Ch 6 Fungal

Question 1

what commonly causes candidiasis?

Answer 1

-antibiotics and steroid inhalers

Question 2

erythematous candidiasis

Answer 2

• white component missing
• most common but overlooked
• “antibiotic sore mouth” especially after broad spectrum
• loss of filliform

Question 3

hyperplastic candidiasis

Answer 3

cannot be removed by scraping

-least common and most controversial

Question 4

candidiasis prevention

Answer 4

• probiotics when taking antibiotic

- yoghurt cultures

Question 5

candidiasis treatment

Answer 5

clotrimazole 10 mg

Question 6

angular cheilitis

Answer 6

• loss of vertical dimension
• vitamine B deficiency
• immunosuppressed/candidiasis
• cheilocandidiasis; exfoliative lesions of the vermillion zone and perioral skin due to superficial candidal infection
• 20% candidiasis alone and 60% combined with staphylococcus aureus and 20% SA alone

Question 7

Angular cheilitis treatment

Answer 7

Mycolog II (triamcinolone 0.1% and Nystatin 100,000 units/gram) ointment
-vitamine B complex

Question 8

denture stomatitis

Answer 8

• classified as a form of erythematous candidiasis
• also termed chronic atrophic candidiasis
• minimal symptoms
• wear dentures 24/7; poor hygiene
• treat candidiasis, remake denture, soak denture, brush palate and brush denture

Question 9

mucocutaneous candidiasis

Answer 9

• suspect when have infections of mouth, nails, skin and other mucosal surfaces
• may be a component of a rare group of immunologic disorders
• mutations in the autoimmune regulator gene
• can get big changes in the finger nails
• increased oral and esophageal cancer

Question 10

what syndrome is associated with mucocutaneous candidiasis?

Answer 10

AI polyendocrinopthay-candidiasis-ectodermal dystrophy syndrome;
disturbances include hypoparathyroidism, hypoparathyroidism, hypoadrenocorticism, diabetes mellitus and IDA

Question 11

what are the histopathologic features of candidiasis?

Answer 11

• periodic acid-schiff (PAS) stains bright magenta
• 10-20% potassium hydroxide preparation
• hyphae or pseudohyphae (elongated yeast cells) must be present to make a diagnosis
• may be superimposed on LP, leukoplakia and SCCa

Question 12

Candidiasis treatment

Answer 12

Nystatin; bitter taste; sucose; poorly absorbed

• Clotrimazole; poorly absorbed; antibacterial properties in addition to antifungal; elevated liver enzymes in 15% of patients
• ketaconazole; cannot take with antiacids, or H2 blocking agents (need) acid environment for absorption; liver issues
• Fluconazole; more effective than KC; acid environ. Not required long 1/2 life for QD dosing; live issues rare; side effects with phenytoin and anticoagulants and oral hypoglycemic agents
• Iodoquniol; non strictly antifungal; antibacterial also; in cream base effective for AC

Question 13

what is the most common systemic fungal infection in US especially in HIV

Answer 13

Histoplasmosis (histo. capsulatum)

Question 14

histoplasmosis

Answer 14

humid areas; soil enriched by bird or bat droppings

• tongue, palate and buccal mucosa
• can be painful and mimic malignancy
• airborne spores are inhaled, pass through the terminal passages of lung and germinate
• most cases mild to no symptoms
• expression of disease depends on amount of spores inhaled and immune status of host
• 2-10% patients with AIDS develop disseminated form

Question 15

what is seen histologically with histoplasmosis?

Answer 15

• multinucleated giant cells in association with granulomatous inflammation
• special stains with PAS and methenamine silver demonstrate the organism
• serologic testing in which orgnaism directed against H Capsulatum are demonstrated and antigen produced by yeast identified

Question 16

treatment of histoplasmosis

Answer 16

-acute H sel limiting and requires no treatment besides supportive care
-patients with chronic form require treatment despite fact that 1/2 will recover spontaneously. Often the pulmonary damage is progressive if untreated death may result in 20% of cases
-amphotericin B, particularly in severe cases; significant kidney damage can result
-itraconazole used for at least 3 month in nonimmunosuppressed patients
-disseminated form death in 80-90% if untreated
(even with therapy 7-23% mortality rate)

Question 17

if a patient is immunocompromised and has uncontrolled diabetes that are ketoacidotic may contract…

Answer 17

Zygomycosis

• ketoacidosis inhibits the binding of iron to transferrin allowing serum iron levels to rise
• growth of fungi enhanced by iron;

Question 18

what are the other names for zygomycosis?

Answer 18

mycormycosis and phycomycosis

Question 19

what is associated with sinus calcification?

Answer 19

aspergillosis

Question 20

zygomycosis

Answer 20

• spores may be liberated into air and inhaled
• in rhinocerebral form patients present with nasal obstruction, blood nasal discharge, facial pain or headache, facial swelling or cellulitis and visual disturbances
• cranial nerve involvement/facial paralysis often present
• progressive disease into cranial vault results in blindness, lethargy and seizures, followed by death
• “if you get this one, you are in trouble and will probably die, usually older ppl”

Question 21

zygomycosis histologic findings

Answer 21

• extensive necrosis with numerous large, branching, nonseptate hyphae
• hyphae tend to branch at 90-degree angle

Question 22

treatment of zygomycosis

Answer 22

• radical surgical debridement
• high dose amphotericin B
• control underlying disease
• prognosis grave with massive tissue destruction; 60% of rhinocerebral form die even with aggressive therapy

Question 23

Aspergillosis

Answer 23

• invasive and non-invasive forms
• with advent of intensive chemo, AIDS, organ and bone marrow transplant, uncontrolled Diabetes M, incidence of invasive form increased dramatically

Question 24

where is aspergillosis found?

Answer 24

• genus found in saprobic organisms in soil, water and decaying organic debris
• spores released in air and inhaled
• most species cannot grow at 37 degrees C
• only the pathogenic species have the ability to replicate at body temperature

Question 25

• allergic fungal sinusitis
• low grade infection of maxillary sinus forms mass of fungal hyphae termed _____ and may undergo dystrophic calcification (anthrolith)

Answer 25

• aspergilloma

- this is all under Aspergillosis