Candidosis Flashcards
What are the risk factors for developing candidiasis?
- immuno-compromised patients (most of it down to immunosupression)
- immunosupressive drugs
- advanced HIV
- Broad spectrum antibiotics
- dialysis
- trauma patient
- diabetes
- long term corticosteoid use
What are some infections that can be caused by candidia?
- periodontitis
- denture implant infection
- denture stomatitis
- CF lung infection
- UTI
- endocarditis
- implant/medical device
What are the classifications of oral candidosis?
- pseudomembranous
- thrush
- erythematous
- Atrophic (HIV related)
- Denture related
- hyperplastic
- candidal leukoplakia (can be pre-malignant)
- Angular chelitis
- Generalised candidosis with oral manifestations
Describe what pseudomembranous (oral thrush) looks like.
- white plaques that are fairly raised
- can be wiped off
How does chronic hyperplastic candida leukoplania appear? What do you need to do?
- looks similar to thrush but CANNOT be wiped off
- the candida is actually in the tissue
- Need to test for pre-malignancy
What is the main antifungal used for angular chelitits?
Topical micanazole
Why are dentures a key surface for candida?
-it has lots of little cracks and crevices for the candida to accumulate
What are the 3 grades/types of denture stomatitis? (based on severity)
- Newton’s type I
- Localised infalmmation
- Newton’s type II
- Diffuse inflammation
- Newton’s type III
- Granular inflammation
What are the signs and symptoms of denture induced stomatitis?
- Inflamed mucosa (particulary under upper denture
- Burning sensation
- Discomfort
- Bad Taste
- In most cases patients are unaware of the problem
Describe the process leading to denture stomatitis.
- candida adhere to and colonise on the acrylic surface
- co-aggregation and biofilm formation
- toxins are released into the mucosa causing inflammation
The biofilm starts on the denture itself
Candida can be descibed as what ?
Opportunistic pathogenic yeasts
What are the 2 main types of candida you will come accross?
- candida albicans
- Candida glabrate
How is the management of candida albicans and candida glabrata different?
Candida albicans is sensitive to fluconazole and miconazole wherease candida glabrata is not and will only grow more if treated with these
Where is candida albicans normally found within the body?
- oral cavity
- vagina
- gut (mucosal surfaces)
Candida albicans competes with what and why is this important to know?
- competes with bacteria
- systemic antibiotics can allow the fungi to outcompete the bacteria and you can end up with thrush
Describe the differences in adhesion between candida albicans and candida glabrata.
Candida albicans has hypha that allow it to push through tissues and adhere to them. This is a problems as this is how it can get into the bloodstream
Candida glabrate just adheres to tissues
How does candida relate to oral cancer?
Chronic candida along with alcohol consumption can drive head and neck cancer
What are different ways that you can collect a candidia sample for lab diagnosis?
- oral rinse
- swab
- biopsy (possible pre-malignancy)
What are the 3 different groups of antifungals?
- echinocandins
- azoles
- polyenes
What are some examples of echinocandins? How do they work?
- caspofungin
- Micafungin
- Anidualafungin
They inhibit glucan synthase whuch destabilises the full cell wall and causes cell death
Note: will be used within the next few years orally for when patients fail to respond to azoles
What are some examples of azoles and how do they work?
- fluconazile
- voriconazole
- posaconazole
Work on the argosterol
Inhibits the pathway and prevents it being made
Is fungistatic
What is an example of a polyene and how does it work?
Nystatin
Acts directly on ergosterol and causes pores in the wall
Cytoplasmic contents leak out and causes cell death and lysis
Is fungicidal
What is the candida treatment algorithm?
What are some problems associated with diagnosis and treatment of candida infections?
- people don’t think its a biofilm so follow guildines but forget to disrupt is with good OH
- Need to think about possible different organisims that might be there because this drives the treatment you give
