Fungal Infections

Question 1

What is the most common candida species?

Answer 1

C.albicans

Question 2

What form do c.albicans take?

Answer 2

Polymorphic

Yeast/ pseudohypae/ hypae

Question 3

What is pathogenic form of c/albicans?

Answer 3

Hyphal

Question 4

How do c.albicans cause pathology?

Answer 4

Yeast –> hyphae transformation
Secreted aspartyl proteases = tissue invasion
Candidalysin = tissue damage

Question 5

How does candidalysin cause tissue damage?

Answer 5

Pore forming toxin

Question 6

When will yeast transform to hyphae?

Answer 6

In pH < 7

Question 7

Mechanism of yeast to hyphae transformation?

Answer 7

Yeast bind oral keratinocytes
Under specific environmental condition yeast transform hyphae form
Hyphae form binds, allows penetration into epithelial cells
Candidalysin and SAPs = damage

Question 8

Predisposing factors of candida species?

Answer 8

Prosthesis
Low saliva rate 
Low pH induces high sugar diet 
Antibitoics 
Immunosuppression

Question 9

Why do antibiotics increase candida risk?

Answer 9

Reduced bacterial competition

Question 10

Why does immunosuppression increase candida risk?

Answer 10

Reduced cellular defence

Question 11

What does candidalysin do?

Answer 11

Pore forming toxin that kills cells and initiate immune response

Question 12

How are candida infections classified?

Answer 12

Acute
Chronic
Candida-associated
HIV-releated

Question 13

Example of acute candida infections?

Answer 13

Acute pseudomembranous candidiasis = thrush

Acute atrophic candidosis

Question 14

Examples of chronic candida infection?

Answer 14

Chronic atrophic candidosis (denture stomatitis)

Chronic hyperplasia candidosis

Question 15

Examples of candida-associated lesions?

Answer 15

Median rhomboid glossitis

Angular chelitis

Question 16

What is acute pseudomembranous candidosis

Answer 16

Thrush

Creamy thick plaques - easily be rubbed off leaving bleeding base

Question 17

How does acute atrophic candidosis present?

Answer 17

Red, painful lesions

Common dorsum of tongue e

Question 18

Who does acute atrophic candidosis present in?

Answer 18

Those on prolonger corticosteroids or antibiotics therapy

Bacterial flora altered - candida flourish

Question 19

Management of candida conditions?

Answer 19

1. confirm diagnosis with swab/ oral rinse
2. investigate and tx underlying cause
3. tx w/ anti fungal

Question 20

What are examples of topical and systemic antifungals?

Answer 20

Topical: nystatin, miconazole
Systemic: fluconazole

Question 21

Issue w/ antifungals

Answer 21

Warfarin interaction

Question 22

How does denture stomatitis present?

Answer 22

Clear boundary where denture has been - red/ atrophic looking lesions

Question 23

How tx denture stomatitis?

Answer 23

Improve denture hygiene - leave out at night/ clear denture

Provide anti fungal

Question 24

How does median rhomboid glossitis present>

Answer 24

Erythematous area on dorsum of tongue

Epithelial proliferation - candida in epihteliuum

Question 25

What feature can often be seen w/ median rhomboid glossitis?

Answer 25

Kissing lesion - lesion on palate

Question 26

Is median rhomboid glossitis malignant?

Answer 26

No and not premalignant

Question 27

How does angular chelitis present?

Answer 27

soreness and fissures at corner of the mouth

Question 28

What can be causes of angular chelitis?

Answer 28

Loss vertical demension Haematological deficiency Systemic disease - Chrons

Question 29

Treatment of angular chelitis?

Answer 29

Address udnerlying cause | Topical anti fungal

Question 30

How does chronic hyper plastic candidosis present?

Answer 30

White or red patch - can't be rubbed off | Often labial commissure or tongue

Question 31

Issue w/ chronic hyperplastic candidosis?

Answer 31

Premalignant - 25% malignant change

Question 32

Causes of CHC?

Answer 32

Usual candida RFs | Smoking

Question 33

Management of CHC?

Answer 33

Biopsy - assess degree dysplasia and risk malignant transformation Systemic antifungal Smoking cessation

Question 34

When excise CHC?

Answer 34

No improvement and high risk malignant transformation