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Dr. Murrahs class > Chapter 6: Fungal & Protozoal Diseases > Flashcards

Chapter 6: Fungal & Protozoal Diseases Flashcards

1
Q

candidiasis is caused by what fungus?

A

candida albicans

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2
Q

candidiasis exists in ___ forms; what are they?

A
  • two forms (dimorphic)
    • yeast form - innocuous
    • hyphal form - invasion of host tissue
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3
Q

___ is by far the most common oral fungal infection in humans

A

candidiasis

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4
Q

up to ___% of people carry candida albicans in their mouth in health. what happens with age?

A
  • 50%
  • rate increases with age
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5
Q

candidiasis is mostly a ___ infection

A

opportunistic

however, healthy patients may develop infection

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6
Q

what are the 4 clinical patterns of candidiasis?

A
  • pseudomembranus
  • erythematous
  • chronic hyperplastic
  • mucocutaneous
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7
Q

what are 5 characteristics that can be present with erythematous candidiasis?

A
  • median rhomboid glossitis
  • chronic multifocal
  • angular cheilitis
  • denture stomatitis
  • acute atrophic (antibiotic sore mouth)
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8
Q

what is the best recognized form of candidiasis?

A

pseudomembranous

aka thrush

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9
Q

what is the clinical presentation of pseudomembranous candidiasis?

A
  • adherent white plaques that resemble cottage cheese
  • removable - apply pressure with gauze
  • underlying mucosa may be normal or erythematous
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10
Q

with pseudomembranous candidiasis, what should you be thinking if the underlying mucosa bleeds?

A

there is likely another process occurring (lichen planus)

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11
Q

what 3 things can pseudomembranous candidiasis be initated by?

A
  • antibiotics: eliminates competing bacteria
  • impairment of immune system: leukemic patients, HIV, infants
  • asthma inhalers
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12
Q

what are the symptoms of pseudomembranous candidiasis?

A
  • mild burning
  • mild unpleasant taste
  • *these may not always be present
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13
Q

what is the distribution of pseudomembranous candidiasis?

A

buccal mucosa, palate, and dorsal tongue

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14
Q

is there a white component in erythematous candidiasis?

A

no

erythematous candidiasis is commonly overlooked clinically

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15
Q

erythematous candidiasis is more common than what other type of candidiasis?

A

pseudomembranous

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16
Q

median rhomboid glossitis is also called ___

A

central papillary atrophy

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17
Q

does median rhomboid glossitis occur in adults or children?

A

it is a disease of adults

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18
Q

describe the clinical presentation of median rhomboid glossitis

A
  • well-demarcated erythematous zone affecting the midline, posterior dorsal tongue
  • anterior to the circumvallate papilla
  • symmetrical
  • surface may be smooth or lobulated
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19
Q

the erythema present in median rhomboid glossitis is due to ___

A

loss of filiform papilla

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20
Q

chronic multifocal candidiasis is median rhomboid glossitis plus what?

A

signs of infection at other sites

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21
Q

what are the other common sites of infection found in chronic multifocal candidiasis?

A
  • hard and soft palate (“kissing lesion”)
  • angles of the mouth (angular cheilitis)
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22
Q

angular cheilitis can be a component of ___, but usually occurs alone

A

chronic multifocal candidiasis

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23
Q

angular cheilitis is common in what people?

A

older patients with reduced vertical dimension

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24
Q

where is angular cheilitis found?

A

accentuated folds at the corners of the mouth where saliva can pool

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25
Q

describe the etiology of angular cheilitis

A
  • 20% candidia albicans alone
  • 20% staphylococcus areus alone
  • 60% combination of both
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26
Q

angular cheilitis infection may more extensively involve the perioral skins, usually due to ___. what is the term for the clinical pattern?

A
  • chronic lip picking
  • clinical patterns is termed cheilocandidiasis
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27
Q

denture stomatitis is also termed ___

A

chronic atrophic candidasis

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28
Q

denture stomatitis is localized to ___

A

denture-bearing areas of a maxillary removable denture

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29
Q

is denture stomatitis symptomatic?

A

no, although it does have a striking clinical appearance

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30
Q

describe how denture stomatitis can develop

A
  • patient wears denture continuously
  • denture harbors most of the organism
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31
Q

what is the treatment for denture stomatitis?

