Chapter 6: Fungal & Protozoal Diseases Flashcards
1
Q
candidiasis is caused by what fungus?
A
candida albicans
2
Q
candidiasis exists in ___ forms; what are they?
A
- two forms (dimorphic)
- yeast form - innocuous
- hyphal form - invasion of host tissue
3
Q
___ is by far the most common oral fungal infection in humans
A
candidiasis
4
Q
up to ___% of people carry candida albicans in their mouth in health. what happens with age?
A
- 50%
- rate increases with age
5
Q
candidiasis is mostly a ___ infection
A
opportunistic
however, healthy patients may develop infection
6
Q
what are the 4 clinical patterns of candidiasis?
A
- pseudomembranus
- erythematous
- chronic hyperplastic
- mucocutaneous
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)
8
Q
what is the best recognized form of candidiasis?
A
pseudomembranous
aka thrush
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
10
Q
with pseudomembranous candidiasis, what should you be thinking if the underlying mucosa bleeds?
A
there is likely another process occurring (lichen planus)
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
12
Q
what are the symptoms of pseudomembranous candidiasis?
A
- mild burning
- mild unpleasant taste
- *these may not always be present
13
Q
what is the distribution of pseudomembranous candidiasis?
A
buccal mucosa, palate, and dorsal tongue
14
Q
is there a white component in erythematous candidiasis?
A
no
erythematous candidiasis is commonly overlooked clinically
15
Q
erythematous candidiasis is more common than what other type of candidiasis?
A
pseudomembranous
16
Q
median rhomboid glossitis is also called ___
A
central papillary atrophy
17
Q
does median rhomboid glossitis occur in adults or children?
A
it is a disease of adults
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
19
Q
the erythema present in median rhomboid glossitis is due to ___
A
loss of filiform papilla
20
Q
chronic multifocal candidiasis is median rhomboid glossitis plus what?
A
signs of infection at other sites
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)
22
Q
angular cheilitis can be a component of ___, but usually occurs alone
A
chronic multifocal candidiasis
23
Q
angular cheilitis is common in what people?
A
older patients with reduced vertical dimension
24
Q
where is angular cheilitis found?
A
accentuated folds at the corners of the mouth where saliva can pool
25
describe the etiology of angular cheilitis
* 20% candidia albicans alone
* 20% staphylococcus areus alone
* 60% combination of both
26
angular cheilitis infection may more extensively involve the perioral skins, usually due to \_\_\_. what is the term for the clinical pattern?
* chronic lip picking
* clinical patterns is termed cheilocandidiasis
27
denture stomatitis is also termed \_\_\_
chronic atrophic candidasis
28
denture stomatitis is localized to \_\_\_
denture-bearing areas of a maxillary removable denture
29
is denture stomatitis symptomatic?
no, although it does have a striking clinical appearance
30
describe how denture stomatitis can develop
* patient wears denture continuously
* denture harbors most of the organism
31
what is the treatment for denture stomatitis?
need to treat both the soft tissues and the denture to prevent recurrence)
32
acute atrophic candidiasis is also called ___ and follows a course of \_\_\_
* antibiotic sore mouth
* broad-spectrum antibiotics
33
with acute atrophic candidiasis, what does the mouth feel like?
feels like hot liquid scalded it
34
what is the clinical presentation of acute atrophic candidiasis?
* diffuse loss of filiform papillae of dorsal tongue (appears bald)
* similar appearance symptomology is noted in xerostomia patients
35
chronic hyperplastic candidiasis is also called \_\_\_
candidal leukoplakia
36
\_\_\_ candidiasis clinically presents as a white patch that cannot be removed
chronic hyperplastic candidiasis
37
\_\_\_ is the least common form of candidiasis
chronic hyperplastic candidiasis
38
why is chronic hyperplastic candidiasis (aka candidal leukoplakia) controversial?
it's a question of which comes first - leukoplakia or candidiasis?
39
where does chronic hyperplastic candidiasis commonly occur?
anterior buccal mucosa
40
pseudomembranous candidiasis
41
pseudomembranous candidiasis
42
erythematous candidiasis
43
median rhomboid glossitis
| (erythematous candidiasis)
44
chronic multifocal candidiasis
| (erythematous candidiasis)
45
angular cheilitis
| (erythematous candidiasis)
46
denture stomatitis
| (erythematous candidiasis)
47
denture stomatitis
48
chronic hyperplastic candidiasis
49
chronic hyperplastic candidiasis
50
acute atrophic candidiasis
51
autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED)
(form of mucocutaneous candidiasis)
52
mucocutaneous candidiasis is a rare group of \_\_\_
immunologic disorders
53
young patients with mucocutaneous candidiasis can develop what 3 things?
