“FUNGAL INFECTIONS”

PRESENTED BY:HAFSA SARA ZUBAIRBDS

INTRODUCTION

• Fungi are eukaryotes, grows predominantly by budding (yeast), or by filamentous extension called hyphae (moulds).

• They are extremely common organism widely distributed in nature.

• Fungal infections tends to be chronic and may require prolong chemotherapy.

• In recent years fungal infection have become much more important in immunocompromised people ( AIDS, DIABETIC, CANCER patient).

CANDIDAL INFECTION / CANDIDIOSIS

• Fungal infection of oral mucosa most frequently encountered are those due to species of genus CANDIDA.

• CANDIDA ALBICANS are principle species associated with infections.

• C.glabrata, C. Tropicalis, C. Krusei, C. Parapsilosis are also pathogenic for man.

• CANDIDA ALBICAN >>>>> commensal organism in the mouth of 40% of population.

• Opportunistic pathogens >>>>> Whenever balance between host and organism is disturbed.

• They act by altering the homeostasis mechanism which maintain host organism balance.

MECHANISM BY WHICH CANDIDA EXERT PATHOLOGICAL EFFECT ON TISSUE:

Enables hyphae to invade oral apithelium

They secrete variety of enzymes (proteinases and phospholipases)

In addition,

Plays role in oral carcinogenesis

Also produce NITROAMINE compound

Tissue injury

Also induce a delayed hypersensitivity reaction

GROUP 1: Primary oral candidoses- confined to the oral mucosa

ACUTE: 1. Pseudomembranous candidosis (thrush) 2. Erythematous candidosis (atrophic)

CHRONIC: 1. Pseudomembranous candidosis 2. Erythematous candidosis 3. Hyperplastic candidosis (candidal leukoplakia)

CANDIDA ASSOCIATED LESIONS: 1. Denture stomatitis 2. Angular cheilitis 3. median rhomboid glossitis

CLASSIFICATION OF ORAL CANDIDOSIS

GROUP 2: Secondary oral candidosis- manifestation of generalized candidosisSystemic mucocutaneous candidosis (hereditary and sporadic types associated with systemic disorders e.g. Endocrine disorders, immunodefficiency states)

PSEUDOMEMBRANOUS CANDIDOSIS

• Also known as thrush.

CLINICALLY:• Appear as adherent white plaque that resembles cottage cheese Or curdled milk on oral mucosa.•May also be present on palate and dorsum of tongue.• Can be wiped away to leave re, raw and often bleeding base.

Pseudomembranous plaque consist of:- Hyphae- Yeast- Desquamative epithelial cells- Debris- Infiltration of neutrophils and fibrin

SYMPTOMS:• Burning sensation of oral mucosa• Unpleasant taste in the mouth• Sometimes patient complains of blisters.

PREDISPOSING FACTORS:- Immunodeficiency - Anaemia- Supression of normal oral flora by antibacterial drugs- xerostomia- Denture wearing- Smoking

MANAGEMENT:- Topical antibiotic treatment (may alone cause thrush to

resolve)IF NOT,

- Course of nystatin or amphotericin lozenges >>> allows normal flora to return to normal.

- HIV infection shoul always be suspected when thrush is seen.IN SUCH PATIENTS,

- Candidosis may respond to flucanazole or itraconazole.

ERYTHREMATOUS CANDIDOSIS

• Seen most commonly on dorsum of tongue in patient undergoing prolonged corticosteroid or antibiotic therapy.• More common then pseudomembranous candidosis.

CLINICAL PRESENTATION:- Antibiotic sore mouth (due to antibiotic therapy)- Burning sensation in mouth- Reddened bald appearance of tongue (due to loss of

filliform papilla)Patient who suffer from xerostomia for any reason (e.g. Pharmacological, postradiation therapy, sjogren syndrome) have an increased prevelence of erythematous candidosis.

HISTOPATHOLOGICAL FEATURES:- Atrophic epithelium containing few hyphae in

superficial layer.- Lamina propria shows mild acute inflammatory

infiltrate and increased vascularity.- Microabscesses may be seen in superficial epithelial

areas.

