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OPT 830-Exam 2-Fungal/Protozoan Infections
Terms in this set (65)
What is the most common fungal infection in humans that is caused by a dimorphic fungal organism which inhabits the oral cavity. It is carried in 30-50% of people in their mouth.
What 3 precipitating factors cause opportunistic infections with Candida?
1-compromised immune system
2-altered oral microenvironment (long term corticosteroid/abx use)
3-virulent strains of C. albicans
What are the 2 most common forms of candidiasis?
1- pseudomembranous candidiasis
2- erythematous candidiasis
Most common form of candidiasis which presents with white plaques on the oral mucosa resembling milk curds. They can be rubbed off with a dry gauze or tongue blade (diagnostic)
Pseudomembranous candidiasis is relatively asymptomatic but some patients may complain of what 2 symptoms?
mild burning sensation
1st form of erythematous candidiasis that occurs in some patients after long-term abx therapy. Presents with multiple red plaques of the mucosa. Pts feel as if their mouth has been scalded.
Acute Atrophic Candidiasis
2nd form of erythematous candidiasis that presents with a well-delineated lesion in the central mid-dorsum of the posterior tongue exhibiting central papillary atrophy and prominent erythema.
Median Rhomboid Glossitis
3rd form of erythematous candidiasis characterized by erythema, fissuring, and scaling at the corners of the mouth.
Chronic lip licking may predispose a pt to what type of candidiasis?
4th form of erythematous candidiasis is seen in denture-bearing areas of pts who wear dentures continuously. This can be a candidal infection or tissue rxn to irritants on a poorly cleaned denture.
Chronic Atrophic Candidiasis
Form of candidiasis most often seen on the anterior buccal mucosa characterized by adherent white plaque that cannot be rubbed off. Should resolve with anti-fungal tx.
Chronic hyperplastic candidiasis
Candida may also populate a pre-existing ____________ or ____________ and these lesions may show an increased frequency of epithelial dyplasia on biopsy. If does not resolve with anti-fungal tx- should rule out dysplasia or SCC.
More severe form of candidiasis in the 1st 2 decades typically associated with various endocrine disturbances.
Sporadic cases of mucocutaneous candidiasis follow an auto recessive inheritance. Lesions involve the mouth, nails, skin, extra oral mucosa. Typically candidiasis precedes the onset of endocrine disturbances. Increased incidence of oral and oropharyngeal carcinoma in pts.
ECS-Endocrine candidiasis syndrome
APECED- AI polyendocrinopathy candidiasis ectodermal dystrophy syndrome
What is a clinical presentation that is diagnostic of pseudomembranous candidiasis?
lesions rub off with gauze
What can be used to identify candidal organisms in the dental office?
KOH- potassium hydroxide prep
What is the 1st effective topical anti-fungal agent used to treat candidiasis that comes in an oral suspension or lozenge but has a bitter taste?
Topical anti-fungal agent used to treat candidiasis that is a lozenge or cream that has a pleasing taste?
What are 3 recently released systemic anti fungal agents that are used when topical agents aren't effective?
FDA has recently disapproved the use of oral ___________ tablets (Nizoral) for candidiasis due to its association with liver toxicity, adrenal insufficiency, and drug interactions.
Most common systemic deep fungal infection in the US. Caused by a dimorphic fungus with the highest incidence in the Ohio and Mississippi river valleys where 90% of the population has been infected. Organism found in soil with bird/bat excrement. Inhaled through spores and affects respiratory system.
What organism causes histoplasmosis?
What are the three forms of histoplasmosis?
Acute, Chronic, Disseminated
This form of histoplasmosis is a self limiting process and occurs in a variable percentage of healthy patients exposed to the organism depending on the quantity of spores inhaled. Pt's experience fever, muscle aches, headache, anorexia and nonproductive cough for 2 weeks. Sometimes calcifications of hilar lymph nodes may be detected on chest radiographs even years later.
Less common form of histoplasmosis affects the lungs of older (mostly male) patients. with emphysema and in immunosuppressed pts. Resembles TB exhibiting cough, fever, weight loss, chest pain, weakness, and radiographic evidence of pulmonary infiltration and cavitation.
Least common form of histoplasmosis that extends to extra pulmonary sites i.e. oral cavity. Occurs in elderly, debilitated, and immunosuppressed pts.
Oral lesions of this disease present as solitary, variably painful, deep seated ulcerations with firm, rolled borders, or irregular red and white lesions clinically resembling a malignancy. Most commonly affects tongue, palate, buccal mucosa.
No tx is required for acute histoplasmosis however the chronic form is treated with what?
IV Amphotericin B
Disseminated form of histoplasmosis is very serious disease and if untreated mortality can be ________% If treated the mortality rate is still 7-23%.
Dimorphic fungus that causes blastomycosis.
Disease caused by dimorphic fungus that is similar to histoplasmosis, has a predilection to males involved in outdoor activities. Route of infection: inhaled spores. Infections are self-limiting and restricted to the lungs but cases of hematogenous dissemination to skin, bone, prostate, meninges, oropharynx, and abdominal organs.
