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SU2018 Oral Path Midterm 1 > Fungal infections > Flashcards

Fungal infections Flashcards

1
Q

… is a very common dimorphic yeast, its yeast form is … and its hyphal form is …

A

candida albicans

comensural

pathogen

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2
Q

when candidiasis develops and the severity of the disease itself appears to depend on these 3 factors

A

host immune status

oral mucosal environment

virulence of the strain

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3
Q

3 ways oral candidiasis can present

A

pseudomembranous

erythematous

hyperplastic

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4
Q

… candidiasis is the most well recognized and is also known as “thrush”. It is white, curdled milk or cottage cheese- like plaques that can be wiped off .

A

pseudomembranous

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5
Q

common sites for pseudomembranous candidiasis

A

buccal mucosa, palate or tongue

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6
Q

pseudomembranous may be asymptomatic but … or … is usually noted

A

burning

unpleasant taste

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7
Q

most common type of canidiasis?

A

erythematous

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8
Q

… is diffuse atrophy of dorsal tongue papillae (“bald tongue”), particularly after broad-spectrum antibiotics. Acute onset and typically associated with “burning” sensation.

A

acute atrophic candidiasis aka “antibiotic sore mouth”

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9
Q

what is the most common type of erythematous candidiasis?

A

central papillary atrophy

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10
Q

… presents as a well defined area of redness in the mid-posterior tongue, usually asymptomatic and most are due to chronic candidiasis. Probably referred to as “median rhomboid glossitis” in the past

A

central papillary atrophy

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11
Q

… is when there is erythema of the palatal denture bearing area, typically asymptomatic. Often referred to as “chronic atrophic candidiasis” but not much evidence to support this concept because usually only the denture is contaminated and there is no invasion of the mucosa (not a true infection)

A

denture stomatitis

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12
Q

… presents as redness and cracking of corners of the mouth usually related to candidiasis but may have other cutaneous bacterial microflora admixed. often waxes and wanes and typically responds well to topical antifungal therapy

A

angular chelitis

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13
Q

… is often associated with lip-licking or chronic use of petroleum-based materials. usually related to candidiasis but may have other bacterial microflora admixed. responds well to topical antifungal

A

perioral candidiasis

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14
Q

…. is when a patient presents with at least 2 of the following: angular cheilitis, central papillary atrophy, “kissing lesion” of the posterior hard palate

A

chronic multifocal candidiasis

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15
Q

…. is also known as candidal leukoplakia” and presents with a white patch that CANNOT be rubbed off. It is uncommon and usually found on the anterior buccal mucosa. It may be problematic because a true leukoplakia may have candidiasis superimposed on it (should resolve with antifungal if it doesnt)

A

hyperplastic candidiasis

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16
Q

…. is a 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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17
Q

… is a rare candidal infection seen in situations of severe uncontrolled DM or immune suppression

A

invasive candidiasis

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18
Q

histopath. features of candidiasis (3)

A
  1. variable response from host
  2. acanthosis usually present
  3. in almost all cases, the candidal hyphae never penetrate deeper than keratin layer
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19
Q

life threatening infections of candidiasis usually require

A

IV ampho B

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20
Q

…. is an imidazole antifungal agent with no significant systemic absorption or side effects and comes in pleasant tasting lozenges. disadvantage is that dosing should be 5x per day for 10 days

A

Clotrimazole (mycelex)

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21
Q

… is a med that was developed in the 1950s and is most commonly used today. It is NOT absorbed systemically and must be in contacct with organism to work. Distadvantage- multiple dosing schedule and tastes bitter

A

Nystatin (mycostatin)

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22
Q

Soak dentures in …. and soak RPDs in …

A

mild bleach solution

Nystatin (100k u/ml)

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23
Q

…. is a triazole antifungal agents that is readily absorbed systemically with no significant side effects but it does have drug interactions with antihyperlipidemics like lipitor. daily dosing is convenient but it is expensive

A

Fluconazole (diflucan)

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24
Q

2 creams used for the treatment of angular chelitis or perioral candidiasis

A

Mycolog II cream

Vytone cream

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25
Q

Mycolog cream is a combo of … and …

A

Nystatin

Triamcinolone (corticosteroid)

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26
Q

Vytone cream is a combo of …. and …

A

Iodoquinol (antifungal and antibacterial)

Hydrocortisone

27
Q

drawback of vytone cream?

A

iodine allergy

28
Q

…. is endemic to Ohio and Miss. River valleys, it is spread by spores in bird or bat droppings

A

Histoplasmosis

29
Q

histoplasmosis- most cases are …

…. lymph nodes are seen coincidentally

A

asymptomatic

calcified hilar

30
Q

clinical presentation of acute histoplasmosis?

