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Oral Pathology > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

very common dimorphic yeast that has the ability to undergo transformation to hyphal form under appropriate conditions, producing germinative or “germ” tubes

A

candida albicans

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2
Q

yeast form of candida albicans

A

commensal

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3
Q

hyphal form of candida albicans

A

pathogen

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4
Q

whether candidiasis develops, and the severity of the disease itself, appears to depend on at least what three factors?

A
  • host immune status
  • oral mucosal environment
  • virulence of the candidal strain
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5
Q

what is the spectrum of the candida disease?

A
  • “carrier” state
  • superficial oral mucosal/cutaneous infection
  • localized invasive candidiasis
  • disseminated candidiasis

*last two are uncommon

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6
Q

what are the three presentations of oral candidiasis

A
  • pseudomembranous
  • erythematus
  • hyperplastic
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7
Q

type of candidiasis that is known as “thrush” that is whic, curled milk or cottage cheese-like plaques that CAN BE WIPED OFF

A

pseudomembranous candidiasis

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8
Q

what are the common sites of pseudomembranous candidiasis

A
  • buccal mucosa
  • palate
  • tongue
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9
Q

type of candidiasis that has an area of redness, variable borders

A

erythematus candadiasis

*tongue is a common site

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10
Q

diffuse atrophy of dorsal tongue papillae, particularly after broad spectrum antibiotics

A

acute atrophic candadiasis (antibiotic sore mouth)

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11
Q

typically associated with “burning” sensation

A

acute atrophic candadiasis

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12
Q

well-defined area of redness in mid-posterior dorsal tongue that is usually asymptomatic

A

central pappillary atrophy

median rhomboid glossitis in the past

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13
Q

what is central papillary atrophy most commonly due to?

A

chronic candadiasis

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14
Q

denture is often contaminated with candidal organisms but NO invasion of mucosa is seen. shows erythema of palatal denture-bearing area - typically asymptomatic

A

denture stomatitis
(chronic atrophc candidiasis)

*found many colonies on antaglio surface of denture but NONE on the mucosal surface

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15
Q

redness, cracking corners of the mouth that often waxes and wanes

A

angular chelitis

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16
Q

what causes angular chelitis

A

usually related to candadiasis but may have other cutaneous bacterial microflora admixed

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17
Q

how do you tx angular chelitis?

A

typically responds well to topical antifungal therapy

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18
Q

redness, cracking of thte cutaneous surface that is often associated with lip-licking or chronic use of petrolatum-based materials

A

perioral candidiasis

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19
Q

what causes perioral candadiasis?

A

lip-licking

-usually related to candidiasis, but may have other cutaneous bacterial microflora admixed

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20
Q

how do you treat perioral candidiasis

A

topical antifunal therapy

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21
Q

when the pt has angular chelitis central papillary atrophy and a “kissing lesion” of the posterior hard palate

A

chronic multifacial candidiasis

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22
Q

also known as “candidal leukoplakia” that has white patches that CANNOT be rubbed off. may be problematic because a true leukoplakia may have candidiasis

A

hyperplastic candidiasis

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23
Q

where is hyperplasitc candidiasis usually found?

A

generally anterior buccal mucosa

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24
Q

what is the tx for hyperplatic candidiasis?

A

antifungal therapy

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25
Q

RARE candidal infection associated with specific immunologic defects related to how the body interacts with candida albicans

A

chronic mucocutaneous candidiasis

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26
Q

RARE candidal infection seen in situations of severe uncontrolled diabetes mellitus or immune supression

A

invasive candidiasis

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27
Q

what are some histological features of candidiasis?

A
  • microabscesses may be seen in the superficial epithelium
  • chronic inflammation of the connective tissue
  • acanthosis is often present
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28
Q

in almost all cases, candidal hyphae never penetrate deeper than what layer?

A

keratin layer

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29
Q

the prognosis for treating oral candidiasis in normal pts is what?

A

good

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30
Q

the prognosis for treating oral candidiasis in immune suppressed pts is what?

A

fair to poor

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31
Q

what does candidiasis tx depend on?

A

severity of the infection

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32
Q

what can superficial oral mucosal infections usually be treated with?

