OROFACIAL FUNGAL INFECTIONS Flashcards
Predisposing factors of oral candidosis (General & Local)
GENERAL
- broad spectrum antibiotics
- cytotoxics
- corticosteroids (inhaler)
- pregnancy
- xerostomia
- immunosuppresion (HIV/extreme ages)
- uncontrolled diabetes
- Nutritional deficiencies
LOCAL
- ill-fitting prosthesis/denture
- xerostomia
- smoker
- rich carb diet
How do drugs effect candida (broad spectrum+ xerogenic agents)
BROAD SPECTRUM
-alter commensal oral microflora
-candida competed with oral microflora for epithelial
cell adhesion and dietary substances
XEROGENIC
- reduce salivary flushing
- reduce antifungal components (lactoferrin, lysozyme, histatines)
How does diabetes contribute to Candidosis
- increase in salivary glucose concentration which encourage candida growth and colonization
- reduce salivary flow (flushing+antifungal components)
- lower oral ph (acidic environment which candida favour)
Haematological factors and candidosis
- Blood group H antigen is a c.albicans receptor
- Increase H antigen in blood type O
What dietary factors are associated with candida?
- Carb rich increase candida adherence
- Deficiencies in: iron,b12,folate, vit c and a
Is candida symptomatic? What other oral features is it associated with?
asymptomatic (1% symptomatic)
oral features
- xerostomia
- altered tatse
- dysphagia + odynophagia (poor nutrition intake)
- angular chelitis
Oral candidosis classification (3)
ACUTE
- Pseudomembraneous candidosis
- Erythematous candidosis
CHRONIC
- chronic hyperplastic candidosis /leukoplakia candidosis
- erythematous candidosis/ Denture induced candidosis /stomatitis
SECONDARY forms
- median rhomboid glossitis
- angular chelitis
- chronic mucocutaneous candidosis
Pseudomembraneous candidosis (features, symptomatic?, associations)
- Detachable white/creamy/yellow confluent patches
- Wipe off leaving erythematous/bleeding base
- asymptomatic
- angular chelitis
- immunosuppresion (HIV diabetes)
- atrophic tongue
- xerostomia
- dysphagia & odynophagia
Pseudomembranous candidosis management (investigation AND treatment)
INVESTIGATIONS
- FBC (include blood group)
- Haematinic measurments for nutritional deficiencies
- Blood glucose level for diabetes
- candida smear/swab
MANAGEMENT
- OHI
- 2% CHX mouthwash
- Nystatin suspension 100,000 units QDS for 1 week
- Miconazole oral gel (25mg/ml QDS (4) for 2 weeks after meals)
Erythematous candidosis (features, symptomatic?, associations, where most common)
+/- painful erythematous patches
dorsum of tongue and palate
associated with broad spectrum antibiotics & HIV
atrophic and depapillation (erythematous=atrophy)
Chronic hyperplastic candidosis (CHC) or candida leukoplakia
(features, symptom?, association, location)
- hyperkeratosis
- bilateral buccal commisieurs extending to angular chelitis
- leukoplakia/erythroleukoplaia raised DOES NOT RUB OFF
- nodular+speckled/homogenous plaque like
- associated with SMOKING
- asymptomatic mainly
- thought that candida can produced nitrosamines increasing risk of dysplasia
-pre-malignant lesion chance of dysplasia (OSCC)
CHC management (investigations+treatment)
INVESTIGATIONS -biopsy malignant risk -FBC -Haematinics -Blood glucose level -VBA for smoking cessation -topical antifungals normally ineffective (nystatin suspension, miconazole oral gel) -Sytemic antifungal fluconazole (2-4 weeks) 50mg QD (1) for 2 weeks or longer
Chronic erythematous candidosis/ Denture stomatitis
what is it? link to candida, associations
- erythema under the fits surface of an upper acrylic denture
- lack of saliva in order for the denture to fit and this allows candida overgrowth
- linked to poor OH/poor fit denture
- angular chelitis
Newtons classification of denture stomatitis/ chronic erythematous candidosis
TYPE 1- pin point erythema
TYPE 2- Diffuse erythema limited to denture fit surface
TYPE 3- Nodular appearance
Denture stomatitis management (treatment)
- improve OHI
- denture hygiene -miltons solution
- tissue conditioner
- Miconazol gel
- nystatin suspension
- 2% CHX mw
- lack of resolution- systemic fluconazole
Miconazole drug interaction
warfarin and atrovastatin can be life threatening
Angular chelitis aetiological factors
lip morphology xerostomia broad spectrum antibiotics diabetes immunosuppression malabsorption (crohns coeliac) Haematinic deficiencies candidosis
Angular chelitis management
- correct predisposing factors (xerostomia/hematinic deficinecies)
- increase OVD, improve denture hygiene, address deep fissuring
- treat intra oral candida e.g. topical antifungals (nystatin suspension or miconazole oral gel)
- miconazole oral gel @ corners of mouth
- chronic -> trimovate cream
Median rhomboid glossitis (what? symtpom?)
- localised candida infection
- atrophy of filiform papilla
- asymptomatic
- diamond shape
- smoking
- corticosteorid inhaler
Chronic mucocutaneous candidosis (CMC)
location, aetiology?
- candida infection affecting skin, nails, mucous membrane
- Impaired cellular immunity to Candida
Candida sampling methods
- smear (no identifications of species)
- concentrated oral rinse (special lab)
- whole saliva culture (not for xerostomia)
- swab (not quantitative)
- sponge imprint culture (special lab)
- biopsy (CHC - malignant risk)
Nystatin (suspension)
polyene antifungal NOT absorbed by the gut
100,000 units QDS for 1 week
Miconazole (use, interaction, dose)
oral gel applied on fit surface of denture
applied for angular chelitis
interaction with warfarin and atrovastatin
2.5ml QDS (4) for 2 weeks after meals
Fluconazole (what, contraindications, interaction, dose)
systemic antifungal
contraindicated preg+breast feeding
50mg QD (once a day) for 1-2 weeks (longer for CHC)
interactions with: warfarin