A

need to treat both the soft tissues and the denture to prevent recurrence)

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32
Q

acute atrophic candidiasis is also called ___ and follows a course of ___

A
  • antibiotic sore mouth
  • broad-spectrum antibiotics
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33
Q

with acute atrophic candidiasis, what does the mouth feel like?

A

feels like hot liquid scalded it

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34
Q

what is the clinical presentation of acute atrophic candidiasis?

A
  • diffuse loss of filiform papillae of dorsal tongue (appears bald)
  • similar appearance symptomology is noted in xerostomia patients
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35
Q

chronic hyperplastic candidiasis is also called ___

A

candidal leukoplakia

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36
Q

___ candidiasis clinically presents as a white patch that cannot be removed

A

chronic hyperplastic candidiasis

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37
Q

___ is the least common form of candidiasis

A

chronic hyperplastic candidiasis

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38
Q

why is chronic hyperplastic candidiasis (aka candidal leukoplakia) controversial?

A

it’s a question of which comes first - leukoplakia or candidiasis?

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39
Q

where does chronic hyperplastic candidiasis commonly occur?

A

anterior buccal mucosa

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40
Q
A

pseudomembranous candidiasis

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41
Q
A

pseudomembranous candidiasis

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42
Q
A

erythematous candidiasis

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43
Q
A

median rhomboid glossitis

(erythematous candidiasis)

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44
Q
A

chronic multifocal candidiasis

(erythematous candidiasis)

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45
Q
A

angular cheilitis

(erythematous candidiasis)

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46
Q
A

denture stomatitis

(erythematous candidiasis)

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47
Q
A

denture stomatitis

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48
Q
A

chronic hyperplastic candidiasis

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49
Q
A

chronic hyperplastic candidiasis

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50
Q
A

acute atrophic candidiasis

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51
Q
A

autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED)

(form of mucocutaneous candidiasis)

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52
Q

mucocutaneous candidiasis is a rare group of ___

A

immunologic disorders

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53
Q

young patients with mucocutaneous candidiasis can develop what 3 things?

A
  • endocrine-candidiasis syndrome
  • autoimmune polyendocrineopathy-candidiasis-ectodermal dystrophy (APECED)
    • 10% have malignancies such as oral or esophageal carcinoma
  • iron-deficiency anemia
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54
Q

in mucocutaneous candidiasis cases, what do the oral lesions look like?

A
  • white plaques that do not rub off
    • similar to chronic hyperplastic candidiasis
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55
Q

What is the treatment for candidiasis?

A

antifungal agents

  • nystatin
  • amphotericin B
  • imidazole agents - clotrimazole
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56
Q

describe the treatment of candidiasis using nystatin

A
  • oral use as suspension or lozenge
  • bitter taste, so sugar is added - don’t use in xerostomia-related candidiasis
  • effectiveness depends on direct contact, so multiple daily doses are necessary
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57
Q

describe the treatment of candidiasis using amphotericin B

A
  • IV treatment for life-threatening systemic fungal infections
58
Q

discribe the treatment of candidiasis using clotrimazole

A
  • one brand name is mycelex
  • formulated as a troche (lozenge)
  • effectiveness depends on direct contact, so multiple daily doses are necessary
  • very few side effects
59
Q

candidiasis should resolve easily following ___

A

antifungal therapy

60
Q

if candidiasis infection recurs after treatment, what should you do?

A

investigate possible predisposing factors

61
Q

___ is the most common systemic fungal infection in the US

A

histoplasmosis

62
Q

what is histoplasmosis caused by?

A

histoplasma capsulatum

63
Q

describe how histoplasma capsulatum is dimorphic

A

it is a yeast at body temperature in a human host, and a mold in the natural environment

64
Q

where is histoplasma capsulatum found? where is it endemic? up to what percent of people living in these areas are infected?

A
  • humid areas with soil enriched by bird or bat excrement
  • it is endemic in the ohio and mississippi river valley
  • 90% are infected
65
Q

how is histoplasmosis spread?

A

airborne spores are inhaled, passed into the terminal passages of the lungs, where they germinate

66
Q

___% of people who are infected with histoplasmosis have either no symptoms or such mild symptoms that the patient doesn’t seek medical care. what are the mild symptoms like, and how long can they last?

