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Oral Disease - Soft tissue > Candida infections > Flashcards

Candida infections Flashcards

1
Q

Where are the candida species found?

A

Common in the oral cavity, GIT and vagina as a commensal

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2
Q

Describe the shape of candida

A

Polymorphic fungus - it takes up many shapes

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3
Q

What is the importance of candida?

A

It is the most common fungal pathogen in humans, and the most medically important fungus

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4
Q

Describe the pathogenicity of candida

A

It is a harmless commensal and opportunistic mycoses, which develops mucosal infections in certain conditions e.g. immunocompromised

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5
Q

What species of candida is most important?

A

Candida albicans

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6
Q

What are the stages of candida albicans infections?

A 
Colonisation 
Superficial infection 
Deep spread infection 
Disseminated infections 
(Host and fungal factors play a role in the development from superficial to deep seated infections)
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7
Q

List the predisposing factors for oral candidal infections

A
  • Immunocompromised - diabetes, HIV/AIDs, cancer or chemo, organ transplants
  • Drugs causing antimicrobial change to flora e.g. antibiotics
  • Diet/nutrition - iron, folate or vit b12
  • Mechanical and chemical - burns, wounds, smoking and dentures
  • Xerostomia - medications, sjogrens
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8
Q

What cells are important for colonisation of candida?

A

Adhesion factors to anchor bacteria to epithelial walls
Enzymes to interact with cell membrane
Hyphae formation for adhesion

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9
Q

What are the adhesion factors in candida?

A

Agglutin like sequence 3

Hyphal wall protein 1

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10
Q

What type of bonding occurs between candida and epithelial walls

A

Covalent - therefore v strong

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11
Q

What enzymes are important in candida infections

A

SAPs - secreted aspartyl proteinases
Lipases
Phosphilipase Bs

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12
Q

How does superficial candida infection arise?

A

Penetration and anchoring of hyphae, causing degredation of epithelium via toxin production (candidalysin)

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13
Q

What is candidalysin?

A

Antimicrobial peptide (toxin) that integrates into the membrane and damages epithelial cells

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14
Q

Why is pain and itching associated with candida infections?

A

Due to toxin production

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15
Q

What occurs with disseminated candida infections?

A

Penetration through epi to major organs which can be fatal

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16
Q

How does the body attempt to clear candida infection?

A

Secretion of proinflammatory mediators to recruit neutrophils (direct killing) and dendritic cells (APC to th17 cells)
These secrete cytokines to kill fungi or repair epithelium

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17
Q

What cytokines are vital in candida infections?

A

TNFa

IL22 and IL17

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18
Q

What is the classification of oral candida infections

A 
Acute 
- Pseudomembranous 
- Atrophic candidiasis 
Chronic 
- Hyperplastic 
- Atrophic 
Others 
- Erythematous 
- Angular chelitis
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19
Q

Describe the clinical features of: pseudomembranous candida

A

White patches which are easily removed on scraping

Associated with extremes of age

20
Q

Describe the clinical features of: atrophic candidiasis

A

Depapillation of tongue - smooth and red

Associated with antibiotics

21
Q

Describe the clinical features of: chronic hyperplastic candida

A

White or a mix of red and white patches
Looks like pseudomembranous but you cannot remove the plaque
Sites- BM adjacent to commissures

22
Q

What is chronic hyperplastic candida associated with

A

Smoking

23
Q

What is the important features of chronic hyperplastic candida

A
  • Fungus is inside the epithelial cells

- Persistent lesions show epithelial dysplasia - considered OPML

24
Q

Describe the clinical features of: chronic hyperplastic candida associated with median rhomboid glossitis

A

Back and middle of the tongue

Glossy appearance

25
Q

Describe the clinical features of: Chronic atrophic candida (denture related stomatitis)

A

Erythema of mucosa associated with area covered by (upper) denture
Angular stomatitis is associated

26
Q

Describe the clinical features of: erythematous candida

A

Erythema and smoothness of the middle of the dorsal tongue
Redness of palate corresponding to tongue
Longer lesion than MRG

27
Q

What is chronic erythematous candida associated with

A

Denture wearing

28
Q

Describe the clinical features of: angular cheilitis/stomatitis

A

Soreness, erythema and fissuring of the commissures (corners of the mouth)

29
Q

What causes angular cheilitis

A

Leakage of candida infected saliva at the commissures

30
Q

Risk factors for angular cheilitis

A

Deep folds due to age
Ill fitting dentures
Nutritional deficiencies

31
Q

Describe the steps for the management of candida

A
  • Establish diagnosis - clinical features and special tests
  • Remove, reduce or manage risk factors
  • Antifungal agents
32
Q

What is CHROMagar

A

Special testing for candida to identify the strain (they appear as different colours)

33
Q

What are the types of tests for candida?

A

Smear
Swab
Saliva
Biopsy

34
Q

What mechanisms can antifungals affect

A
  • Nucleic acid biosynthesis
  • Ergosterol biosynthesis
  • Membrane function
  • Cell wall biosynthesis
35
Q

How do Azoles work?

A

Prevent biosynthesis of ergosterol

36
Q

How does Nystatin work?

A

Punch holes in the plasma membrane, resulting in lysis of the cell

37
Q

What anti-fungals are involved in preventing cell wall biosynthesis

A

Echinocandins

Caspofungins

38
Q

How do caspofungins work?

A

Prevent beta glucan synthesis which makes the cell walls - causes the candida to burst

39
Q

What are the most commonly used antifungals in dentistry?

A

Nyastatin
Fluconazole
Miconazole
Intraconazole

40
Q

What types of therapy is used for candida

A

Topical

Systemic

41
Q

Describe topical antifungal therapy

A

Nyastatin in the form os lozenges and suspension

Miconazole gel for lips, tongue and denture fitting surfaces

42
Q

How can dentures be treated if affected by candida

A

Placed overnight in:
Sodium hypochlorite
CHX

43
Q

When are systemic antifungals considered

A

If local therapy doesn’t work

Or it is severe

44
Q

Prophylaxis of candida

A
  • CHX mouthwash daily if uncontrollable risk factors

- Rinsing mouth after using steroid inhalers

45
Q

When should azoles be avoided

A

In pts taking NOACs/warfarin

Instead - nyastatin

Oral Disease - Soft tissue (12 decks)

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