A

one of the milder topical systemic antifungal angents

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33
Q

life threatening infections usually require what for treatment?

A

intravenous amphotericin B

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34
Q

imidazole antifungal agent with no significant absorption or side effects

A

clotrimazole (mycelex)

*pleasant tasting lozenges

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35
Q

what is the disadvantage to clotrimazole?

A

dosing schedule (should be dissolved in mouth 5 times per day)

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36
Q

antifungal developed during the 1950s that is NOT absorbed systemically and must be IN CONTACT with the organism in order to be effective

A

nystatin (mycostatin)

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37
Q

what is the disadvantage to nystatin

A

taste, bitter to many

-multiple dosing schedule, pt compliance

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38
Q

triazole antifungal angent that is readily absorbed SYSTEMICALLY and no significant degree of side effects

A

fluconazole (diflucan)

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39
Q

what are the disadvantages to fluconazole?

A

-relatively expensive

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40
Q

when do you use topical antifungal agents?

A

in treatment of angular cheilitis or perioral candadiasis

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41
Q

combination of nystatin and triamcinolone

A

mycolog II cream

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42
Q

combination of iodoquinol and hydrocodone

A

vytone cream

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43
Q

deep fungal infection that is endemic to ohio and mississippi river valleys

A

histoplasmosis

44
Q

how many new cases of histoplasmosis are there annually?

A

500K

45
Q

how is histoplasmosis spread?

A

spores in bat or bird droppings in the soil

46
Q

most cases of histoplasmosis are what?

A

asymptomatic

47
Q

what might acute histoplasmosis have?

A

flu-like symptoms

48
Q

what might chronic histoplasmosis have?

A

cavitary pulmonary lesions

49
Q

what populations are most likely affected by disseminated histoplasmosis?

A
  • elderly
  • debilitated
  • immunocompromised
50
Q

in what form of histoplasmosis are oral lesions uaually seen?

A

disseminated

*affects tongue, palate, and buccal mucosa

51
Q

what do oral lesions of histoplasmosis look like?

A

chronic variably painful ulcer or granular erythematous plaque

52
Q

clinically, oral lesions of histoplasmosis may be identical to what?

A

malignancy

53
Q

histoplasmosis is what?

A

granulomatous inflammation with or without necrosis

54
Q

how big are the yeast cells for histoplasmosis?

A

1-2 micron yeast, usually within macrophages

55
Q

histoplasmosis is best visualized by what?

A

silver stain (GMS) or PAS)

56
Q

what are the three ways to dx histoplasmosis?

A
  • ID of characteristic yeasts in tissue sections
  • culture of the H. capsulatum organism from a suspected lesion
  • serologic testing for antibodies or yeast related antigens
57
Q

what is the tx for acute histoplasmosis?

A

no tx necessary

58
Q

what is the tx for chronic or disseminated histoplasmosis?

A

amphotericin B

*ketoconazole or itraconazole for mild cases or as maintenance therapy

59
Q

what is the prognosis of tx ACUTE histoplasmosis in an immunocompromised pt?

A

good

60
Q

what is the prognosis of tx CHRONIC histoplasmosis?

A

fair

61
Q

what is the prognosis of tx DISSEMINATED histoplasmosis?

A

poor

*mortality rate of 90% if untreated, 7-23% if treated

62
Q

deep fungal infection endemic to desert southwest US known as the hypersensitivity rx

A

coccidioidomycosis

63
Q

how many ppl are infected with coccidioidomycosis annually?

A

100K

64
Q

how is coccidioidomycosis transferred?

A

inhalation of spores

65
Q

what is the illness like in 40% of coccidioidomycosis infected pts?

A

flu-like symtoms

66
Q

dissemination of coccidioidomycosis occurs in how many pts?

A

less than 1%

67
Q

where does infection of coccidioidomycosis usually occur on the human body?

A

skin of the central face may be affected, oral lesions are rarely described

68
Q

how is the dx of coccidioidomycosis made?

A

culture or biopsy

69
Q

what is the host response to coccidioidomycosis

A

ranges form acute to granulomatous infection

70
Q

what is the tx for disseminated coccidioidomycosis?