HISTOPATHOLOGICAL FEATURES:

- Atrophic epithelium containing few hyphae in superficial layer.

- Lamina propria shows mild acute inflammatory infiltrate and increased vascularity.

- Microabscesses may be seen in superficial epithelial areas.

MANAGEMENT:

- Itraconazole is usually effective.

CHRONIC HYPERPLASTIC CANDIDOSIS

• Also known as candidal leukoplakia because of its firm presentation as firm and adherent white patches occuring in oral mucosa.

CLINICAL FEATURES:

- Occurs in man of middle age or over- Heavy smokers- white leathery bilateral plaques are found.- cannot be scraped off.- Fissures occasionally present.- rough and nodular surface- Palate or tongue may be involved.

HISTOLOGICALLY:- Epithelium shows hyperparakeratosis and irregular

acanthosis.- Cells are separated by oedema and numerous

neutrophil leukocytes.- neutrophil often collecting as microabscesses.- Candidal hyphae invade the parakeratin butnever

penetrate into prickle cell layeR- Inflammatory cells are present.- Areas os atrophic epithelium.- Cellular atypia is seen.

MANAGEMENT:- Stopping the patient from smoking.- Fluconazole for several months.- Any iron deficiency should be treated.- Vigorous antifungal therapy.

CANDIDAL HYPHAE INFILTRATE

CANDIDA-ASSOCIATED DENTURE STOMATITIS (CHRONIC ATROPHIC CANDIDOSIS)

• Due to wearing of ill fitting dentures.• poor dental hygiene.• Wearing denture througout night.• increase carbohydrate diet.

CLINICALLY:- Chronic erythema- oedema of mucosa

• Three pattern of inflammation can be identified (NEWTONS CLASSIFICATION)

1. Pin point areas of erythema – localized inflammation2. Diffuse area of erythema – generalised inflammation3. Erythema associated with granular or multinodular

mucosal surface.

HISTOLOGICALLY:- Mild acanthosis with prominent blood vessels.- Inflammatory infiltrate

MANAGEMENT:- Antifungal drugs- Elimination of c.albicans from denture base is important and can be

achieve by soaking denture in 0.1% hypochlorite or dilute chlorhexidine overnight.- coat fitting surface of the denture with miconazole gel .- Denture must be removed and scrubbed clean at intervals and miconazole

re-applied three times a day.

ANGULAR CHEILITIS

• Multifactorial disease• Occurs in denture wearers.

CLINICALLY:- Soreness - erythema- Fissuring at corner of mouth.- deep fold skin at the angles of mouth.

PREDISPOSING FACTORS:- Iron deficiency- Deficiency of riboflavin- deficiency of folic acid - Deficiency of vitamin B12

MANAGEMENT:- Apply miconazole gel 24mg/ml to the angles of the

mouth 10 days.OR

- Fusidic acid cream.

MEDIAN RHOMBOID GLOSSITIS

• Located in the midline of dorsal surface of tongue =, just anterior to foramen caecum.

CLINICALLY:- Rhomboid in shape.- devoid of papillae- surface appear reddish in colour- sirface smooth, nodular, or fissured- Usually asymptomatic

• In smokers, an opposing (kissing) lesion may be seen on the palate.

Infection of superficial epithelial layers and development of lesion

Allows candidal hyphae to proliferate

Trauma or variation in the surface anatomy

o HISTOLOGICALLY:

- Devoid of lingual papillae- Epithelial atrophy- parallel sided rete process- Surface covered by parakeratotic acanthotic squamous

epithelium.- Neutrophil infiltration- Fibrosis

MANAGEMENT:- Antifungal drugs

CHRONIC MUCOCUTANEOUS CANDIDOSIS

• Superficial candidal infection of mucosa, nails and skin.

CLINICALLY:- Thick white plaque present- cannot be wiped off

HISTOPATHOLOGICAL FEATURES:- On PAS, candidal hyphae and yeast are readily

identified.-

Thank you…..