FUNGAL INFECTIONS

Histoplasmosis is caused by what organism

Where (locations)

From what?

Histoplasma Capsulatum

Ohio and mississippi river valleys

Spores in bird or bat droppings

Clinical Features of Histoplasmosis:

Asymp?

Acute

Chronic

Disseminated

Calcified hilar lymph nodes seen

Flu like

Cavitatary pulmonary lesions

Elderly, debilitated or immunocomp

Oral Lesions of. Histoplasmosis:

_______ disease secondary to ______ over previously _______ mucosa

Where?

Localized - implantation - traumatized

Tongue, palate, buccal mucosa

Clinically, oral lesions of histoplasmosis may be identical to what

Malignancy

Histoplasmosis has ________ inflammation, with or without _________

Granulomatous - necrosis

Histolgy of Histoplasmosis reveals _______micron _____, usually with _____ which are best visualized by ______ stain or ______

1-2, yeasts, macrophates

Silver - PAS

Tx for Chronic or disseminated histo

Mild?

Amphotericin B

Ketoconazole or itraconazole

What disease has a geographically similar range to histoplasmosis?

Where?

What is more common?

Blastomycosis

Wisconsin, minnesota, canada

Histo is 10x more common

What organism casues blastomycosis

Acquired by what

Most cases, the infection is limited to what

Blastomyces dermatitidis

Inhalation of spores

Lungs

When disseminated, blastomycosis sites include what (6)

Skin*

Bone, prostate, meninges, oropharyngeal mucosa, visceral organs

Blastomycosis is usually ________, otherwise _____ complaints

Acute is ____ like symptoms

Chronic is _____ like symptoms

Asymp

PUlmonary

Pneumonia

TB

Blastomycosis Skin and oral mucosa lesions:

Enlarging _______ nodules that ______

Varying degrees of ______

Oral lesions resemble ______-

Erythematous - ulcerate

Pain

Squamous carcinoma

Diagnosis of Blastomycosis:

______ prep of lesional tissue

ID of characteristic yeasts - size? Stain?

Doubly refractive _________

Culture is ______ but _______

KOH

8-20 microns - Silver or PAS

Cell wall

Slow but accurate

Most cases of blastomycosis are ______ and require what tx?

Tx for those with immunodeficiencies?

Asymp - none

Systemic amphotericin B

Coccidiodomycosis:

What organism?

Endemic to where?

________ fever represents a _______ reaction

Coccidioides

Southwest US

Valley - Hypersensitivity

Clinical Features of Coccidiodomycosis:

Inhalation of _______

______like illness in 40% of patients

_________ in <1%

Skin of _______ face may be affected, _____lesions are rare

Spores

Flu

Dissemination

Central - oral

HIstopathology of Coccidiodomycosis:

Size?

Contain what?

Large - 20-60 microns

Endospores

Diagnosis of Coccidiodomycosis is made by what (2)

Culture or biopsy

Tx of Coccidiodomycosis:

Disseminated cases?

MIlder cases?

May be more aggressive in who?

Prognosis is good if what?

Amphotericin B

Itraconazole or fluconazole

Persons of color

Not immunocomp

What disease affects immunocompromised patients almost exclusively?

Cryptococcosis

Cryptococcosis:

Organism?

Lives where?

Transmission?

Cryptococcus neoformans

Pigeon droppings

Air borne spores

Cryptococcosis Clinical Features:

_____ like symptoms with inital _____ infection

DIsseminates into ________ resulting in _______, _______ and ____ stiffness

_____ lesions develop in 10-20%

____lesions are rare

Flu - pulmonary

Meninges - headache, vomiting, neck

Cutaenous

Oral

Histology of Cryptococcosis:

Size?

With what?

Visualized with what (3)

Diagnosis is based on ________ or ________

4-6 microns

Clear halo - mucopolysaccaride capsule

MIcicarmine, PAS, silver

Culture or ID in tissue sections

Cryptococcosis:

Severe cases are treated with what

Less severe?

Progonisis? Why?

AMphiotericin B and flucytosine

Fluconazole

Poor - immunocomp patients

What two organisms are most common in Aspergillosis

Aspergillus flavus and fumigatus

Spectrum of Aspergillosis: (3)

Spores in what (3)

Allergy, localized infection of invasive

Soil, water, decaying organic debris

Where is Aspergilloma?

Aspergillus in maxillary sinus

Clinical Features of Aspergillosis:

Features vary depending on _________and ________

Allergy may trigger _______

Tissue damage post ______

______ patients

Immune status and extent of invasion

Asthma

Extraction

Immunocomp

Diagnosis of Aspergillosis:

______ Exam of infected tissue

Branching _______ _______

Occlusion of _______ vessels by ______

Histopath

Septate hypae

Small blood - hypae

Tx of Aspergillosis:

________, with or without _____

Good prognosis if _____

Poor prognosis if ________

AmphotericinB - debridement

Normal immune status

Immunocomp

Aspergillosis causes signs and symptoms because what

Vaso invasiveness!