A

amphotericin B

71
Q

what is the tx for mild cases of coccidioidomycosis

A

fluconazole or itraconazole

72
Q

coccidioidomycosis may be more aggressive in what population?

A

ppl of color

73
Q

generally, coccidioidomycosis has a good prognosis if the pt….

A

is not immunocompromised

74
Q

this deep fungal infection has organisms that liv in pigeon droppings and is treansmitted by air-borne sopores

A

cryptococcosis

75
Q

cryptococcosis affects what population almost exclusively?

A

immunosuppressed

76
Q

what are the clinical presentations of cryptococcosis?

A
  • flu-like symptoms with initial pulmonary infection

- disseminates to meniges, resulting in headache, vomiting, neck stiffness

77
Q

4-6 micon yeasts with a clear halo (representing a mucopolysaccharide capsule)

A

cryptococcosis

78
Q

dx of cryptococcosis is based on what?

A

culture or ID of organsims in tissue secretions

79
Q

what are severe cases of cryptococcosis tx with?

A
  • amphotericin B

- flucytosine

80
Q

what are less severe cases of cryptococcosis tx with?

A

fluconazole

81
Q

cryptococcosis what is the usual px for cryptococcosis

A

usually poor bc pts are immunocompromised

82
Q

also known as mucormycosis, it is several genera of molds, including Mucor, Rhizopus, and Absidia

A

zygomycosis

83
Q

what population does zygomycosis affect?

A

severe diabetic or immunocompromised pts

84
Q

what is zygomycosis in oral region

A

rhinocerebral

85
Q

what is the clinical presentation of zygomycosis ?

A
  • nasal obstruction, bloody nasal discharge
  • facial pain, swelling, palatal perforation
  • black necrotic lesions
  • with progression superiorily, visual disturbances and blindness result
  • seizures and death occur with intracranial invasion
86
Q

what is the dx of zygomycosis based on?

A
  • histopathologic findings bc culture is too low
  • large branching nonseptate hyphae with extensive tissue necrosis
  • hyphae often seen plugging small blood vessels
87
Q

what type of px does zygomycosis have?

A

poor

88
Q

very common deep fungal infection that is second in frequency to candidiasis

A

aspergillosis

89
Q

spectrum of disease that includes allergy, localized infection, or invasive

A

aspergillosis

90
Q

the clinical features of aspergillosis vary depending on what?

A

immune status and extent of tissue invasion

91
Q

maxillary sinus fungus ball

A

aspergilloma

92
Q

does aspergillosis cause tissue damage?

A

yes, it is locally invasive

93
Q

what is the extent of aspergillosis in immunocompromised pts?

A

disseminated

94
Q

a biopsy of aspergillosis shows what?

A

branching septate hyphae

  • occlusion of small blood vessels by hyphae
  • granulomatous inflammation if the host is NOT immune compromised
95
Q

if a pt is immunocompromised with aspergillosis, is there inflammation?

A

only a little (granulomatous if the host is NOT immune compromised)

96
Q

what is the tx of aspergillosis?

A 
non-invasive = debridement
invasive = voriconazole or itraconazole (with or without debridement)
97
Q

what is the px of aspergillosis pt with normal immune status?

A

good

98
Q

what is the px of aspergillosis pt with immunocompromised status?

A

poor

99
Q

was approved for topical use in the US, but tastes bitter and is no longer available

A

amphotericin B

100
Q

IV forms of this are used to tx life threatening diseases?

A

amphotericin B

101
Q

first oral antifungal agent that could be absorbed systemically

A

ketoconazole

102
Q

requires acidic stomach environment to work

A

ketoconizole

103
Q

drug that has a convenient single daily dose and has problems with drug interactions and idiosycratic hepatotoxicity (1 in 12,000)

A

ketoconizole

104
Q

drug that is approved for tx histoplasmosis

  • well absorbed, daily dosing
  • minimal side effects
  • quite expensive
A

itraconazole (sporanox)

105
Q

triazole compound; IV or oral

  • approved for tx candida, aspergillus and several others
  • side effects include PHOTOSENSITIVITY
  • 1rst line therapy for INVASIVE ASPERGILLOSIS
  • quite expensive
A

voriconazole

Oral Pathology (9 decks)

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