A

flu-like

31
Q

clinical presentation of chronic histoplasmosis

A

cavitary pulm. lesions

32
Q

clinical presentation of oral lesions due to histoplasmosis

A
  • chronic painful ulcer OR granular erythematous plaque
  • usually seen in disseminated form
  • affects tongue,palate or buccal mucosa
  • may be identical to malignancy
33
Q

histoplasmosis presents as a … inflammation with or without …

best visualized by …

A

granulomatous
necrosis
silver stain (GMS) or PAS

34
Q

DX of Histoplas.

A

ID small yeasts in tissue sections

culture H. capsulatum from lesion

Sero. testing for antibodies or yeast related antigens

35
Q

tx for mild cases of histoplasmosis?

A

ketoconazole or itraconazole

36
Q

prognosis for actue histoplasmosis?
chronic histoplasmosis?
disseminated?

A

good
fair
poor (90% mortality with no tx, 7-23% with tx)

37
Q

…. is endemic to desert SW U.S., is termed “valley fever” and represents a hypersensitivity rxn

A

Coccidioidomycosis

38
Q

clinical features of Coccidioidomycosis?

A
  • skin of central face may be affected (oral lesions are rarely described)
  • inhalation of spores
  • flu-like in 40% of patients
  • dissemination in less than 1%
39
Q

Coccidioisomycosis histopathologically shows …. that contain ….

A 
large spherules (20-60 micron)
endospores
40
Q

tx for Coccidioidomycosis

A

ampho B for disseminated cases

fluconazole or itraconazole for mild cases

generally good prognosis if patient is not immunocompromised

41
Q

Coccidioidomycosis may be more aggressive in

A

persons of color

42
Q

…. is an organism that lives in pigeon droppings and is transmitted by air-borne spores. affects immunocompromised patients almost exclusively

A

cryptococcus

43
Q

clinical presentation of crypto.

A

flu like with initial pulm. infection

disseminates to meninges resulting in headache, vomiting and neck stiffness

cutaneous lesions may develop in 10-20%

oral lesions are rare

44
Q

histoplath of crypto

A

4-6 micron yeasts with a clear halo representing a mucopolysaccharide capsule

45
Q

tx of severe cases of crypto

A

ampho B and flucytosine

46
Q

tx for less severe cases of crypto

A

fluconazole

47
Q

prognosis for crypto

A

poor because most are immunocompromised

48
Q

… is also known as … and there are several genera of molds including …., … and …

A

zygomycosis

mucormycosis

Mucor, rhizopus and absidia

49
Q

zygomycosis affects … and present with …

A

severe diabetic or immunocompromised patient

rhinocerebral form in oral region

50
Q

clinical presentation of …. is nasal obstruction, bloody nasal discharge, facial pain, swelling, palatal perforation, black/necrotic lesions, blindess is progresses superiorly and seizures and death occur with intrcranial invasion

A

zygomycosis

51
Q

Dx of zygomycosis is usually based on the … because … is too slow

A

histopath

culture

52
Q

what is seen in the histopath of zygomycosis

A

large, branching, nonseptae hyphae with extensive tissue necrosis

hyphae are usually seen plugging small blood vessels

53
Q

tx of zygomycosis

A

radical surgical debridement

IV ampho B

control of diabetes

poor prognosis

54
Q

…. is common and second in frequency to candidiasis, spectrum of disease that included allergy, localized infection or invasive infection. Found in spores in soil, water, decaying organic debris. May be “nosocomial” infection

A

aspergillosis

55
Q

4 ways aspergillosis can present

A

allergic fungal sinusitis

“aspergilloma” (maxillary sinus fungus ball)

tissue damage- locally invasive

disseminated (immunocomp pt.)

56
Q

biopsy of aspergillosis shows … which contrasts with …

A

branching septae hyphae

mucormycosis/zygomycosis which doesnt have septae

57
Q

… is significant with standard ampho B but newer liposomal preparations are relatively non-toxic

A

nephrotoxicity

58
Q

… is the first oral antifungral agent that could be absorbed systemically but it requires an acidic stomach environment. single dose is convenient. there are some problems with drug interactions and idiosyncratic hepatotoxicity

A

ketoconazole (nizoral)

59
Q

… is approved for treating histoplasmosis and is well absorbed. daily dosing, minimal side effects but expensive

A

itraconazole (sporanox)

60
Q

… is the first line of therapy for invasive asperogillosis

A

voriconazole

61
Q

voriconazole is approved for treating …

A

candida, aspergillus and several other species

62
Q

side effects of voriconazole

A

photosensitivity

63
Q

voriconazole- expensive?

A

yes

SU2018 Oral Path Midterm 1 (5 decks)

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