Most deep fungal infections have their primary foci in the lungs, therefore those presenting with distant organs or skin involvement should be managed aggressively as untreated or severe disease can lead to severe scarring, disfigurement and even death.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
describes the etiopathogenesis , clinical features, investigations, differential diagnosis and management and prophylaxis of all important viral lesions affecting the oral cavity
Dental Plaque
Soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable & fixed restorations”
Bowen , 1976
Bacterial aggregations on the teeth or other solid oral structures
Lindhe, 2003
Describe relationship between plaque and oral diseases
Describe role of plaque in development of caries
Define Dental Caries
Describe the aetiology and the role different factors play in ini4a4on and progression of the disease
Describe the role played by different microorganisms
Certains medications have been associated with gingival enlargement.
the seminar gives a complete analysis of etilogy and pathogenesis involved in digo as well as sequlae of it
Tuberculosis is a disease characterized by granulomatous lesions caused by Mycobacterium Tuberculosis. A German scientist Robert Koch discovered the causative organism of TB in 1882.
Since time immemorial, it has been a global health problem. TB has shown a decline in its prevalence globally; however, it is still highly prevalent in Asian countries.
TB is usually overlooked in the differential diagnosis of oral lesions as it is supposed to be a rare entity.
Oral manifestations of TB occur either due to infected sputum or due to hematogenous spread.
TB is an age old disease and has been known to mankind for thousands of years.
Not only the lesions in the body helps us to know about syphilis but also a minute nodule or lesion helps us to discover the syphilis. He who knows syphilis knows the medicine well. Earlier you found the disease the treatment and the prognosis will be good. Discover syphilis through your body's gateway.
Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
describes the etiopathogenesis , clinical features, investigations, differential diagnosis and management and prophylaxis of all important viral lesions affecting the oral cavity
Dental Plaque
Soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable & fixed restorations”
Bowen , 1976
Bacterial aggregations on the teeth or other solid oral structures
Lindhe, 2003
Describe relationship between plaque and oral diseases
Describe role of plaque in development of caries
Define Dental Caries
Describe the aetiology and the role different factors play in ini4a4on and progression of the disease
Describe the role played by different microorganisms
Certains medications have been associated with gingival enlargement.
the seminar gives a complete analysis of etilogy and pathogenesis involved in digo as well as sequlae of it
Tuberculosis is a disease characterized by granulomatous lesions caused by Mycobacterium Tuberculosis. A German scientist Robert Koch discovered the causative organism of TB in 1882.
Since time immemorial, it has been a global health problem. TB has shown a decline in its prevalence globally; however, it is still highly prevalent in Asian countries.
TB is usually overlooked in the differential diagnosis of oral lesions as it is supposed to be a rare entity.
Oral manifestations of TB occur either due to infected sputum or due to hematogenous spread.
TB is an age old disease and has been known to mankind for thousands of years.
Not only the lesions in the body helps us to know about syphilis but also a minute nodule or lesion helps us to discover the syphilis. He who knows syphilis knows the medicine well. Earlier you found the disease the treatment and the prognosis will be good. Discover syphilis through your body's gateway.
Oral Mycotic Infections Candidiasis (Candidosis, Moniliasis, Thrush) /orthodo...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Fungi were found by Heinrich Anton de Bary in 1858.
Most fungi cause skin or cosmetic infections while bacteria & viruses cause fatal diseases.
Organ transplantation, Immunosuppressive drugs,Anticancer drugs, Broad-spectrum antimicrobials ,HIV-disease leads to Immunosuppression causing Opportunistic Fungal Infections
This PowerPoint presentation demonstrate a useful review of Oral candidiosis, including its different types, clinical presentations, differential diagnosis, and treatment options.
this ppt is about different types of candidiasis. it describes about predisposing factors, classification and types of candidiasis. clinical & histological features of all types of candidiasis with pictures is discussed along with differential diagnosis, investigations and treatment.
Oral Candidiasis also referred to as oral thrush is commonly encountered in a daily life of a dentist. An overview on this topic for undergraduate students.
