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BDS5 oral disease > candida > Flashcards

candida Flashcards

1
Q

give an example of opportunistic fungal infections/genus

A

Candida
Aspergillus
Cryptococcus
Pneumocystis

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2
Q

give an example of cutaneous fungal infections/species

A

Malassezia (dandruff)
Trichophyton (athlete’s foot)
Microsporum (tinea capitis)

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3
Q

how many candida species are pathogenic to humans?

A

15

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4
Q

what is the danger of C. krusei and C. auris?

A

they’re weak but antifungal resistant

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5
Q

give two antifungal resistant Candida species

A

C. krusei
C. auris

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6
Q

what are the main stages of Candida infection

A

1 colonisation
2 superficial infection
3 deep-seated infection (if immunocompromised)
4 disseminated infection

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7
Q

what occurs in the colonisation stage of candida infection?

A

epithelial adhesion - adhesins, hyphae
nutrient acquisition - hydrolytic enzymes

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8
Q

what occurs in the superficial infection stage of candida infection? (3)

A

penetration - hyphae
damage - toxins and inflammation
host protein degradation - enzymes

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9
Q

what occurs in the deep-seated infection stage of candida infection? (2)

A

further penetration, damage and protein degradation
evasion of host defences

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10
Q

what occurs in the disseminated infection stage of candida infection? (2)

A

endothelial adhesion
tissue penetration

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11
Q

how do epithelial cells react to candida infection and what effects does this have? (3)

A

pro-inflammatory cytokines released to attract WBCs
- direct fungal killing
- barrier repair
- antimicrobial peptides released

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12
Q

natural predisposing factors to candida infection (6)

A
  • other infections
  • disrupted flora
  • cancer, compromised immunity
  • pregnancy
  • diabetes
  • infancy or old age
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13
Q

diet predisposing factors to candida infection (2)

A
  • carbohydrate-rich
  • haematinic deficiency
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14
Q

mechanical/chemical predisposing factors to candida infection (3)

A
  • burns, wounds
  • denture wear
  • tobacco use
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15
Q

iatrogenic predisposing factors to candida infection (2)

A
  • antibiotics
  • steroids and immunosuppressive drugs, chemotherapy, transplants
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16
Q

other predisposing factors/conditions to candida infection (3)

A
  • HIV/AIDS
  • thymic aplasia
  • xerostomia
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17
Q

list the types of candida infection affecting the oral cavity (7)

A
  • acute pseudomembraneous
  • acute atrophic
  • erythematous
  • chronic mucocutaneous
  • angular cheilitis
  • chronic hyperplastic
  • chronic atrophic
18
Q

describe acute pseudomembraneous candidiasis (presentation, alternative name) (3)

A
  • removable white patches (dead cells, fungae)
  • tongue, BM, palate
  • AKA thrush
19
Q

what test would you do if you suspected acute pseudomembraneous candidiasis?

A

smear or saliva test

20
Q

normal sites for acute pseudomembraneous candidiasis (3)

A

tongue
BM
palate

21
Q

describe acute atrophic candidiasis (AKA, presentation, common association)

A
  • AKA antibiotic sore mouth or acute erythematous candidiasis
  • localised or generalised erythema
  • bright red, sore tongue
  • associated with prolonged broad spectrum antibiotic use
22
Q

common cause of acute atrophic candidiasis

A

prolonged broad spectrum antibiotic use (antibiotic sore mouth)

23
Q

describe erythematous candidiasis (types, presentation)

A
  • painful localised erythema usually on tongue
  • acute = acute atrophic candidiasis/antibiotic sore mouth
  • chronic = HIV-associated with kissing lesion on palate
  • median rhomboid glossitis form
24
Q

common sites for erythematous candidiasis (2)

A

tongue
palate if HIV-associated

25
Q

what condition is chronic erythematous candidiasis commonly associated with?

A

HIV (kissing lesion on palate)

26
Q

describe median rhomboid glossitis (2)

A
  • form of erythematous candidiasis
  • area of atrophy/erythema on posterior midline of tongue
27
Q

describe chronic mucocutaneous candidiasis (cause, presentation)

A
  • often secondary to immunodeficiency or endocrine disorders
  • red flat rash of skin folds
  • scalp, nails affected
  • non-invasive infection but resistant to topical treatment
28
Q

what is angular cheilitis?

A

painful cracking at corners of mouth, usually bilateral

29
Q

common causes of angular cheilitis (2)

A
  • overclosure of mouth (saliva)
  • nutritional deficiency (vit B2)
30
Q

describe chronic hyperplastic candidiasis (presentation, demographic)

A
  • thickened irregular-surfaced white patch that cannot be rubbed off
  • often bilateral on commissural region of BM, lateral tongue border or palate
  • often older males, smokers
31
Q

chronic hyperplastic candidiasis common demographic

A

older males
smokers

32
Q

common sites for chronic hyperplastic candidiasis

A
  • bilateral commissural areas of BM
  • lateral borders of tongue
  • palate
33
Q

histology of chronic hyperplastic candidiasis (4)

A
  • test-tube rete processes
  • plasma cells in lamina propria
  • inflammation in stratum corneum
  • PAS stain for hyphae
34
Q

what histological stain is used for fungal hyphae?

A

PAS stain (periodic acid-Schiff)

35
Q

describe chronic atrophic candidiasis (AKA, presentation, cause)

A
  • AKA denture-related stomatitis
  • redness over denture-bearing mucosa, esp palate
  • due to poor denture hygiene +/or dry mouth
36
Q

list types of antifungals and their mechanism (4)

A

1 ergosterol biosynthesis inhibitors
- (tri)azoles (eg miconazole)
- allylamines (eg terbinafine)
- morpholines
2 beta-glucan synthesis inhibitors
- echinocandins (eg caspofungin)
3 nucleic acid biosynthesis
- pyrimidine analogues
4 pore forming
- polyenes (eg amphotericin B, nystatin)

37
Q

what are the three main steps in candidiasis management?

A

1 diagnosis
2 remove/reduce predisposing factors
3 antifungal medication

38
Q

management of oral-only candidiasis (3)

A

topicals:
- nystatin 3-4x/day (lozenge, pastille, suspension)
- miconazole gel 3-4x/day for 2/52 on lips/tongue/denture
- soak denture overnight in NaOCl 5000ppm or CHX 0.1%
if non-resolving then use systemics

39
Q

management of severe oral +/or body-wide candidiasis (4)

A

systemic antifungals:
- fluconazole 50-100mg OD 10-14 days
- itraconazole 100-200mg OD
- +/- prophylaxis as 1 week per month medication +/or regular CHX MW
- echinocandins if azole-resistant

40
Q

what drug interactions are important to consider with antifungals? (2)

A
  • DOACs/warfarin - especially with azoles
  • stop statins for use with fluconazole due to rhabdomyolysis)
41
Q
A

BDS5 oral disease (26 decks)

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