Oral candidosis

Question 1

Oral candidosis

Answer 1

Infection of the oral/peri-oral tissues with candida species
commonest fungal infection
C.Albicans
50% general population
opportunistic pathogen

Question 2

OC- Microbiology

Answer 2

Dimorphic yeast like fungus:
1. Blastospore
2. Hyphae

Question 3

Local factors predisposing to OC

Answer 3

Epithelial changes
Xerostomia
High carb diet
Smoking
Broad spectrum antimicrobials
Corticosteroids
Head and neck irradiation

Question 4

Systemic factors

Answer 4

Physiological
Malnutrition
Endocrine
Malignancy
Primary immunodeficiency
Secondary immunodeficiency

Question 5

CF - OC

Answer 5

Mucosa red, white or both
evidence of predisposing factors

Question 6

Classification - OC

Answer 6

1. Primary (oral and perioral tissues)
2. Secondary (other parts of the body as well as oral cavity)

Question 7

Pseudomembranous candidosis

Answer 7

Thrush
M:F
Semi adherent white plaque
Wiped off to reveal erythematous base
Recur:
Acute –> palate, dorsum of the tongue, buccal mucosa
Chronic –> palate, oropharynx, tongue dorsum

Question 8

Erythematous candidosis

Answer 8

acute v chronic
erythematous areas
- corticosteroid use
- antibiotic therapy
- HIV

Dorsum of tongue
Opposing palate

Question 9

Chronic hyperplastic candidosis

Answer 9

candidal leukoplakia
M:F
Adherent plaques
white/speckled lesions

Question 10

Angular cheilitis

Answer 10

inflammation, fissuring and pain of the skin at the commissure
2% of adults
mixed infection

Question 11

Median rhomboid glossitis

Answer 11

papillary atrophy, occassionally hyerplastic, exophytic
midline of tongue
elliptical or rhomboid in shape

Question 12

Denture associated erythematous candidosis

Answer 12

erythema and oedema of oral mucosa in contact with dental prosthesis
F>M
Older pts

Question 13

Denture associated erythematous candidosis

Answer 13

erythema and oedema of oral mucosa in contact with dental prosthesis
F>M
Older pts

Question 14

Chronic mucocutaneous candidosis

Answer 14

heterogenous group of syndromes
persistent, severe, and diffuse mucocutaneous candidal infections affecting skin, nails and mucous membranes
due to impaired cell mediated immunity against candida species
Classification:
1. Candidosis Endocrinopathy Syndrome (CES)
2. Autoimmune polyendocrinopathy candidosis ectodermal dysplasia (APECED)

Question 15

Chlorhexidine gluconate

Answer 15

gel, mouth rinse, spray
biguanide antiseptic and disinfectant
effective in management of OC

Question 16

Nystatin oral suspension

Answer 16

polyene
topical effect
effective against C.Albicans
inhibits ergosterol formation in fungal cell membrane

Question 17

Azole antifungal drugs

Answer 17

Topical v systemic
risk of significant drug interactions
miconazole and fluconazole
inhibit cytochrome p450 dependent enzyme 14a demethylase
inhibits synthesis of ergosterol

results in depletion of ergosterol in cell wall. accumulation of toxic intermediate sterols. membrane permeability and inhibited fungal growth

Question 18

Miconazole gel

Answer 18

antimicrobial properties
24mg/ml
5ml applied to mouth
risk of significant drug interactions esp with warfarin

Question 19

Fluconazole

Answer 19

50mg capsules
risk of significant drug interactions