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Oral Medicine > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

General predisposing factors to opportunistic infection?

A

1) Broad-spectrum Antibiotics

2) Corticosteroids (Immunomodulators)

3) Cytotoxics

4) Poorly Controlled Diabetes Mellitus

5) Xerostomia

6) Nutritional Deficiencies

7) Immunosuppression (e.g. extremes of age or HIV)

8) Haematological

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2
Q

Local predisposing factors to opportunistic infection?

A

1) Trauma (e.g. ill-fitting prostheses)

2) Tobacco Smoking

3) Reduced Salivary Flow

4) Carbohydrate-rich Diet
-> Increased Candida adherence to epithelial cells

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3
Q

2 acute forms of fungal infection?

A

Pseudomembranous candidosis
Erythematous candidosis

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4
Q

3 chronic forms of candidosis?

A

Hyperplastic
Erythematous (denture stomatitis)

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5
Q

Chronic secondary forms of fungal infection?

A

Median rhomboid glossitis
Angular cheilitis
Chronic mucocutaneous candidosis

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6
Q

Clinical presentation of thrush?

A

Detachable confluent-white or yellow patches (milk curds) on oral mucosa (often palate)

Wiped away to leave erythematous, bleeding base

Often asymptomatic

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7
Q

Histology of white plaques?

A

Desquamated epithelial cells
Necrotic material
Fibrin
Fungal hyphae

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8
Q

Risk factors of thrush?

A

Immunocompromised pt (extremes of age, poorly controlled diabetes, malignancy, HIV, leukaemia or immunosuppressant drug users)

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9
Q

Thrush is often associated with…

A

Angular cheilitis
Oesophageal candidosis (particularly in HIV pts) -> odynophagia, dysphagia & chest pain

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10
Q

Management of thrush?

A

Improve OH

Identify & treat systemic predisposing factor (e.g. immunosuppression, deficiencies, diabetes etc)

Live active yoghurt (encourages return to normal microflora)

Topical agents:
- CHX m/w (antibacterial & antifungal)
- Nystatin suspension
- Miconazole oral gel (avoid with warfarin)

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11
Q

Clinical presentation of acute erythematous candidosis?

A

Painful erythematous patches

Commonly on dorsum of tongue & palate

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12
Q

What is acute erythematous candidosis associated with?

A

LT broad-spectrum antibiotic use (antibiotic sore mouth)

LT corticosteroid use

HIV

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13
Q

Clinical presentation of chronic hyperplastic candidosis?

A

White-erythematous raised lesions which do not rub off

Usually asymptomatic & found bilaterally on buccal mucosa (towards commissures)

Nodular/speckled = more prone to malignant change OR homogenous plaque-like

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14
Q

What is CHC associated with?

A

Middle-aged male smokers

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15
Q

What is the risk associated with CHC?

A

Malignant transformation to OSCC

If left untreated, 5-10% show dysplasia & may transform to OSCC

Angular cheilitis

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16
Q

How to manage CHC?

A

Biopsy (as it is a premalignant lesion)

FBC (vitamin, iron, folate, glucose levels) & thyroid tests

Remove predisposing factors (e.g. smoking)

Topical antifungals not effective => 2-4+ weeks oral (systemic) fluconazole

17
Q

What is denture stomatitis (chronic erythematous candidosis)?

A

Chronic erythema of mucosa below fit surface of acrylic upper denture or ortho appliance

18
Q

Aetiology of denture stomatitis?

A

Denture or appliance fit => saliva excluded from supporting mucosa & commensal candida overgrowth occurs

19
Q

Clinical presentation of denture stomatitis?

A

Marked erythema of palatal mucosa with margins corresponding to appliance

‘Relief areas’ of denture may have underlying spongy granular change

Usually asymptomatic or angular cheiiltis present

20
Q

What is denture stomatitis associated with?

A

Poor OH
Poor denture design (non-hygienic design OR poorly fitting denture => trauma)

21
Q

Newton’s classification of denture stomatitis

A

Type
1 = Pin-point hyperaemia
2 = Diffuse erythema limited to fit surface of denture
3 = Nodular appearance of palatal mucosa

22
Q

Management of denture stomatitis?

A

Improve denture cleaning:
- Regular cleaning instruction +/- antiseptic soak (e.g. CHX)
- Eliminate tissue trauma (tissue conditioners)
- Improved design (more hygienic or less traumatic)

Antifungal - miconazole gel (applied to denture fit surface) except warfarin & statin pt

Review - if lack of resolution consider systemic issue or lack of compliance

23
Q

Clinical presentation of median rhomboid glossitis?

A

Asymptomatic diamond-shaped smooth erythematous area at junction between anterior 2/3rd & posterior 1/3rd of tongue (anterior to circumvallate papillae)

Localised candida infection leading to filiform papillae atrophy

‘Kissing lesion’ = similar patch on palate

24
Q

What is associated with median rhomboid glossitis?

A

Smoking & corticosteroid use (asthmatics)

25
Q

Aetiology of angular cheilitis?

A

Multi-factorial infection with C. albicans, S. aureus & B-haemolytic streptococci

26
Q

Clinical presentation of angular cheilitis?

A

Symmetrical erythematous fissuring at commissures +/- yellow crusting

27
Q

What is the main demographic associated with angular cheilitis?

A

Elderly edentulous pts with denture stomatitis

Decreased vertical dimension => maceration of underlying skin by saliva

28
Q

Risk factors of angular cheilitis?

A

Lip morphology

Malnutrition
- Reduced haematinic levels (iron, B12, folate)
- Malabsorption disorders (e.g. Crohns, OFG)

Immunosuppression (e.g. HIV)

Diabetes

Broad-spectrum antibiotics

Xerostomia (e.g. age, medication related or Sjogren’s)

29
Q

Management of angular cheilitis?

A

Correct predisposing factor (e.g. increase denture OVD)

Treat candida infection
- I/O = topical antifungal
- E/O = miconzaole gel applied to corners of mouth

30
Q

How to treat chronic angular cheilitis?

A

Trimovate cream application
(Triad: antifungal, antibacterial & steroidal)

31
Q

Why take a microbial sample?

A

Identify candida species & their antifungal resistance

Identify candida quantity

32
Q

Sampling methods & advantages & disadvantages?

A

Whole saliva culture
+ Gives fungal load
- Not suitable in xerostomia

Concentrated oral rinse
+ Gives fungal load

Swab
+ Site specific
- Not quantitative

Smear
+ No lengthy culture required
- Candida species not identified

Sponge imprint culture
+ Gives fungal load
+ Site specific

Biopsy
+ Indicated for CHC
- MOS procedure

33
Q

How to polyenes work & give example?

A

Fungicidal - generate pores in cell membrane => leakage

Not absorbed by gut

e.g. Nystatin

34
Q

How do azoles work & give example?

A

Fungostatic - interfere with ergosterol fungal cell membrane synthesis

e.g. Miconazole, fluconazole

35
Q

When do you give topical antifungal agents?

A

Superficial infections

e.g. Denture wear, antibiotic drug use or diabetics

36
Q

How is miconazole gel applied & what risks?

A

To affected area or fit surface of denture (can be left in)

GIT absorption => serious interactions with warfarin & statins

37
Q

When do you use systemic antifungals?

A

Immunosuppressed
Candidal leukoplakia

Oral Medicine (9 decks)

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