chpt 6 Fungal infections Flashcards
Infection from a yeastlike fungal organism
Candidiasis (older pts call it moniliasis)
what is dimorphism and why important to Candidiasis
can exist as yeast (innocuous) or hypae (infectious)
Most Common oral fungal infection in humans
candidiasis
Best recognized form of oral candidiasis
pseudomembranous candidiasis (Thrush)
2 common ways to get the opportunistic fungal infection Candidiasis
antibiotic treatment Steroid inhalers
Clinical appearance of Pseudomembranous Candidiasis
cottage cheese like white plaques that scrape off commonly occurring on cheeks, palate, dorsal tongue
2 ways to get pseudomembranous oral candidiasis
broad spectrum antibiotics Immune suppression
Symptoms of pseudomembranous oral candidiasis
burning sensation
Alternating unpleasant salty/bitter taste
What candidiasis form is more common than pseudomemberanous oral candidiasis
Erythmatous candidiasis
When does Erythmatous Candidiasis present and with what symptoms
after broad spectrum antibiotic Antibiotic sore mouth
Scalded mouth
What is the clinical appearance of Erythmatous Candidiasis
diffuse loss filiform papillae dorsal tongue w/ red/bald tongue appearance
What is a risk factor for Erythmatous Candidiasis
Xerostomia (pharmacologic, Sjogren’s)
What is median rhomboid glossitis
Central papillary atrophy of tongue, a form of erythmatous candidiasis. Midline, posterior dorsal tongue
External appearance of chronic multifocal candidiasis
angles of the mouth (Angular Cheilitis)
How tell difference between Leukoplakia and Chronic Hyperplastic Candidiasis (both are white lesions that will not rub off)
histology of chronic hyperplastic candidiasis will have fungal hyphae
2 ways to prevent Candidiasis
take probiotics or increase active yogurt culture intake while taking antibiotics
Siversky’s preferred antifungal treatment for Candidiasis infection
Clotrimazole 10mg
Causes of Angular Cheilitis
1) Loss Vertical Dimension
2) Vitamin B Deficiency
3) Immunosuppressed w/ Candidiasis
Exfoliative lesions of the vermillion zone and perioral skin due to superficial candidal infection
Cheilocandidiasis(Angular cheilitis)
Angular cheilitis can be a mixture of what
20% candidiasis alone
60% Candidiasis + S. Aureus
20% S. Aureus alone
Siversky’s Angular cheilitis Treatment
Mycolog II (Nystatin antifungal 100,000 units/gram and Triamcinolone low dose steroid .1%)
Why pair a low dose steroid (Triamcinolone) with anti-fungal (Nystatin)
steroid decreases inflammation caused by antifungal
What is Siversky’s treatment for Central Papillary Atrophy/Median Rhomboid Glossitis
tongue scraper
Form of Erythmatous candidiasis that is due to 24 hour denture wear, and is confined to the denture bearing areas of the mouth
Denture stomatitis
Treatment for Denture Stomatitis (form of Erythmatous Candidiasis)
treat candidiasis Remake denture
OHI (remove/soak/brush denture, brush palate)
What must be present in histology for a Candidiasis diagnosis
Hyphae or pseudohyphae (elongated yeast cells)
What can Candidiasis be superimposed on
1) Lichen planus
2) Leukoplakia
3) Squamous Cell carcinoma
Systemic antifungal Siversky would use to treat Candidiasis
Fluconazole
Most common systemic fungal infection in US, especially HIV
Histoplasmosis (generally a pulmonary disease)
Histoplasmosis found commonly in what areas
humid areas w/ soil enriched by bird or bat excrement
Of the three forms of Histoplasmosis (Acute, Chronic, Disseminated), which manifests oral lesions
Disseminated
Most commonly affected sites by Disseminated Histoplasmosis
tongue, palate, buccal mucosa
What is the clinic presentation of Histoplasmosis
solitary, variably painful ulcer of several week’s duration possibly with rolled margins making it look malignant
Histoplasmosis histology that is like Tuberculosis and Sarcodosis
Granulomas
Treatment for Acute Histoplasmosis
None. Self-limiting
Treatment for Chronic Histoplasmosis
IV Amphotericin B if does not resolve (significant kidney damage from Amphotericin B)
What can be used to treat Chronic Histoplasmosis if patient is nonimmunosuppressed
3 months Itraconazole
Opportunistic fungal infection normally from decaying material
Zygomycosis
Who is Zygomycosis found commonly in
uncontrolled diabetics w/ ketoacidosis
Why is ketoacidosis helpful to Zygomycosis infection
ketoacidosis inhibits iron binding which increases serum iron. Iron enhances zygomycosis fungal growth
Rhinocerberal Zygomycosis has what clinical symptoms
- Nasal obstruction
- Bloody noses
- Facial pain/swelling/cellulosis
- Facial paralysis
- Blindness (advanced stages)
- Seizures (advanced stages)
Histology of Zygomycosis
90 deg branching thick hyphae w/ extensive necrosis
Treatment for Zygomycosis
surgical debridement
High dose amphotericin B
Fungal infection with both invasive and non-invasive forms from soil, water, or decay
Aspergillosis
Only what form of Aspergillosis grows at 37 C.
Pathogenic
Clinical presentation of Aspergillosis
Show as allergic fungal sinusitis
What is the mass of fungal hypae called when the infect the maxillary sinus
Aspergilloma
What is the differential for a mass found in the maxillary sinus (Antrolith)
Sinusitis
Aspergillosis
Can there be necrosis with Aspergillosis
Yes, the hyphae can occlude blood vessels
Aspergillosis immunocompetent treatment
Local debridement, corticosteroid, antifungal