The form of this disease resembles pneumonia with high fever, chest pain, malaise, night sweats, and productive cough.
More common form of this disease is characterized by low-grade fever, night sweats, weight loss, and chronic productive cough stimulating tuberculosis. Cutaneous and oral lesions may be the first and only sign of this disease.
Oral lesions of this disease may result from extension of pulmonary disease or local inoculation. Lesions are irregular, nodular, proliferative masses or ulcerations with irregular borders and varying degrees of pain. May resemble SCC.
Most acute cases of this disease require no treatment however the chronic form or with extra pulmonary lesions can be treated with what 2 drugs?
Deep fungal infection most often seen in South America. Can also affect visitor and immigrants. Male predilection. Involves the lungs and is self-limiting. Hematogenous/lymphatic spread may occur to lymph nodes, skin, adrenal glands, and mulberry-like ulcerations.
(South American Blastomycosis)
Paracoccidioidomycosis is treated with what drug for mild cases and what 2 drugs for severe cases?
severe: oral Itraconazole or IV amphotericin B
Disease produced by dimorphic fungus most commonly found in the semi-arid desert soils of the southwestern US and Mexico. ROI: inhalation of spores into lungs with incubation time 1-3wks.
40% who have symptoms of this disease experience flu-like symptoms: fatigue, cough, chest pain, muscle aches, and headaches which last several wks then resolve.
Occasionally this disease will cause a hypersensitivity rxn triggering an attack of erythema multiform (maculopaupular skin rash) or erythema nodosum (painful erythematous nodules in SubQ CT of legs). Rxn known as what?
What are the 2 forms of Coccidioidomycosis?
Chronic progressive and Disseminated
Form of coccidioidomycosis that usually presents in immunocompromised patients taking large doses of corticosteroids (transplant pts), cancer chemotherapy, end stage HIV, pregnant females, infants, and elderly.
Skin lesions of this disease form papules, abscesses, verrucous plaques and nodules, and display a predilection for the central face- especially the nasolabial fold.
What are 4 drugs used to treat coccidioidomycosis? (FAIK)
Uncommon deep fungal infection that poses no problem in healthy people but can be fatal in immunocompromised patients, especially AIDS patients who are not on HAART. Inhaled spores found in pigeon excrement or contaminated soil.
Initial infection in lungs is asymptomatic but disseminated infection occurs in immunosuppressed pts most frequently involving the meninges, skin, bone, and prostate gland.
If cryptococcosis presents in the oral cavity- what is it's appearance?
Craterlike ulcers or friable erythematous plaques
What is the treatment for cryptococcal meningitis?
Amphotericin B + Flucytosine (2wks)
Itraconazole or Fluconazole (10wks)
What is the most common type of zygomycosis that affects the head and neck area?
What is the form of mucor that is the primary interest to the oral health care provider that occurs in uncontrolled type 1 diabetics and immunocompromised pts.
This is a fulminating disease characterized by extensive necrosis and tissue destruction caused by the fungus invading small blood vessels resulting in infarction and necrosis (may be due to affinity for iron). Infection can be in the nasal cavity or maxillary sinus.
Invasive Fungal Sinusitis
Nasal involvement in this disease results in obstruction, bleeding, facial swelling, cellulitis, visual disturbances and proptosis. Can progress into cranial vault and lead to blindness seizures and death.
Invasive Fungal Sinusitis (zygomycosis)
Maxillary sinus involvement of this disease initially presents as intramural swelling of the maxilla and palate that later ulcerates causing massive necrosis and tissue destruction.
Invasive Fungal Sinusitis (Zygomycosis)
What is the tx for zygomycosis?
Radical surgical debridgement of necrotic tissue
2nd most common opportunistic fungal infection caused by inhalation of spores found in soil, water, decaying organic debris. 2 most common species that cause it are A. flavus and A. fumigatus.
In healthy patients infected with aspergillosis, what is the term for (1) an invasive infection of the maxillary sinus (2) an allergy affecting the maxillary sinus.
1-invasive fungal sinusitis
2-allergic fungal sinusitis
What 3 terms describe a non-invasive accumulation of aspergillus organisms that occur in the maxillary sinus?
What are tx for the following? 1-fungus ball 2-Allergic fungal sinusitis 3-invasive aspergillosis
2-debridement +systemic corticosteroids
3-voriconazole, itraconazole, amphotericin B +debridement
A fungus ball in aspergillosis that calcifies in the maxillary sinus.
What 3 types of patients does disseminated aspergillosis typically occur?
Leukemia (high dose corticosteroids)
Common disease caused by the protozoal organism Toxoplasma Gondii
This disease poses no problem for healthy adults however it is devastating to the developing fetus and immunocompromised. Originates from intestinal tract of cats.
When contracted during pregnancy (1st tri) organism can cross the placental barrier and cause infection of the fetus resulting in blindness, mental retardation, delayed psychomotor development.
Toxoplasmosis is diagnosed via what method?
Rising serum anti-body titers within 10-14 days after infection.
How is toxoplasmosis treated? What about in AIDS pts?
sulfadiazine + pyrimethamine + folic acid
AIDS pts (Bactrim)
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