A
  • 99%
  • mild symptoms are flu-like and can last for 1-2 weeks
67
Q

most patients who become exposed to histoplasmosis are ___ and inhale and ___ number of spores

A
  • healthy
  • small
68
Q

in general, describe the patients who become infected with histoplasmosis

A
  • older
  • debilitated
  • immunocompromised
    • up to 10% of AIDS patients develop disseminated disease in endemic areas
69
Q

most histoplasmosis oral leasions occur with the ___ form

A

disseminated

70
Q

describe the clinical presentation of histoplasmosis oral lesions

A
  • appears as a solitary, variably painful ulceration of several weeks duration
  • ulcerated lesions have firm, rolled margins
  • clinically indistinguishable from malignancy
  • may appear erythematous or white with an irregular surface
71
Q

the histopathology of histoplasmosis shows ___

A

granulomatous inflammation

72
Q

what is the treatment for acute histoplasmosis?

A
  • none or palliative care
73
Q

what is the treatment for chronic histoplasmosis?

A
  • require treatment despite the fact that 50% recover spontaneously
  • pulmonary damage is progressive if untreated
  • 20% succomb to untreated disease
  • treatment of choice is IV amphotericin B, but can cause kidney damage
74
Q

what is the treatment for disseminated histoplasmosis?

A
  • 90% will succomb to disease if untreated
  • amphotericin B is treatment of choice
75
Q
A

candidiasis

76
Q
A

histoplasmosis

77
Q
A

blastomucosis

78
Q
A

blastomycosis

79
Q
A

blastomycosis

80
Q
A

blastomycosis

81
Q
A

blastomycosis

82
Q

___ is 10x less common than histoplasmosis

A

blastomycosis

83
Q

what causes blastomycosis?

A

blastomyces dermatidis

84
Q

describe how blastomyces dermatitidis is dimorphic

A
  • grows as yeasts at body temperature
  • grows as mold in rich, moist soil
85
Q

where is blastomyces dermatitidis found?

A

in eastern areas of the US and into canada

86
Q

what is the male:female ratio of the prevalence of blastomycosis, and what is it likely due to?

A
  • 9:1 male:female
  • likely due to a greater degree of outdoor activity in med where the organisms grow
87
Q

is the occurance of blastomycosis in immunocompromised patients common or rare?

A

rare

88
Q

how is blastomycosis acquired?

A

inhalation of spores after a rain; spores grow in alveoli of lungs

89
Q

acute blastomycosis symptoms resemble ___

A

pneumonia

90
Q

chronic blastomycosis symptoms resemble ___

A

tuberculosis

91
Q

blastomycosis oral lesions result from ___ or ___

A

extrapulmonary dissemination or local inoculation

92
Q

describe the clinical presentation of blastomycosis oral lesions

A
  • lesions may be irregulat with an erythematous or white surface
  • pesions may appear as ulcerations with irregular rolled borders with variable degrees of pain
  • all oral lesions are indistinguishable from SCCA clinically
93
Q

blastomycosis infection can induce a benign reaction of the epithlium termed ___. what does it look like to the untrained eye?

A
  • pseudoepitheliomatous (pseudocarcinomatous) hyperplasia
  • looks like cancer
94
Q
A

paracoccidioidomycosis (south american blastomycosis)

95
Q

what causes paracoccidioidomycosis?

A

paracoccidioides brasiliensis

96
Q

what is a host of paracoccidioides brasiliensis?

A

nine-banded armadillo

97
Q

what is the male:female ratio of paracoccidioiomycosis?

A

15:1 male:female

98
Q

most patients infected with paracoccidioidomycosis are employed in ___

A

agriculture

99
Q

what is the treatment of paracoccidioidomycosis?

A

it is generally self-limiting

100
Q

what is the histology of paracoccidioidomycosis?

A

granulomatous inflammation (characterized by collections of macrophages and multinucleated giant cells)

101
Q

describe the histologic appearance of paracoccidioides brasiliensis

A

the organism often shows multiple daughter buds on the parent cell, resulting in an appearance described as resembling “mickey mouse” or the spokes of a ship’s steering wheel (“mariner’s wheel”)

102
Q

___ infection is thought to be attributable to a protective effect of female hormones (because beta-estradiol inhibits the transformation of the hyphal form of the organism to the pathogenic yeast form)

A

paracoccidioides brasiliensis

103
Q

coccidioidomycosis is also called ___

A

san joaquin valley fever

104
Q

what causes coccidioidomycosis?

