good presentation for students

1. “FUNGAL INFECTIONS”
PRESENTED BY:
HAFSA SARA ZUBAIR
BDS

2. 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).

3. 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.

4. 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

5. 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
candidosis
Systemic mucocutaneous candidosis (hereditary and sporadic types
associated with systemic disorders e.g. Endocrine disorders,
immunodefficiency states)

6. 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.

7.  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.

8. 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.

9. 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.

10. 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.

11. 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.

12. CANDIDAL HYPHAE INFILTRATE

13. 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 inflammation
2. Diffuse area of erythema – generalised inflammation
3. Erythema associated with granular or multinodular mucosal surface.

14.  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.

15. 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

16.  MANAGEMENT:
- Apply miconazole gel 24mg/ml to the angles of the mouth 10
days.
OR
- Fusidic acid cream.

17. 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

18. 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

19. 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.
-

20. Thank you…..