Pleomorphic adenoma of the buccal salivary glandPrashant Munde
Salivary gland swellings can result from tumors, an inflammatory process
or cysts. It can sometimes be difficult to establish; whether pathology arises
from the salivary gland itself or adjacent structures. Neoplasms of the salivary
glands account for less than 1% of all tumors, 3–5% of all head and neck
tumors and benign pleomorphic adenoma (PA) of minor salivary glands arising
de novo is very rare. PA is the most common tumor of the salivary gland. While
the majority arises from the parotid gland, only a small percentage arises from
the buccal minor salivary gland. A case of PA of minor salivary glands in the
buccal mucosa in a 70‑year‑old female is discussed. It includes review of
literature, clinical features, histopathology, radiological findings and treatment
of the tumor; with emphasis on diagnosis.
Pericytes are the perivascular or mural cells of micro vessels. They are of mesenchymal origin and capable of differentiating into a number of different cell lineages. They are intimately associated with endothelial cells and communicate with them via direct physical contact or through paracrine signaling pathways. These interactions are important for blood vessel maturation, remodelling, and maintenance. Pericytes are versatile and their varying morphological characteristics and distribution make them difficult to study. The lack of universal pericytes markers is a major problem. A number of different functions have been attributed to pericytes, and in some organs they have more specific roles. The role of pericytes in tumor vessels is debated, but pericytes may contribute to stability, and might protect the vessels from antiangiogenic therapy. Understanding the process of angiogenesis in angiogenesis dependent diseases role of pericytes may be of therapeutic benefit.This article gives an overview of pericytes their role in health and disease particularly in relation to oral cavity.
The objective of this review is to introduce Merkel cells (MCs), to provide a basic
overview on the theoretical background of function, development and clinical
importance of MCs. The origin of human MCs have been controversial. Some
investigators believe that it is a neural crest derivate, whereas others have
proposed that it is a differentiation product of the fetal epidermal keratinocytes.
MCs are cells primarily localized in the epidermal basal layer of vertebrates
and concentrated in touch‑sensitive areas in glabrous, hairy skin and in some
mucosa. In routine light microscopy, human MCs can hardly be identified.
Cytokeratin 20 (CK20) is a reliable marker with highest degree of specificity.
MCs can be also distinguished by electron microscopy. MC carcinoma (MCC)
is an uncommon and often aggressive malignancy and found mainly in elderly
patients. It occurs most frequently in the head and neck region. Diagnosis is
based on typical histological presentation on hematoxylin and eosin (H and E)
stained slides together with the results of immunohistochemistry. Histologically,
MCC has been classified into three distinct subtypes: Trabecular, intermediate
and small cell type.
With the discovery in 1956 that the correct chromosome number in humans is 46, the new era of clinical
cytogenetics began its rapid growth. During the next few years, several major chromosomal
syndromes with altered numbers of chromosomes were reported, i.e. Downsyndrome (trisomy21),
turner syndrome (45,x) and klinefelter syndrome (47,xxy). Since then it has been well established that
chromosome abnormalities contribute significantly to genetic disease resulting in reproductive loss,
infertility, stillbirths, congenital anomalies, abnormal sexual developmentmental retardation and
pathogenesis of malignancy.specific chromosome abnormalities have been associated with over 60
identifiable syndromes. They are present in at least 50% of spontaneous abortions, 6% of stillbirths,
about 5% of couples with two or more miscarriages and approximately 0.5% of newborns. In women
aged 35 or over, chromosome abnormalities are detected in about 2% of all pregnancies. Some of the
abnormalities and their clinical consequences will be Discussed in the following sections.
Chondroblastic osteosarcoma of the left zygomatic bone rare case report and ...Prashant Munde
Chondroblastic osteosarcoma (COS), a subgroup of intramedullary
osteosarcoma (OS), is the most common osteosarcoma that occurs in
adolescents and early adulthood. The COS has similar clinical and radiological
features to those of conventional OS. We present a case of 20‑year‑old male
patient with the chief complaint of pain and swelling in the left zygomatic region.
The computed tomography (CT) and three‑dimensional (3D) CT face showed
erosion, calcific foci, sunray type of spicules suggestive of OS. On fine‑needle
aspiration cytology (FNAC) examination, initial diagnosis was malignant
chondroid lesion, with differential diagnosis of mesenchymal chrondrosarcoma,
COS on incisional biopsy and finally COS on excisional biopsy. The patient
underwent radical resection of left zygomatic arch, followed by chemotherapy.