A

coccidioides immitis

105
Q

coccidioides immitis is a ___ organism

A
  • saprophytic (lives on dead/decaying organic matter)
  • it is also dimorphic
106
Q

describe how coccidioides immitis is dimorphic

A
  • mold in natural environment
  • yeast in infected host tissues
107
Q

how is coccidioidomycosis spread?

A

athrospores are produced by the mold, become airborne, and can be inhaled

108
Q

what are the endemic areas where coccidioides immitis is found?

A

southwestern US and mexico

109
Q

___% of people with coccidioidomycosis are asymptomatic

A

60%

110
Q

occasionally, patients with coccidioidomycosis may have a hypersensitivity reaction which causes the development of ___ or ___

A
  • erythema multiforme-like cutaneous reaction or erythema nodosum
111
Q

describe erythema nodosum which can be a result of coccidioidomycosis

A
  • affects the legs and is characterized by multiple painful inflammatory nodules
  • this reaction occurring in conjunction with coccidiodomycosis is termed valley fever
112
Q
A

coccidioidomycosis

113
Q
A

cryptococcosis

114
Q

cryptococcosis is caused by ___

A

cryptococcus neoformans

115
Q

cryptococcus neoformans lives in ___

A

pigeon excrement

116
Q

cryptococcus neoformans grows in ___

A

yeast in both the soil and infected tissue

117
Q

what does cryptococcus neoformans have that protects it from host defenses?

A

prominent mucopolysaccharide capsule

118
Q

is the primary infection of cryptococcosis symptomatic or asymptomatic?

A

asymptomatic

119
Q

most patients diagnosed with cryptococcosis have ___

A
  • immune suppression
    • 10% of AIDS pts will acquire this infection
    • dissemination is common in immunocompromised patients
120
Q

where is the most frequent site of involvement for disseminated cryptococcosis?

A

meninges

121
Q

zygomycosis is also called ___

A

mucormycosis

122
Q

zygomycosis is found on ___

A

decaying organic material

123
Q

which form of zygomycosis is most important to oral health care providers?

A

rhinocerebral form

124
Q

what can enhance the growth of zygomycosis?

A

iron

125
Q

which patients are at risk for zygomycosis infection?

A
  • diabetic patients who are uncontrolled (ketoacidosis inhibits iron binding to transferrin, allowing serum iron levels to rise)
  • patients taking deferoxamine (iron-chelating agent)
  • immunocompromised patients
126
Q

what are the presenting symptoms of rhinocerebral zygomycosis?

A
  • nasal obstruction
  • bloody nasal discharge
  • facial pain and headache
  • facial swelling/cellulitis
  • visual disturbances/proptosis
127
Q

what can result from untreated zygomycosis, and how does it appear?

A

massive tissue destruction, which appears black and necrotic

128
Q

what is the treatment for zygomycosis?

A
  • radical surgical debridement
  • high doses of amphotericin B
129
Q

___% of patients with rhinocerebral zygomycosis succumb to their disease

A

60%

130
Q
A

zygomycosis aka mucormycosis

131
Q
A

aspergillosis

132
Q
A

aspergillosis

mass has undergone dystrophic calcification, forming an antrolith

133
Q

describe the noninvasive form of aspergillosis

A
  • affects a normal host
  • allergic reaction affecting the sinuses (allergic fungal sinusitis)
  • large mass of fungal hyphae is called an aspergilloma
134
Q

describe the invasive form of aspergillosis

A
  • localized can occur in a normal host
  • extensive involvement in immunocompromised patients
135
Q

where is aspergillosis found?

A

worldwide

136
Q

what are the two most common fungal infections worldwide?

A
  1. candidiasis (most common)
  2. aspergillosis (second in frequency to candidiasis)
137
Q

what are the two most common species that cause aspergillosis?

A

a. fumigatus (90% of infections) and a. flavus

138
Q

in aspergillosis, if the aspergilloma mass undergoes dystrophic calcification, what does it form, and how can it be visualized?

A
  • antrolith
  • can be visualized via xray
139
Q

what is the treatment for noninvasive aspergillosis in an immunocompetent patient?

A

surgical debridement

140
Q

what is the treatment for allergic fungal sinusitis?

A

surgical debridement and corticosteroids

141
Q

what is the treatment for locally invasive aspergillosis in an immunocompetent patient?

A

debridement and antifungals

Dr. Murrahs class (17 decks)

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