* endocrine-candidiasis syndrome
* autoimmune polyendocrineopathy-candidiasis-ectodermal dystrophy (APECED)
* 10% have malignancies such as oral or esophageal carcinoma
* iron-deficiency anemia
54
in mucocutaneous candidiasis cases, what do the oral lesions look like?
* white plaques that do not rub off
* similar to chronic hyperplastic candidiasis
55
What is the treatment for candidiasis?
antifungal agents
* nystatin
* amphotericin B
* imidazole agents - clotrimazole
56
describe the treatment of candidiasis using nystatin
* 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
57
describe the treatment of candidiasis using amphotericin B
* IV treatment for life-threatening systemic fungal infections
58
discribe the treatment of candidiasis using clotrimazole
* 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
candidiasis should resolve easily following \_\_\_
antifungal therapy
60
if candidiasis infection recurs after treatment, what should you do?
investigate possible predisposing factors
61
\_\_\_ is the most common systemic fungal infection in the US
histoplasmosis
62
what is histoplasmosis caused by?
histoplasma capsulatum
63
describe how histoplasma capsulatum is dimorphic
it is a yeast at body temperature in a human host, and a mold in the natural environment
64
where is histoplasma capsulatum found? where is it endemic? up to what percent of people living in these areas are infected?
* humid areas with soil enriched by bird or bat excrement
* it is endemic in the ohio and mississippi river valley
* 90% are infected
65
how is histoplasmosis spread?
airborne spores are inhaled, passed into the terminal passages of the lungs, where they germinate
66
\_\_\_% 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?
* 99%
* mild symptoms are flu-like and can last for 1-2 weeks
67
most patients who become exposed to histoplasmosis are ___ and inhale and ___ number of spores
* healthy
* small
68
in general, describe the patients who become infected with histoplasmosis
* older
* debilitated
* immunocompromised
* up to 10% of AIDS patients develop disseminated disease in endemic areas
69
most histoplasmosis oral leasions occur with the ___ form
disseminated
70
describe the clinical presentation of histoplasmosis oral lesions
* 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
the histopathology of histoplasmosis shows \_\_\_
granulomatous inflammation
72
what is the treatment for acute histoplasmosis?
* none or palliative care
73
what is the treatment for chronic histoplasmosis?
* 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
what is the treatment for disseminated histoplasmosis?
* 90% will succomb to disease if untreated
* amphotericin B is treatment of choice
75
candidiasis
76
histoplasmosis
77
blastomucosis
78
blastomycosis
79
blastomycosis
80
blastomycosis
81
blastomycosis
82
\_\_\_ is 10x less common than histoplasmosis
blastomycosis
83
what causes blastomycosis?
blastomyces dermatidis
84
describe how blastomyces dermatitidis is dimorphic
* grows as yeasts at body temperature
* grows as mold in rich, moist soil
85
where is blastomyces dermatitidis found?
in eastern areas of the US and into canada
86
what is the male:female ratio of the prevalence of blastomycosis, and what is it likely due to?
* 9:1 male:female
* likely due to a greater degree of outdoor activity in med where the organisms grow
87
is the occurance of blastomycosis in immunocompromised patients common or rare?
rare
88
how is blastomycosis acquired?
inhalation of spores after a rain; spores grow in alveoli of lungs
89
acute blastomycosis symptoms resemble \_\_\_
pneumonia
90
chronic blastomycosis symptoms resemble \_\_\_
tuberculosis
91
blastomycosis oral lesions result from ___ or \_\_\_
extrapulmonary dissemination or local inoculation
92
describe the clinical presentation of blastomycosis oral lesions
* 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
blastomycosis infection can induce a benign reaction of the epithlium termed \_\_\_. what does it look like to the untrained eye?
* pseudoepitheliomatous (pseudocarcinomatous) hyperplasia
* looks like cancer
94
paracoccidioidomycosis (south american blastomycosis)
95
what causes paracoccidioidomycosis?
paracoccidioides brasiliensis
96
what is a host of paracoccidioides brasiliensis?
nine-banded armadillo
97
what is the male:female ratio of paracoccidioiomycosis?