Although clinically unsuspected in this unusual site, histopathology along with
immunohistochemistry (IHC) results confirmed the COS. Because zygomatic
location of COS is very rare, this report aimed to discuss clinical, radiographic,
histopathologic, IHC findings and diagnostic pitfalls of COS in light of the
literature.
Orofacial pain in patients with cancer a review Prashant Munde
Orofacial pain is commonly associated with cancer and may motivate patients to seek care from an oral and maxillofacial surgeon. Pain may be a presenting symptom of primary tumors, metastatic disease, systemic cancer, or distant non-metastasized cancer. Patients with head and neck cancer undergoing therapy may suffer treatment-induced complications, which are often associated with acute pain. Following cancer therapy, permanent changes to tissues may cause late effects of treatment that may result in chronic orofacial pains. Oral and maxillofacial surgeons should be knowledgeable regarding these orofacial pain presentations.Orofacial pain is commonly associated with cancer and may motivate patients to seek care from an oral and maxillofacial surgeon. Pain may be a presenting symptom of primary tumors, metastatic disease, systemic cancer, or distant non-metastasized cancer. Patients with head and neck cancer undergoing therapy may suffer treatment-induced complications, which are often associated with acute pain. Following cancer therapy, permanent changes to tissues may cause late effects of treatment that may result in chronic orofacial pains. Oral and maxillofacial surgeons should be knowledgeable regarding these orofacial pain presentations.
Investigations in hemorrhegic disorders ppt Prashant MunePrashant Munde
Clinical assessment, pertinent history, and family history are good indicators for determining patient's bleeding tendencies.
The most appropriate laboratory tests performed are Routine screening tests include a complete blood cell count, platelet count, and evaluation of a peripheral blood sample, a prothrombin time, and an activated partial thromboplastin time.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS
Oral mycotic infections
1.
2. Presented by:
Dr.Prashant Munde
( MDS- I )
Guided by :
Dr. Mrs. SHUBHANGI KHANDEKAR
( PROFESSOR & GUIDE )
Dr. Mrs. ALKA DIVE
( PROFESSOR & H.O.D)
MYCOTIC INFECTIONS OF
THE ORAL CAVITY
SEMINAR
3. INTRODUCTION
• Mycotic infections are fungal infection of
animals, including humans.
• Mycotic infections are common and a variety of
environmental and physiological conditions can
contribute to the development of fungal
diseases.
• Inhalation of fungal spores or localized
colonization of the skin may initiate persistent
infections; therefore, Mycotic infections often
start in the lungs or on the skin.
4. The fungi that cause subcutaneous Mycotic
infections normally reside in soil or on
vegetation.
They enter the skin or subcutaneous tissue
by traumatic inoculation with contaminated
material.
In general, the lesions become granulomatous
and expand slowly from the area of
implantation to local lymph nodes.
5. Extension via the lymphatics draining the
lesion is slow except in sporotrichosis.
Mycotic infections are usually confined to
the subcutaneous tissues, but in rare
cases they become systemic and produce
life-threatening disease.
6. CAUSES
• People are at risk of fungal infections when
they are taking strong antibiotics for a long
period of time because antibiotics kill not only
damaging bacteria, but healthy bacteria as
well.
• This alters the balance of microorganisms in
the mouth, vagina, intestines and other places
in the body, and results in an overgrowth of
fungus.
7. Individuals with weakened immune systems
• with HIV/AIDS,
• under steroid treatments, and taking
chemotherapy.
• with diabetes also tend to develop fungal
infections.
• Very young and very old people, also, are
groups at risk.
8. PATHOGENESIS
• The response to infection with many fungi is
the formation of granulomas.
• Granulomas are produced in the major
systemic fungal diseases, e.g.,
coccidioidomycosis, histoplasmosis, and
blastomycosis, as well as several others.
• The cell-mediated immune response is
involved in granuloma formation.
9. • Activation of the cell-mediated immune
system results in a delayed hypersensitivity
skin test response to certain fungal antigens
injected intradermally.
• Acute suppuration( pyogenic response ),
characterized by the presence of neutrophils
in the exudate, also occurs in certain fungal
diseases such as aspergillosis and
sporotrichosis.
10. • Intact skin is an effective host defense
against certain fungi (e.g., Candida,
dermatophytes), but if the skin is damaged,
organisms can become established.
• The normal flora of the skin and mucous
membranes suppress fungi.
