Oral Fungal Infections

Question 1

What is oral candidosis?

Answer 1

• Opportunistic fungal infection of the oral cavity
• Rarely itself painful
• “disease of the diseased”

Question 2

What are the classifications of oral candidosis?

Answer 2

1. Pseudomembranous (white); ACUTE
2. Erythematous (red); ACUTE
3. Hyperplastic (raised & white); CHRONIC
4. Other (associated lesions); primarily oral candidosis with other causes
   - Angular cheilitis
   - Denture stomatitis
   - Median rhomboid glossitis
   - Linear gingival erythema

Question 3

What is Newton’s type used to describe?

Answer 3

Chronic denture-induced erythematous candidosis

Question 4

What are the Newton types?

Answer 4

• Type I = pin point lesions
• Type II = diffuse erythema
• Type III = granular

Question 5

What fungus is commonly associated with candidosis?

Answer 5

Candida albicans

Question 6

What structure of blastospores is associated with virulence?

Answer 6

Hyphae (mycelium)

Question 7

Name some candidal virulence factors

Answer 7

• Adherence
• Switching mechanisms
• Germ tube formation
• Extracellular enzymes
• Acidic metabolites

Question 8

What local factors predisposes a patient to oral candidal infections?

Answer 8

• AB use
• Dentures (fungal infections adhere well to acrylic)
• Local corticosteroids
• Dry mouth (saliva contains secretory IgA); polypharmacy

Question 9

What general factors predisposes a patient to oral candidal infections?

Answer 9

• Age (extremes)
• Endocrine disease (diabetes- II/ uncontrolled I)
• Immunodef (systemic steroids, HIV)
• Nutritional def (iron)
• Smoking

Question 10

What is the clinical presentation of pseudomembranous candidosis?

Answer 10

• White patch (plaque) on erythematous mucosa
• Can be scraped off
• Usually asymptomatic but discomfort when eating, burning sensation and bad taste

Question 11

What is the clinical presentation of erythematous candidosis?

Answer 11

• Red, shiny, atrophic mucosa
• Painful and exacerbated by hot/ spicy foods
• Sometimes bilateral angular cheilitis

Question 12

What is the clinical presentation of hyperplastic candidosis?

Answer 12

• ALWAYS found on inner labial commisures bilaterally or dorsum of tongue
• Raised and white
• Primarily seen in smokers and diabetic pts

Question 13

How would you investigate hyperplastic candidosis and why?

Answer 13

• BIOPSY!

- Potential for malignant change

Question 14

What tests can be used in the diagnosis and aid of treatment for oral canididosis?

Answer 14

• DIRECT SMEAR = not specific but will tell if fungal or not
• SWAB & SENSITIVITY = culture; shows how many bugs growing and what they are vulnerable to
• ORAL RINSE = rinse w/ 10ml PBS –> cultured
• BIOPSY = chronic hyperplastic candidosis (looking for malignant change)

Question 15

List some candida species

Answer 15

• C. albicans
• C. glabrata
• C. tropicalis
• C. krusei
• C. dubliniensis

Question 16

What are the treatment options for oral candidosis?

Answer 16

• OH
  
  • -> dentures = soak in hypochlorite, CHX or make new
  • -> rinse after steroid inhaler use
• Diet (decrease CHOs)
• Correct any chronic traumas
• Antifungals
• Take blood to detect nutritional defs = FBC- iron, blood glucose
• Smoking cessation

Question 17

List THREE groups of the antifungal drugs

Answer 17

• Polyenes
• Imidazoles
• Triazoles

Question 18

What is the topical treatment for fungal infections? (incl dose and frequency)

Answer 18

• Polyenes & Imidazoles

NYSTATIN 100,000 units/mL (rinse 1ml 4x daily after food for 7 days)
MICONAZOLE 20mg/g (pea sized 4x daily after food)

Question 19

What is the systemic treatment for fungal infections? (incl dose and frequency)

Answer 19

• Triazoles

FLUCONAZOLE 50mg (1 capsule daily for 14 days)
ITRACONAZOLE 100mg (1 capsule daily for 15 days)

Question 20

Which antifungal may have potential interactions with which drugs?

Answer 20

• Miconazole, Fluconazole, Itraconazole

- Interacts with warfarin and cause myopathy (muscular pain)