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OPT 830 Fungal and Protozoal Infections
Terms in this set (87)
The most common fungal infection in humans
This fungal organism is dimorphic and causes the most common oral fungal infections.
1. Compromised immune system
2. Altered oral microenvironment
3. A more virulent strain
Candidal infections are generally opportunistic and occur in 3 scenarios.
1. Long term antibiotic use
2. Long term corticosteroid use
Examples of an altered microenvironment that can lead to candidiasis
More common of the candidiasis patterns; characterized by white plaques on oral mucosa resembling curdled milk. Commonly found with long term broad spectrum ABX use or compromised immune systems
Another name for the pseudomembranous pattern of Candidiasis. Can be asymptomatic or with a mild burning sensation
They can be rubbed off
An important clinical diagnostic criteria of Candidiasis concerning the plaques
The less common of the two candidiasis patterns exhibiting red plaques
1. Acute Atrophic Candidiasis
2. Median Rhomboid Glossitis
3. Angular Chelitis
4. Chronic atrophic candidiasis
Erythematous plaque can occur in four different patterns
Acute atrophic candidiasis
Occurs in some patients after long-term antibiotic therapy; presents with multiple red plaques of the mucosa
Median rhomboid glossitis
Well-delineated lesion in the central mid-dorsum of the posterior tongue exhibiting central papillary atrophy and prominent erythema
1. Candidia Albicans
2. Staphylococcus Aureus
Most cases of angular chelitis are caused by a combined infection of two species
Characterized by erythema, fissuring, and scaling at the corners of the mouth. Decreased VDO can predispose patient to this condition.
Candidiasis as a result of chronic lip licking
Chronic atrophic candidiasis
Seen in denture-bearing areas of patients who wear their dentures continuously
May appear like chronic atrophic candidiasis but is actually a tissue reaction to irritants from a poorly cleaned denture.
Chronic hyperplastic candidiasis
Candidiasis that is characterized by an adherent white plaque that cannot be rubbed off. Commonly seen on the anterior buccal mucosa
Another name for Chronic hyperplastic candidiasis
Candidia can also populate in these pre existing hyperplastic conditions.
Severe form of candidiasis that usually develops in the first two decades of life; associated with various endocrine disturbances
1. Endocrine-candidiasis syndrome
2. Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED)
Two conditions associated with mucocutaneous candidiasis
In APECED mutations in the ______________ gene causes destruction of T lymphocytes that produce _____________.
MIcroscopically this shows squamous epithelium with thickened parakeratin with neutrophils and hyphae. It appears bright magenta under a PAS stain
First effective topical agent used to treat candidiasis; comes in lozenge or oral suspension form
Poor choice for xerostomia patients because sugar is added to disguise the bad taste
Another topical agent used to treat candidiasis, but with a more pleasing taste
Used for angular chelitis because it comes with antibacterial preparations.
Three systemic antifungal agents that can be absorbed across the GI tract
Contraindicated as initial therapy for oral candidiasis due to association with liver toxicity and drug interactions
Ketoconazole interraction with this drug causes life threatening arrhythmias
The most common systemic (deep) fungal infection in the US. Found in humid areas in bat or bird excrement. Infection by inhalation of spores.
Histoplasmosis is caused by this dimorphic organism
Capable of growing as an yeast or as a mold
The three types of histoplasmosis
Self-limiting fungal infection which occurs in healthy patients exposed to the organism; symptoms include fever, muscle aches, headache, anorexia, and non-productive cough
Fungal infection that most often affects the lungs of older patients with emphysema and immunosuppressed patients
Clinically resembles TB with cough, chest pain, fever, night sweats, weakness, weight loss and radiographic evidence of pulmonary infiltration and cavitiation.
Least common form of a specific fungal inf multiple extrapulmonary sites; oral lesions mostly occur due to this form. Mostly occurs in elderly debilitated or immunocompromised patients.
Gomori methenamine silver (GMS) stain
Used to identify histoplasma capsulatum, blastomyces dermatitidis, paracoccidioides brasiliensis, and coccidioidomycosis in a culture
Dimorphic fungal species which causes blastomycosis though spore inhalation; Usually self-limiting and restricted to the lungs; less common than histoplasmosis
This can occur in the acute or chronic form but is mostly asymptomatic in either form. When symptomatic, the acute form resembles pneumonia with high fever, chest pain, malaise, night sweats, and a productive cough. The chronic form, which is more common, is characterized by a low-grade fever, night sweats, weight loss, and a chronic productive cough, simulating tuberculosis.
The lesions appear as irregular nodular proliferative masses or as ulcerations with irregular borders and may clinically resemble squamous cell carcinoma, biopsy is required. Histologically appears with granulomatous inflammation with a doubly refractile cell wall that stains positive with a GMS stain.