• When the normal flora is inhibited, e.g., by
antibiotics, overgrowth of fungi such as
C. albicans can occur.
12. CANDIDIASIS
(Candidosis,moniliasis,thrush)
• The fungal infections of the oral mucosa most
frequently occurred due to species of Candida,
Candida albicans.
• Infections can be short-lived, superficial skin
irritations to exaggerated , fatal systemic
diseases.
• Candida is present as a commensal organism in
the mouth of up to 40% of subjects with
clinically normal mouths.
13. • The number of organisms in the saliva of the
carrier increased with pregnancy, tobacco smoking
and with wearing of dentures.
• Account for 80% of nosocomial fungal
infections
• Candida is also present as a commensal
organism in throat ,lung, bowel and vagina.
• The primary oral reservoir for the organism in
carriers in the dorsum of the tongue .
14. • Isolation of the Candida from the mouth of an
adult is not confirmatory evidence of infection
and must be considered together with the clinical
findings .
• The histological sections must show the hyphae
but not spores alone to confirm the diagnosis.
• Budding cells of varying size that may form both
elongate pseudohyphae and true hyphae.
• Forms off-white, pasty colony with a yeasty odor.
15. • Both general and local predisposing
factors are important in the pathogenesis
of oral Candida infections for example;
debilitated patients , such as those
receiving antibiotic, steroid or cytotoxic
therapy are particularly susceptible to
Candida infections, with local factors
such as tobacco smoking ,trauma and
xerostomia.
16. Factors predisposing to oral
candidal infection.
*Local factors:
• Mucosal traumas
• Denture wearing
• Tobacco smoking
*Age:
• Extremes of age ;
• neonates ,infants, old age
*Drugs:
• Broad –spectrum antibiotics
• Steroids, Local systemic.
• Immunosuppressant
20. ACUTE PSEDOMEMBRANEOUS
CANDIDOSIS(THRUSH)
• Most common form of the candidosis
• Generally associated with local disturbance or
systemic illness
• Thrush occurs in up to 5% of new born
infants, which is probably associated with
immature antimicrobial defences, also its seen
in about 10% of elderly debilitated patient .
22. Acute Pseudomembranous Candidosis (Thrush)
presents clinically as a soft, thick white coating
slightly elevated plaques.
The white plaques on the affected mucosa, which
can be wiped away
to leave a red, or
normal appearing
mucosa .
23. The white plaques grossly resembling milk curds,
consists of tangled mass of fungal hyphae with
intermingled desquamatated epithelium,keratin
fibrin, necrotic debris, leukocytes, and bacteria.
24. Lesions may occurs on
any mucosal surface of
the mouth and vary in
size from small patches
to confluent lesions
covering a wide area.
Most frequently present
on buccal mucosa & tongue
but also seen on palate
,gingiva & floor of mouth.
In severe cases entire oral
cavity may be involved.
26. ACUTE ATROPHIC (ERYTHEMATOUS)
CANDIDIOSIS.
• Also known as ANTIBIOTIC SORE MOUTH
• Seen most commonly on the dorsum of the
tongue in patients undergoing prolonged
corticosteroid or antibiotic therapy.
• present as a red rather than
white and often painful area of
oral mucosa which resembles
thrush without the overlying
psedomembrane.
27. • Usually occurs as a
sequelae to a course of
broad spectrum
antibiotics.
• Generalized pain, burning,
erythema
• May occur at any site
• Red and consisistently
painful
Comes under category of Erythematous Candidosis
Includes
Central paipllary atrophy of the tongue
cheilocandidiasis
28. Central papillary atrophy of the tongue
Median Rhomboid Glossitis
• Asymptomatic, symmetric ,
erythematous lesion on dorsal
aspect of post. region of tongue,
Just anterior to foramen cecum.
• Red depapillated smooth or
fissured, due to loss of filiform
papillae
• Strong association with chronic
smoking
• Etiologic debate
– Developmental or chronic
candidal infection
30. CHRONIC ATROPHIC CANDIDOSIS
( DENTURE STOMATITIS)
• This is common and usually symptomless
condition found in about 50% of denture
wearer ,more frequently in women than in man.
• Clinically there is chronic erythema and
oedema of the mucosa directly covered by the
denture.
• The palate is usually affected but it is very
unusual to see lesions related to lower
dentures.