15:1 male:female
98
most patients infected with paracoccidioidomycosis are employed in \_\_\_
agriculture
99
what is the treatment of paracoccidioidomycosis?
it is generally self-limiting
100
what is the histology of paracoccidioidomycosis?
granulomatous inflammation (characterized by collections of macrophages and multinucleated giant cells)
101
describe the histologic appearance of paracoccidioides brasiliensis
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
\_\_\_ 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)
paracoccidioides brasiliensis
103
coccidioidomycosis is also called \_\_\_
san joaquin valley fever
104
what causes coccidioidomycosis?
coccidioides immitis
105
coccidioides immitis is a ___ organism
* saprophytic (lives on dead/decaying organic matter)
* it is also dimorphic
106
describe how coccidioides immitis is dimorphic
* mold in natural environment
* yeast in infected host tissues
107
how is coccidioidomycosis spread?
athrospores are produced by the mold, become airborne, and can be inhaled
108
what are the endemic areas where coccidioides immitis is found?
southwestern US and mexico
109
\_\_\_% of people with coccidioidomycosis are asymptomatic
60%
110
occasionally, patients with coccidioidomycosis may have a hypersensitivity reaction which causes the development of ___ or \_\_\_
* erythema multiforme-like cutaneous reaction or erythema nodosum
111
describe erythema nodosum which can be a result of coccidioidomycosis
* affects the legs and is characterized by multiple painful inflammatory nodules
* this reaction occurring in conjunction with coccidiodomycosis is termed valley fever
112
coccidioidomycosis
113
cryptococcosis
114
cryptococcosis is caused by \_\_\_
cryptococcus neoformans
115
cryptococcus neoformans lives in \_\_\_
pigeon excrement
116
cryptococcus neoformans grows in \_\_\_
yeast in both the soil and infected tissue
117
what does cryptococcus neoformans have that protects it from host defenses?
prominent mucopolysaccharide capsule
118
is the primary infection of cryptococcosis symptomatic or asymptomatic?
asymptomatic
119
most patients diagnosed with cryptococcosis have \_\_\_
* immune suppression
* 10% of AIDS pts will acquire this infection
* dissemination is common in immunocompromised patients
120
where is the most frequent site of involvement for disseminated cryptococcosis?
meninges
121
zygomycosis is also called \_\_\_
mucormycosis
122
zygomycosis is found on \_\_\_
decaying organic material
123
which form of zygomycosis is most important to oral health care providers?
rhinocerebral form
124
what can enhance the growth of zygomycosis?
iron
125
which patients are at risk for zygomycosis infection?
* 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
what are the presenting symptoms of rhinocerebral zygomycosis?
* nasal obstruction
* bloody nasal discharge
* facial pain and headache
* facial swelling/cellulitis
* visual disturbances/proptosis
127
what can result from untreated zygomycosis, and how does it appear?
massive tissue destruction, which appears black and necrotic
128
what is the treatment for zygomycosis?
* radical surgical debridement
* high doses of amphotericin B
129
\_\_\_% of patients with rhinocerebral zygomycosis succumb to their disease
60%
130
zygomycosis aka mucormycosis
131
aspergillosis
132
aspergillosis
mass has undergone dystrophic calcification, forming an antrolith
133
describe the noninvasive form of aspergillosis
* affects a normal host
* allergic reaction affecting the sinuses (allergic fungal sinusitis)
* large mass of fungal hyphae is called an aspergilloma
134
describe the invasive form of aspergillosis
* localized can occur in a normal host
* extensive involvement in immunocompromised patients
135
where is aspergillosis found?
worldwide
136
what are the two most common fungal infections worldwide?
1. candidiasis (most common)
2. aspergillosis (second in frequency to candidiasis)
137
what are the two most common species that cause aspergillosis?
a. fumigatus (90% of infections) and a. flavus
138
in aspergillosis, if the aspergilloma mass undergoes dystrophic calcification, what does it form, and how can it be visualized?
* antrolith
* can be visualized via xray
139
what is the treatment for noninvasive aspergillosis in an immunocompetent patient?
surgical debridement
140
what is the treatment for allergic fungal sinusitis?
surgical debridement and corticosteroids
141
what is the treatment for locally invasive aspergillosis in an immunocompetent patient?
debridement and antifungals