Species that causes paracoccidioidomycosis which is another deep fungal infection
Deep fungal infection which initially involves the lungs and may spread to lymph nodes, skin, and adrenal glands; mulberry-like ulcerations in oral cavity. Has a predilection for males due to protective female hormones
This fungal infection occurs most commonly in South America
1. Mickey Mouse ears
2. mariner's steering wheels
Two resemblances seen with paracoccidioides under a microscope
The dimorphic species responsible for coccidioidomycosis which can infect through spore inhalation
This fungal species is most common in the semi arid desert soils of Southwestern US and Mexico
Symptoms include flu-like symptoms including fatigue, cough, chest pain, muscle aches, and headache, which may last for several weeks and then resolve without consequence.
Coccidioides immitis causes this hypersensitivity reaction characterized by an extensive maculopapular rash
Coccidioides immitis causes this hypersensitivity reaction characterized by painful erythematous nodules in the subcutaneous tissue of legs.
Combination of coccidioidomycosis and associated hypersensitivity reaction
Chronic progressive pulmonary coccidioidomycosis
One of the rare forms of coccidioidomycosis that was not elaborated in the handouts
May be seen in immunocompromised patients who are taking large doses of corticosteroids, receiving chemotherapy, TNF alpha therapy, HIV patients, Pregnancy, infants and elderly
Skin lesions display predilection for nasolabial fold and appear as papules, abcesses, verrucous plaques and nodules.
Species that causes cryptococcosis which is a deep fungal infection spread by pigeon poop.
Uncommon deep fungal infection which mostly affects AIDS patients who are not on cART; requires inhalation of spores then involves meninges, skin, bone, and prostate if it disseminates. Skin lesions present as erythematous papules or pustules, crater like ulcers or erythematous plaques
Microscopically, granulomatous inflammation organisms are round-to-oval structures surrounded by a clear halo that stains with GMS, PAS, and mucicarmine stains.
Caused by several normally harmless fungal organisms which are found in decaying organic materials
The subphylum of fungus that cause mucormycosis
The first symptom is nasal obstruction along with bleeding, facial swelling, cellulitis, visual disturbances, and proptosis. Progression into the cranial vault can lead to blindness, seizures, and death. Massive necrosis and tissue destruction.
Another name for mucormycosis
Yet another name for Mucormycosis
Most common species of Mucormycotina that can cause the associated disease in the head and neck area
Mucormycosis form which is of primary interest to the oral health care provider; occurs most commonly in uncontrolled diabetics and immunocompromised patients
Invasive fungal sinusitis
Fulminating disease characterized by extensive necrosis and tissue destruction caused by a fungus invading small blood vessels causing infarction and necrosis; affects maxillary sinus
Opportunistic fungal disease second only to candidiasis in frequency
1. Aspergillus Flavus
2. Aspergillus Fumigatus
The two most common species of Aspergillus which infect humans (second one is more prevalent)
Can be acquired as a nosocomial infection
Invasive fungal sinusitis
In healthy patients, aspergillosis can present as a localized invasive infection of the maxillary sinus
Allergic fungal sinusitis
Aspergillus infection which presents as an allergy affecting the maxillary sinus or bronchopulmonary tract and causing asthma like symptoms in susceptible patients.
A non-invasive accumulation of aspergillus organisms in the maxillary sinus
Another name for a fungus ball
Another name for fungus ball
Formed when a fungus ball becomes calcified
This can occaisionally occur in susceptible patients following an extraction or Endo treatment of the Maxillary posterior teeth.
Fungal disease which primarily occurs in immunocompromised patients, high dose corticosteroid patients, leukemia patients, and uncontrolled diabetics which begins with TB-like symptoms and spreads to other organs
protozoal organism that causes Toxoplasmosis
Common disease caused by a protozoal organism; transmitted via cat poop
In healthy individuals, the clinical symptoms are either nonexistent or mild, low-grade fever, fatigue, or cervical lymphadenopathy.
In immunocompromised patient, dissemination causes pneumonia, necrotizing encephalitis, myositis, and myocarditis. AIDS patients can have CNS involvement, which is very serious, and typically manifests as headache, lethargy, disorientation, and hemiparesis.
Infection of the fetus that results in blindness, impairment, and delayed psychomotor development
Lymph nodes of affected patients demonstrate reactive lymphadenopathy along with numerous focal collections of eosinophilic epithelioid histiocytes.
Protozoal infection that is transmitted to humans from the bite of a certain sandfly found in middle eastern countries, India , and Brazil
Most common form of leishmaniasis that develops 3-6 weeks after a person is bitten; crater-like lesions seen
More destructive form of leishmaniasis which involves skin with ulcerative plaques and nodules that can develop months to years later. Most commonly afftesd the nasal, oral, pharyngeal, tracheal, and laryngeal mucosa. Can cause perforation of the nasal septum and palate.
Leishmaniasis form demonstrating grayish skin discoloration, hepatosplenomegaly, fever, and weight loss
Another name for Visceral Leishmaniasis
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