31. CHRONIC ATROPHIC CANDIDOSIS
(denture stomatitis)
– May be asymptomatic
– Candida colonize the
denture surface
– Minimal or no candidal
invasion of mucosa
- Secondary infection by Candida in tissues
modified by continual wearing of dentures
Poor denture hygiene
High carbohydrate diet
32. Clinically ,patterns of inflammations
can be identified
1- Pin - point of erythema – localized
inflammation.
2- Diffuse area of erythema –
generalized inflammation.
3- Erythema associated with a
granular or multinodular mucosal
surface, chronic inflammatory
papillary hyperplasia.
33. ANGULAR CHEILITIS
• Multifactorial disease of
infectious origin
• Fungal or bacterial or
combined
– Candida or Staph aureus
or Streptoccocci
• Mainly in denture wearers
– 30% of patient with
denture stomatitis have
anguar cheilitis
34. Clinically characterized by
soreness, erythema ,Cracks,
crusts, pain and fissuring at the
corners of mouth.
– Loss of vertical dimension
– Deep folds of skin at angles of
mouth
– Nutritional deficiencies
Iron ,folic acid , B12
36. CHRONIC HYPERPLASTIC CANDIDOSIS.
(candidal leukoplakia)
• Commonly referred to as candidal leukoplakia,
presents clinically as a persistent firm,
adherent white plaques on the oral mucosa
which is indistinguishable from leukoplakia.
• They cannot be removed by scraping but
fragments may be detached and identification
of hyphae in smears of such material assists
in diagnosis.
37. Chronic Hyperplastic Candidosis
(Candidal Leukoplakia)
• The lesions present as
dense ,opaque white
patches of irregular
thickness with a rough
or nodular surface.
• Most frequent
location:
• Lips , tongue,
buccal mucosa at
commissures
38. • It is considered to be a premalignant lesion
and epithelial dysplasia is seen in about 50%
of cases.
• It is not been conclusively shown whether
chronic hyperplastic candidosis is primarily
leukoplakia with a secondary candidal
infection or whether its primarily a chronic
candidal infection which in time leads to
epithelial hyperplasia and acanthosis.
39. • According to Cawson and Binnie , there is a
definite relationship between chronic
candidiasis and oral epidermoid carcinoma
basing on this , chronic candidiosis itself is a
cause of leukoplakia and thus must be regarded
as having possible premalignant potential.
• Roed -peterson and his associates have
reported a high incidence of candida organisms
and occurance of cytological epithelial atypia in
the biopsied lesions of leukoplakia.
41. • This is a group of disorders characterized
by persistent superficial candidal infections
of the skin, scalp, nails & mucous membranes
• Oral mucosa involved in most cases
• similar to chronic hyperplastic
candidiasis and occur in same
intraoral locations.
CHRONIC MUCOCUTANOUS
CANDIDOSIS
42. • Oral manifestations occur in numerous
forms of candidiasis and these have been
categorised and modified by Lehner, and
includes the -
o CHRONIC LOCALISED MUCOCUTANEOUS
CANDIDIASIS
o CHRONIC DIFFUSE MUCOCUTANEOUS
CANDIDIASIS
o CANDIDASIS ENDOCRINOPATHY SYNDROME
43. FEATURESSUBGROUP
Severe form occuring in early life, no
genetic transmission,Widespread skin
involvement and granulomatous and
horny masses on scalp, nail and face.
CHRONIC LOCALISED
MUCOCUTANEOUS
CANDIDIASIS
Least common form, of late onset
Severe skin and oral lesions raised
crusty sheets involving groin,limbs,
face , scalp, shoulder, nails, and mouth.
CHRONIC DIFFUSE
MUCOCUTANEOUS
CANDIDIASIS
Genetically transmitted (AR)
Mildmoderate oral and skin lesions
Hypoparathyrodism,Addison's disease
,D.M or ovarian insufficiency.
CANDIDASIS
ENDOCRINOPATHY
SYNDROME
CHRONIC MUCOCUTANOUS CANDIDOSIS
45. ETIOLOGY AND PATHOGENESIS
Deep fungal infections are characterized by
primary involvement of the lungs.
Infections may disseminate from this focus to
involve other organs.
Oral infections typically follow implantation of
infected sputum in oral mucos or may also follow
hematogenous spread of fungus from another site
such as the lung.
