Fungal and Parasitic Infections

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Candida albicans,
Spores and pseudohyphae (dimorphism)
30-50% carry the organism
Three factors can determine infection
– The immune status
– The environment of the mouth
– The strain of candida albicans

Types of Candidiasis
• Pseudomembranous
– White removable plaques of yeasts, epithelial cells
and debris
– Underlying mucosa is erythematous or normal
– Non-bleeding

• Cause: Antibiotics, impaired immune system


Differential Diagnosis 2 .

Types of Candidiasis • Erythematous – Acute atrophic: patchy denuded areas. bald tongue – Central papillary atrophy of tongue (median rhomboid glossitis) and chronic multifocal candidiasis – Angular cheilitis (perlèche): sometimes staph. aureus with candida albicans or alone. cheilocandidiasis – Denture stomatitis: Not always associated with candida 3 .

Types of Candidiasis • Chronic hyperplastic – Cannot be removed – Candida albicans can cause hyperkeratosis – Speckled leukoplakia – Presence of epithelial dysplasia 4 .

R.Types of Candidiasis • Mucocutaneous – Immunologic dysfunction – Sporadic or A. – Endocrine-candidiasis syndrome Laboratory Tests for Candidiasis • Exfoliative cytology & histopathology • KOH (10% solution) – Single drop on a slide containing smear tissue. epithelial cells are resolved • Culture in Sabouraud’s agar 5 .

river valleys • Ingested by macrophages. can be absorbed. • Ketokonazole (imidazome): Nizoral. once daily. intravenous use for severe and life-threatening infections • Clotrimazole (imidazole): Mycelex. combination with corticosteroid (Vytone) excellent for angular cheilitis Histoplasmosis • Histoplasma capsulatum • Yeast and mold. acidic environment needed. rarely causes liver toxicity. cannot be absorbed in the GI tract. severe and lifethreatening side effects • Iodoquinol: antifungal and antibiotic properties. flu-like symptoms • Acute (self-limiting). rare liver toxicity. can interact with several medications and cause side effects • Itraconazole (triazole): Sporanox. itraconazole. ketoconazole 6 . drug interactions with erythromycin. chronic (old. plaques or growths. direct contact with fungus • Amphotericin B (polyene): Fungizone. can mimic squamous cell carcinoma • Medications: Amphotericin B. can be absorbed. suspension (not available anymore). COPD. cisapride and astemizole (life threating cardiac arrhythmia) Treatment • Fluconazole (triazole): Diflucan. T-lymphocytic immunity. suspension or pastille. immunosuppressed) and disseminated (AIDS) forms • Mouth: Ulceration.Treatment • Nystatin (polyene): Mycostatin.

erythematous areas Histologically can show pseudoepitheliomatous hyperplasia (mimics squamous cell carcinoma) Paracoccidioidomycosis (South American Blastomycosis) 7 .Blastomycosis • • • • • Blastomyces dermatitidis Same region as histoplasmosis Primarily lung. can become disseminated Mouth: Ulceration.

oral destruction (can mimic malignancy). small blood vessel invasion resulting in infarction • In some cases. severe in immunocompromised patients Zygomycosis (mucormycosis. sinus involvement.Cryptococcosis • Cryptococcus neoformans • Most common life-threatening fungal infection in AIDS – Cryptococcal meningitis – Disseminated skin involvement (head and neck) • Pigeons • Mucopolysaccharide wall for protection • Asymptomatic or flue-like illness. cranial involvement. rarely in healthy individuals • Rhinocerebral involvement • Nasal obstruction. cellulitis. phycomycosis) • Saprobic organism • Insulin-dependent diabetics with uncontrolled disease or ketoacidosis. immunocompromised patient. therapy should start prior to culture results 8 .

Aspergillosis • Aspergillus flavus & fumigatus (most frequent) • Noninvasive and invasive • Invasive: immunocompromised patients and diabetics • Allergic fungal sinusitis • Aspergilloma and antrolith • Fungi occlude vessels Parasitic infections • Toxoplasmosis – Developing fetus – Immunocompromised patients • AIDS. transplant & cancer patients • Leishmaniasis (kala-azar) – AIDS – Cutaneous involvement – Rarely intraoral lesions 9 .