Infective Stomatitis - Fungal

Question 1

Explain how Candida albicans can exist (i.e. what form)?

Answer 1

It displays dimorphism

1. yeast form
2. pathogenic hyphal form

Question 2

What is the most common oral fungal infection

Answer 2

Candida albicans

Question 3

T or F, Candida albicans is part of the normal oral flora

Answer 3

True, It may be. It can be cultured in up to 50% of patients but with PCR, probably present in all patients

Question 4

List the clinical forms of Oral Candidiasis

Answer 4

1. Pseudomembranous (thrush)
2. Erythematous “acute atrophic” candiosis
3. Chronic atrophic candidosis
4. Chronic hyperplastic candidosis
5. Angular cheilitis
6. Median rhomboid glossitis “chronic atrophic candidosis”

Question 5

Describe the presentation of pseudomembranous candidosis

Answer 5

White material that can be wiped off: tangled hyphae, yeasts, dead epithelial cells, & debris

• Normal or erythematous mucosa underneath
• Symptomatic, burning sensation to pain
• Metallic taste

Question 6

Describe the presentation of Erythematous “acute atrophic” candidosis

Answer 6

Painful, burning sensation

- Often associated with antibiotics: “antibiotic sore mouth”

Question 7

Erythematous “acute atrophic” candidosis usually affects what location in the mouth?

Answer 7

Usually affects gingiva

Loss of filiform papillae on tongue

Question 8

Describe the presentation of Chronic atrophic candidosis

Answer 8

“Denture stomatitis” or “denture sore mouth”

• Erythematous change limited to mucosa covered by denture and confined to denture bearing tissues
• Asymptomatic to symptoms

Question 9

Chronic atrophic candidosis affects what area of the mouth?

Answer 9

Only the Maxilla and in patients who wear dentures 24 hrs/day

Question 10

Describe the presentation of Chronic hyperplastic candidosis

Answer 10

Also known as “candidal leukoplakia”
- Indistinguishable from leukoplakia

• White lesion that DOES NOT wipe off
• Biopsy if no resolution with antifungal therapy.

Question 11

Describe the presentation of Angular cheilitis

Answer 11

Candida about 90&, rest caused by Strep or Staph

• Erythema or fissuring at labial commissures
• Unilateral or Bilateral

Question 12

Predisposing factors to angular cheilitis

Answer 12

reduced vertical dimension

accentuated folds at the corners of the mouth

Question 13

Describe the presentation of Median rhomboid glossitis

Answer 13

Also known as “chronic atrophic candidosis” or “central papillary atrophy”

• Well-defined, erythematous, rhomboid (diamond-shaped) area at midline of posterior dorsal tongue
• Often asymptomatic

Question 14

How do you diagnose candida albican infections

Answer 14

Diagnosis by clinical features, mucosal smear and tissue culture
- exfoliative cytology: PAS stain

Question 15

Treatment for candida albicans

Answer 15

Oral or systemic antifungal therapy

1. Nystatin (Mycostatin)
   - Oral suspension: 1 tsp. 5x daily for 2 wks.
2. Clotrimazole (Mycelex)
   
   • Troches: 10 mg 5x daily for 7-10 days
3. The “azoles”: ketoconazole and fluconazole are absorbed systemically
   
   • Fluconazole (Diflucan): 2 tabs. (200 mg) Day 1 and then 1 tab. (100 mg) daily for 2 wks.

Question 16

Most deep fungal infections cause what?

Answer 16

Primary lung involvement

Question 17

What predisposes a person to a deep fungal infection?

Answer 17

Increased susceptibility to infection and recurrence in immunocompromised (HIV+)

Question 18

Name the various deep fungal infections

Answer 18

Histoplasmosis
Coccidiomycosis
Blastomycosis
Cryptococcosis
Aspergillosis

Question 19

How do deep fungal infections present?

Answer 19

Chronic, non-healing intra-oral ulcers which can mimic squamous cell carcinoma

Question 20

Name the subcutaneous fungal infections

Answer 20

Sporotrichosis

Question 21

Name the opportunistic fungal infectiosn

Answer 21

Zygomycosis (mucormycosis)

- often in immunosuppressed/diabetics

Question 22

How do you treat deep fungal infections?

Answer 22

Biopsy with tissue staining and culture

Treat with systemic anti-fungal medications