46. Oral manifestation of deep
fungal infections
• Oral lesions are relatively
uncommon presenting most
frequently as non-specific
ulceration or as nodular
granulomatous lesion.
47. A. North american blastomycosis
(gilchrist’s disease)
B. South american blastomycosis
(paracoccidioidomycosis)
C. Histoplasmosis
( darling’s disease)
D. Coccidioidomycosis:
(san joaquin valley fever)
E. Cryptococcosis
F. Phycomycosis
G. Sporotrichosis
49. North American Blastomycosis
(Gilchrist’s disease)
• Blastomyces dermatitidis- causes blastomycosis
• Free-living species distributed in soil of a large
section of the north U.S.
• Inhaled 10-100 conidia convert to yeasts and
multiply in lungs.
• Affects mainly lungs and nearly 50% of those
infected show cough and fever or no symptom.
• It may spread to other parts of the body,
skin is involved in 20% to 40% of cases.
50. Cutaneous features
Skin lesions are common on the face, neck and
the extremities as the infection spreads from
the lungs to other parts of the body.
Lesions begin as papules, pustules or as
subcutaneous nodule. Within weeks to months,
the lesions develop into ulcers and form crusty
sores.
51. Clinically, the chronic, non healing oral ulcers
may resemble those of epidermoid carcinoms
and cervicofacial actinomycosis.
Over a period of months to years, lesions
grow larger and heal to form raised wart-like
scars.
Lesions may cover much of the face causing
severe disfigurement.
52. Figure 2-25 Blastomycosis showing granuloma (macrophages) with a central abscess.
The basic inflammatory response in a deep fungal infection is
granulomatous.
In the presence of these microorganisms, macrophages and
multinucleated giant cells dominate the histologic picture .
Peculiar to blastomycosis is pseudoepitheliomatous
hyperplasia, associated with superficial infections in which
ulceration has not yet occurred.
53. Histologic freatures:-
Inflammed connective tissue shows giant cells and
macrophages and typical round budding organisms with
doubly refractile capsule measuring between 5 to 15
microns in diameter.
54. TREATMENT
• Those suffering from mild symptoms require
no treatment as symptoms are usually self-
limiting and the infection clears
spontaneously
• When other organs or skin are involved,
sponteneous resolution does not occur
• Itraconazole – oral
• Amphotericin B – intravenous
56. South American Blastomycosis
(Paracoccidioidomycosis)
• Paracoccidioides brasiliensis
• Distributed in Central and South America
• Lung infection occurs through inhalation or
inoculation of spores.
• Systemic lesions are similar to those of North
American Blastomycosis
57. • The organisms enter the body
through periodontal tissues and
subsequently reach the regional lymph
nodes, producing lymphadenopathy,
• Papillary lesions & Widespread
ulcerations of the oral cavity
58. The difference between north and South American
Blastomycosis is in size of micro organisms.
South American Blastomycosis 10 to 60 microns in
diameter
North American Blastomycosis 5 to 15 microns in
diameter.
South American Blastomycosis North American Blastomycosis
59. Diagnosis and Treatment
• Presumptive diagnosis made if budding yeast
cells and pseudohyphae are found.
• Growth on selective, differential media
differentiates Candida species
• Topical antifungals for superficial infections,
amphotericin B and fluconazole for systemics
61. HISTOPLASMOSIS ( Darling’s Disease)
Ohio Valley Fever
Caused by Histoplasma capsulatum ,
worldwide in distribution, although it is
endemic in the northestern United States.
The organism multiplies in soil enriched with
the droppings of birds and bats and the
spores remain viable for years.
Infection is by inhalation of infected dust
containing spores of fungus excreta of birds ,
such as pigeons, starlings and blackbirds.
62. HISTOPLASMOSIS- PATHOLOGY
• The parasite in its yeast phase multiplies in
the monocytes and macrophages and
produces areas of necrosis where parasites
may abound.
• From these foci the blood stream may be
invaded producing metastatic lesions in the
liver, spleen and lymph nodes.
• Pulmonary histoplasmosis may produce
changes similar to those of tuberculosis.
63. The ulcerated areas are covered by
nonspecific grey membrane and are indurated.
