fungal infections of the orofacial tissues

Question 1

what is the actual name of fungal candida

Answer 1

candida albicans

Question 2

which type of candida is usually resistant to azole antifungal drugs

Answer 2

candida glabrata

Question 3

which types of pts dont get candida or fungal infeciton

Answer 3

usually immunocompetant pts dont get candida unless they have other factors which come into play

Question 4

what are the risk factors of orofacial fungal infections

Answer 4

Risk factors:
* Smoking
* Denture/orthodontic appliance wear
* Dry mouth (myriad of causes)
* Carbohydrate rich diets (feed the bugs)
* Immune modulating drugs including steroids like asthma preventer inhalers, topical creams and oral tablet forms of corticosteroid
* Immunocompromise status e.g. diabetes, HIV, chemotherapy, radiotherapy, use even short term broad spectrum antibiotics
* Nutritional deficiency states (ferritin, folate, B12)
* Local causes include inflammatory lesions of the oral mucosa or wounds which breach the epithelium
Acidic intraoral environment e.g. due to acid reflux in GORD or chronic vomiting
* Symptoms vary from totally unaware and asymptomatic to discomfort and frank burning pain or dysaesthesias and taste abnormalities

Question 5

what are the 5 types of oral candidosis

Answer 5

acute pseudomembraneous candidosis
erythematous candidosis
angular cheilitis
chronic hyperplastic candidiosis (CHC)
chronic mucocutaneuos candidosis (CMC)

Question 6

what is acute pseudomembraneous candidosis

Answer 6

• thrush
• creamy white plaque which when wiped raw looks like erythmatous base
• common in babies or elderly
• can happen after inhaler or antibiotic
• usually asymptomatic

Question 7

what is erythmatous candidosis

Answer 7

aka denture stomatitis
erythema means denture stomatitis

Question 8

what is angular cheilitis

Answer 8

can be fungal or bacterial
corners of mouth
streptococal aureus

Question 9

what is chronic hyperplastic candidosis

Answer 9

a malignant condition- take biopsy!!!
classically in commisural mucosa- along occlusion line of cheek

Question 10

chronic mucocutaneous candidosis

Answer 10

a persistant mucocutaneous candidal infection of the skin, nails and mucous membranes
usually happens in early childhood
may occur in conjunction with endocrine disorders e.g. addisons disease

Question 11

what are the treatments/ management for fungal infections

Answer 11

there are 2:
identifying the risk factors and modifying them
medications

Question 12

how would you manage fungal infections by modifying risk factors

Answer 12

1. smoking cessation
2. improve denture hygiene- milton disinfectant, clean dentures with soap and water
   don’t wear denture at night
   dilute in sodium hypochlorite
3. use chlorhexidine mouthwash- 10ml, 0.2%
4. improve diabetic control
5. oral rinses or swabs
   the rinse is done - 30ml sterile saline- 30 seconds

Question 13

which bloods should you do when potential urofungal infections

Answer 13

FBC- identifies anaemia
haeminitncs- reveals ferritin, B12 and folate levels
HB1AC

Question 14

Medications given in fungal infections

Answer 14

AZOLES
miconazole - gel
fluconazole -tablet
Inhibit fungal cytochrome P450 dependent enzyme 14alpha demethylase which inhibits ergosterol synthesis
ergosterol maintains the cell membranes of fungal cells

chlorhexidine mouthwash
polyenes- commonly nystatin
amphoteracin

Question 15

what is different in the treatment of angular cheilitis

Answer 15

a topical treatment must be given alongside something like nystatin e.g. miconozole cream, or hydrocortisone

Question 16

in which cases would you reassess a fungal infection pt

Answer 16

if theyre not responding to meds/interventions
there may be a systemic cause

Question 17

what is a mould infection

Answer 17

a type of fungi that has no chlorophyll and cannot make its own food
get their food and moisture from decaying matter
some can invade blood vessels and cause tissue infarction and necrosis
- can be devastating in immunocompromised pts

Examples:
Zygomycosis - hyphae invade into the tissues, don’t just sit on top
Aspergillosis due to aspergillus (found in shower heads for example)
Exophalia a rare cause of necrosis of the gingivae with a characteristic rim of black mucosa.