Ch 6 Fungal Flashcards
what commonly causes candidiasis?
-antibiotics and steroid inhalers
erythematous candidiasis
- white component missing
- most common but overlooked
- “antibiotic sore mouth” especially after broad spectrum
- loss of filliform
hyperplastic candidiasis
cannot be removed by scraping
-least common and most controversial
candidiasis prevention
- probiotics when taking antibiotic
- yoghurt cultures
candidiasis treatment
clotrimazole 10 mg
angular cheilitis
- 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
Angular cheilitis treatment
Mycolog II (triamcinolone 0.1% and Nystatin 100,000 units/gram) ointment -vitamine B complex
denture stomatitis
- 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
mucocutaneous candidiasis
- 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
what syndrome is associated with mucocutaneous candidiasis?
AI polyendocrinopthay-candidiasis-ectodermal dystrophy syndrome;
disturbances include hypoparathyroidism, hypoparathyroidism, hypoadrenocorticism, diabetes mellitus and IDA
what are the histopathologic features of candidiasis?
- 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
Candidiasis treatment
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
what is the most common systemic fungal infection in US especially in HIV
Histoplasmosis (histo. capsulatum)
histoplasmosis
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
what is seen histologically with histoplasmosis?
- 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
treatment of histoplasmosis
-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)
if a patient is immunocompromised and has uncontrolled diabetes that are ketoacidotic may contract…
Zygomycosis
- ketoacidosis inhibits the binding of iron to transferrin allowing serum iron levels to rise
- growth of fungi enhanced by iron;
what are the other names for zygomycosis?
mycormycosis and phycomycosis
what is associated with sinus calcification?
aspergillosis
zygomycosis
- 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”
zygomycosis histologic findings
- extensive necrosis with numerous large, branching, nonseptate hyphae
- hyphae tend to branch at 90-degree angle
treatment of zygomycosis
- 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
Aspergillosis
- 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
where is aspergillosis found?
- 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
- allergic fungal sinusitis
- low grade infection of maxillary sinus forms mass of fungal hyphae termed _____ and may undergo dystrophic calcification (anthrolith)
- aspergilloma
- this is all under Aspergillosis