They appear as nodular ,ulcerative , or
vegetative lesions on the buccal mucosa, gingiva ,
tongue, palate , or lips.
Figure 2-23 Histoplasmosis-caused chronic ulcers.
65. HISTOPLASMOSIS-
MANAGEMENT
• Only symptomatic acute pulmonary
histoplasmosis, chronic histoplasmosis and
acute disseminated histoplasmosis require
therapy.
• Itraconazole or ketoconazole are indicated
for moderate disease. Severe infection is
treated with intravenous amphotericin B to a
total dose of 1.5 g followed by itraconazole.
67. Coccidioidomycosis:
San Joaquin Valley Fever
• Coccidioides immitis - causes coccidioidomycosis
• Distinctive morphology – blocklike arthroconidia
in the free-living stage and spherules containing
endospores in the lungs.
• Lives in alkaline soils in semiarid, hot climates and
is endemic to southwestern U.S.
68. • Arthrospores inhaled from dust,
creates spherules and nodules in the
lungs.
• A skin eruption resembling erythema
multiforme occasionally appears
concomitantly with coccidioidomycosis
infection
• Amphotericin B treatment
70. CRYPTOCOCCOSIS
• Cryptococcus neoformans causes
cryptococcosis.
• A widespread encapsulated yeast that
inhabits soil around pigeon roosts
• Common infection of AIDS, cancer or
diabetes patients.
71. • Infection of lungs leads to cough,
fever, and lung nodules
• Dissemination to meninges and brain
can cause severe neurological
disturbance and death.
72. Diagnosis and Treatment
• Negative stain demonstrating
encapsulated budding yeast
• Biochemical tests, serological testing
• Systemic infection requires
amphotericin B and fluconazole.
74. • Phycomycosis, also known as mucormycosis,
fungal infections caused by the genera Mucor
and Rhizopus.
• Organisms in this family of fungi, which
normally are found in bread mold or decaying
fruit and vegetables, are opportunistic,
infecting humans when systemic health is
compromised.
PHYCOMYCOSIS/ ZYCOMYCOSIS
75. • In the head and neck, lesions are most likely to occur in
the nasal cavity, paranasal sinuses, and oropharynx.
Pain and swelling precede ulceration.
• Tissue necrosis result in perforation of palate. Extension
into the orbit or brain is a common complication.
• The fungus has a predilection for arterial wall invasion,
which may lead to infarction.
76. PHYCOMYCOSIS/ Zycomycosis
Microscopically, an acute and chronic inflammatory infiltrate
is seen in response to the fungus .
The organism is usually readily identified in hematoxylin and
eosin-stained sections in areas of tissue necrosis.
Characteristic necrotic vessel walls containing thrombi and
fungi may be evident.
Microscopically, the
fungus consists of large,
pale-staining, nonseptate
hyphae that tend to
branch at obtuse angles.
Round or ovoid sporangia
are also frequently seen
in tissue sections.
78. SPOROTRICHOSIS
Caused by Sporothrix schenckii lives as a
saprophyte on plants in many areas of the
world.
In which portal of entry is not entirely
understood.
Reported to occur after-
Exposure to animals
Accidental injury to thorns of plants
Lab. or clinical inoculation of hospital
workers
79. Etiology and Pathogenesis
Subcutaneous Fungal Infections affect primarily
subcutaneous tissues results from inoculation of
the skin or mucosa by contaminated soil or
thorny plants.
After an incubation period of several weeks,
subcutaneous nodules, which frequently become
ulcerated, develop.
Systemic involvement is rare but may occur in
individuals with suppressed immune responses.
80. Clinical Manifestations
Involve skin, subcutaneous tissue,oral, nasal and
pharangeal mucosa.
Skin lesions appear as red papule often described as
“Sporotrichotic chancres “forms at the site of
inoculation.
Oral lesions are described as nonspecific ulcerations
healing by soft pliable scars.
Over the next several weeks, similar nodules form
along proximal lymphatic channels.
The nodules intermittently discharge small amounts
of pus and ulceration may occur.
81. SPOROTRICHOSIS-
Diagnosis
• Culture of pus, joint fluid, sputum, or
a skin biopsy specimen is preferred.
• In skin lesions, the organisms are
hard to find because of small size of
fungus 3-5 microns.