Zygomycosis is also known as what?

Several types of ________

Affects severe ______ or _______ patients

_________ form in oral region

Mucormycosis

Molds

Diabetics or immunocomp

Rhinocerebral

Clinical features of Zygomycosis:

____ obstruction, ______ nasal discharge

_____ pain, ______, ______ perforation

______ and ______ lesions

If progresses superiorly, _____ disturbances and _______

What occurs with intracranial invasion?

Nasal - bloody

Faical - swelling, palatal

Black, necrotic

Visual, blindness

Siezures and death

Diagnosis of Zygomycosis is based on _____ because ________ is slow

Large, branching ______ hyphae with extensive _______-

Hypae are often seen plugging what?

Histopath - culture

Nonseptate hypahe - tissue necrosis

Small blood vessels

Tx of Zygomycosis:

Radical ____ debridement

IV __________

If patient is diabetic ?

Prognosis?

Surgical

Amphotericin B

Control diabetes

Poor

Difference between zygomyosis and aspergillosis?

Same?

Zygomycosis - non septate hypae (asper is septate), needs immediate tx

Both vasoinvasive

Candidiasis:

Organism?

Very common _____ yeast

Yeast form _______ = Commensal - what does this mean?

What form is the pathogen?

Candida Albicans

Dimorphic

Spores = cannot cause disease

Hyphal

The ability of candidiasis to undergo transformation to hyphal form under appropriate conditions produces ____________ or ______ tubes

Germinative / germ tubes

Colony of hyphae with or without spores

What disease will you see this

Mycelia

Candidiasis

Pathenogenesis of Candida depends on what three factors?

What disease?

Host immune status

Oral mucosal environment - Xerostomia

Virulence of strain

What cohorts of patients will you see candidiasis (4)

Babies

Elderly

Uncontrolled diabetics

Immunocomp

White Lesions of Oral candidiasis: (2)

Acute pseudomembranous candidiasis

Hyperplastic candidiasis

Red lesions of oral candidiasis (3)

Acute atriphic candidiasis

Central papillary atrophy of tongue

Chronic atrophic candidiasis

Angular chelitis is a form of what

Oral candidiasis

Acute pseudomembranous candidiasis is also known as what?

What does it look like?

Where?

Symptoms?

Thrush

WHite, curdiles milk or cottage cheese like

Buccal mucosa, palate or tongue

Burning or unpleasant taste

What type of candidiasis is known as candidal leukoplakia?

Can it be rubbed off?

Where is it?

Resolves with what?

Hyperplastic

No

Anterior buccal mucosa

Antifungal leukoplakai

A true leukoplakia may have _____ superimposed on it

Candidiasis

Acute Atrophic Candidiasis:

_______, variable ______

Common site?

Diffuse atrophy of _______ papillae, particularly after __________ antibiotics

Typically causes ____ sensation

Redness, borders

Tongue

Dorsal tongue - broad spectrum

Burning

Central Papillary atrophy was referred to as what in the past?

Median rhomboid glossitis

What are most Central Papillary atrophies due to?

Chronic candidiasis

Well defined area of redness on the mid-posterior dorsal tongue that is usually asymp

Central Papillary atrophy

Chronic Atrophic Candidiasis is also known as what?

Denture sore mouth

Erythema of palatal denture bearing area?

Caused by what

Chronic Atrophic Candidiasis

Denture contaminated with candidal organisms

Redness, cracking corners of the mouth

Angular Chelitis

Treatment of Angular Chelitis:

Superficial Oral Mucosal Infections:

Life threateneing infections:

Milder topical or systemic antifungal agents

Intravenous Amphotericin B

Prescription for Clotrimazole Oral Troches

Disp

SIg

50

Dissolve one in mouth 5x per day

What antifungal is not absorbed systemically and must be in contact with organism to be effective

Nystatin - Mycostatin

Disadvantage of Nystatin/Mucostatin (2)

Taste, multiple dosing schedule

IV form that is used to treat life threatening systemic/candidal infections

What is significant with this antifungal?

Amphotericin B (Fungizone)

Nephrotoxicity

First oral antigfungal agent that could be absorbed systemically

Imidazole

What antifungal requires acidic stomach environment, has a single daily dose and probems with drug interactions/idiosyncracitic hepatotoxicity

Ketaconazole (nizoral)

Imidazole antifungal agent with no significant systemic absorption or side effects

Clotrimazole (Mycelex)

Clotrimazole is _______ tasting, but disadvantage is that it needs to be dissolved in mouth how many times per day?

Pleasant

5

Triazole antifungal agent that is readily absorbed

Fluconazole - Diflucan

Fluconazole - Diflucan is _____ but ______

Convenient (daily dosing)

Expensive

Approved for treating histoplasmosis

Itraconazole (sporanox)

Itraconazole (sporanox):

_____ absorbed, ____ dosing

Side effects?

$?

Well, daily

Minimal

Expensive