moderate cases, amphotericin B for severe cases

71
Q

organism that causes coccidioidomycosis

A

Coccidioides immitis

72
Q

grows in semiarid, desert soil (arthrospores)

A

coccidioidomycosis

73
Q

endemic to southwestern US and Mexico, estimated 100,000 infections per year in the US

A

coccidioidomycosis

74
Q
  • acute infection is asymptomatic in 60% of cases

* 40% develop flu-like symptoms about 1-3 weeks after inhaling the arthrospores

A

coccidioidomycosis

75
Q

a hypersensitivity response to a coccidioidomycosis infection, resembles erythema multiforme or erythema nodosum

A

“valley fever”

76
Q

immunosuppression greatly increases the risk of dissemination

A

coccidioidomycosis

77
Q

common extrapulmonary infection location of coccidioidomycosis

A

skin (central face, nasolabial fold area)

78
Q

intraoral lesions are uncommon

A

coccidioidomycosis and cryptococcosis

79
Q

tx for coccidioidomycosis

A

amphotericin B for immunosuppressed, dissemination, and severe lung infection

80
Q

organism that causes cryptococcosis

A

Cryptococcus neoformans

81
Q

worldwide distribution, uncommon in healthy persons, infection can be devastating for an immunocompromised pt

A

cryptococcosis

82
Q

organism lives in pigeon droppings, spreads via inhalation of spores

A

cryptococcosis

83
Q

dissemination is common in immunocompromised patients, meninges is most common site of involvement (uncommon in oral cavity)

A

cryptococcosis

84
Q

headache, fever, vomiting, neck stiffness—initial signs of infection in may pts

A

cryptococcal meningitis

85
Q

80% of pts diagnosed with disseminated cryptococcosis have ?

A

AIDS

86
Q

first and second most common site of dissemination of cryptococcosis

A

1) meninges

2) skin

87
Q

tx of cryptococcosis

A

combination antifungal therapy including amphotericin B

88
Q

formerly the most common life-threatening fungal infection in AIDS pts, has become much less of a problem since the advent of ART (antiretroviral therapy), still a major cause of death worldwide in countries where pts cannot afford ART, estimated 5-10% of AIDS pts will get this

A

cryptococcosis

89
Q

organisms that cause mucormycosis (zygomycosis)

A

Mucor, Absidia, Rhizomucor Rhizopus genera (worldwide distribution)

90
Q

a severe and sudden opportunistic infection, seen especially in uncontrolled insulin-dependent diabetics who are ketoacidotic (causes elevated iron serum levels which enhances the growth of these fungi)

A

mucormycosis (zygomycosis)

91
Q

almost never occurs in healthy individuals

A

mucormycosis (zygomycosis)

92
Q

mucormycosis (zygomycosis) can involve several areas of the body, but _________ form is most relevant to DDS

A

rhinocerebral

93
Q

Initial symptoms may include:
• nasal obstruction or bloody discharge
• facial pain, headache
• facial swelling or cellulitis
• swelling and ulceration of palate or maxillary alveolus
• visual changes, facial paralysis
• radio graphic opacification of the maxillary sinus

A

rhinocerebral mucormycosis

94
Q

ulcerated surfaces appear necrotic and black, massive tissue destruction can occur

A

rhinocerebral mucormycosis

95
Q

dx of mucormycosis

A

biopsy—organisms tend to invade small blood vessels, infarction and extensive necrosis, large hyphae that tend to branch at 90 degree angles

96
Q

biopsy reveals large hyphae that tend to branch at 90 degree angles

A

mucormycosis

97
Q

tx of mucormycosis

A

radical surgical debridement of necrotic tissue, high dose IV amphotericin B, control pt’s underlying systemic disease

98
Q
  • poor prognosis—40-50% mortality rate

* survivors have functional and cosmetic issues related to tissue defects

A

mucormycosis

99
Q

palatal obturation

A

mucormycosis

100
Q

organism that causes aspergillosis

A

Aspergillus fumigatus or A. flavus (worldwide distribution, inhalation of spores)

101
Q

non-invasive vs invasive forms of aspergillosis

A
  • non-invasive form usually occurs in healthy pt

* invasive form usually occurs in immunosupressed pts (AIDS, transplant pts, uncontrolled diabetics)

102
Q

can be acquired in the hospital (nosocomial infection), especially if construction is going on which stirs up spores

A

aspergillosis

103
Q

Invasive or non-invasive aspergillosis? healthy pt

A

non-invasive

104
Q

Invasive or non-invasive aspergillosis? may manifest as allergic fungal sinusitis, affects the sinuses or bronchopulmonary tract

A

non-invasive

105
Q

Invasive or non-invasive aspergillosis? may manifest as an aspergilloma—fungus ball, mass of fungal hyphae in the maxillary sinus

A

non-invasive

106
Q

a mass of fungal hyphae in the maxillary sinus

A

aspergilloma

107
Q

Invasive or non-invasive aspergillosis? may occur after maxillary or molar extraction or endo tx, predisposes overlying sinus to infection

A

non-invasive

108
Q

Invasive or non-invasive aspergillosis? immunocompromised pt

A

invasive

109
Q

Invasive or non-invasive aspergillosis? a relatively uncommon location, gingival sulcus point of entry?, painful gingival ulceration and diffuse gray or purple swelling

A

invasive—oral invasive aspergillosis

110
Q

Invasive or non-invasive aspergillosis? starts in the lungs (chest pain, cough, fever) —> enters bloodstream and can spread almost anywhere

A

invasive—disseminated aspergillosis

112
Q

Tx for aspergilloma? Allergic fungal sinusitis? Invasive aspergillosis?

A
  • Aspergilloma—surgical debridement
  • Allergic fungal sinusitis—surgical debridement and systemic corticosteroids
  • Invasive aspergillosis—aggressive debridement and systemic voriconazole
113
Q

3 manifestations of non-invasive aspergillosis:

A

allergic fungal sinusitis
aspergilloma
after max molar extraction or endo tx

Oral Pathology Exam 2 (8 decks)

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