• It can be cultered on SDA
83. LABORATORY DIAGNOSIS
• There are four approaches to the
laboratory diagnosis of fungal diseases:
(1) DIRECT MICROSCOPIC EXAMINATION,
(2) CULTURE OF THE ORGANISM,
(3) DNA PROBE TESTS, AND
(4) SEROLOGIC TESTS.
84. • Direct microscopic examination of clinical
specimens such as sputum, lung biopsy material,
and skin scrapings depends on finding
characteristic asexual spores, hyphae, or yeasts
in the light microscope.
• The specimen is either treated with 10% KOH to
dissolve tissue material, leaving the alkali-
resistant fungi intact, or stained with special
fungal stains.
DIRECT MICROSCOPIC
EXAMINATION
85. Some examples of diagnostically important
findings made by direct examination are
(1) spherules of C. immitis and
(2)wide capsule of Cryptococcus neoformans
seen in India ink preparations of spinal fluid.
Calcofluor white is a fluorescent dye that binds
to fungal cell walls and is useful in the
identification of fungi in tissue specimens.
Methenamine-silver stain is also useful in the
microscopic diagnosis of fungi in tissue.
91. • Fungi are frequently cultured on Sabouraud's
agar, which facilitates the appearance of the
slow-growing fungi by inhibiting the growth of
bacteria in the specimen.
Inhibition of bacterial growth is due to :
• low pH of the medium
• chloramphenicol
• cycloheximide.
• The appearance of the mycelium and the
nature of the asexual spores are frequently
sufficient to identify the organism.
SABOURAUD'S AGAR
92. DNA TECHNIQUES
• Tests involving DNA probes can identify colonies
growing in culture at an earlier stage of growth than
can tests based on visual detection of the colonies.
• As a result, the diagnosis can be made more rapidly.
• At present, DNA probe tests are available for
1. Coccidioides,
2. Histoplasma,
3. Blastomyces,
4. Cryptococcus.
93. • A significant rise in the antibody titer must be
observed to confirm a diagnosis.
• The complement fixation test is most frequently
used in suspected cases of coccidioidomycosis,
histoplasmosis, and blastomycosis.
• In cryptococcal meningitis, the presence of the
polysaccharide capsular antigens of C.
neoformans in the spinal fluid can be detected by
the latex agglutination test.
SEROLOGY
95. ANTIFUNGAL THERAPY
• The most effective antifungal drugs, amphotericin B
and the various azoles, exploit the presence of
ergosterol in fungal cell membranes that is not found
in bacterial or human cell membranes.
• Amphotericin B disrupts fungal cell membranes at
the site of ergosterol and azole drugs inhibit the
synthesis of ergosterol, which is an essential
component of fungal membranes.
• Another antifungal drug, caspofungin (Cancidas),
inhibits the synthesis of -glucan, which is found in
fungal cell walls but not in bacterial cell walls. Human
cells do not have a cell wall.
96. TREATMENT MODELATIES
• Look for underlying cause and treat it
• If antibiotics or corticosteroids are
the cause, reduce the dose or change
the treatment
• Intermittent or prolonged topical
antifungal may be necessary when the
underlying cause is unavoidable
• Denture cleansing is necessary
97. ANTIFUNGAL AGENTS
• Amphotericin B is an effective
treatment for all forms of oral fungal
infection
• Other agents that are less cytotoxic
may also be effective
• Azoles are considered better but
expensive
• Newer azoles may be required in
invasive or resistant infections
98. Antifungal agents..
• Flucytosine Active against Candida
and Cryptococcus species
• Fluconazole has been active against
oral candidosis in HIV disease
• Nystatin is oftenly used for
Candidosis
99. COMPLICATIONS
• Drug resistance
• Drug interactions and adverse
effects
• Structural defects or loss of function
(eg, resulting from fungal destruction
of the maxilla, orbit, and/or cranial
base)
100. PROGNOSIS
• Most fungal infections in healthy individuals
are self-limiting and have a good prognosis
• If a deep fungal oral lesion develops, the
lesion likely represents a potentially serious
underlying infection
• Although most deep fungal infections
respond to aggressive antifungal therapy,
infections can be fatal
101. CONCLUSION
• Most deep fungal infections have their
primary foci in the lungs, therefore
those presenting with distant organs or
skin involvement should be managed
aggressively as untreated or severe
disease can lead to severe scarring,
disfigurement and even death