57
ORAL MANIFESTATION OF FUNGAL INFECTION Presentor: Reman Dhakal BDS 4 th year
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ORAL MANIFESTATION OF FUNGAL INFECTION
Presentor Reman Dhakal
BDS 4th year
CONTENTSbull Introductionbull Classificationbull Candidosisbull Histoplasmosisbull Rhinosporidiosis bull Aspergillosis bull Mucormycosisbull Cryptococcosis bull Conclusionbull References
Introduction
bull Eukaryotic grows predominantely by budding
bull They are extremely common organism and widely distributed Fungai (mainly candida) is also a normal oral flora
Pattern of infection Fungal infection Etiological agent
Superficial and cutaneous
Pityriasis versicolor Malassetia furfurTinea nigra Exophiala werneckiiWhite piedra Trichosporon beigeliiBlack piedra Piedraia hortaeDermatophytosis Microsporum spp
Trichophyton sppCandidiasis of skin nail mucosa
Candida spp
Sub ndash cutaneous
Chromoblastomycosis Fonsecaea pedrosoiPhialophora verrucosa etc
Mycetoma Madurella mycetomatisExophiala FusariumAspergillus etc
Sporotrichosis Sporothrix schenckii
CLASSIFICATION
Deep by Dimorphic fungi
Blastomycosis Blastomyces dermatitidis
Coccidioidomycosis Coccidioides immitis
Histoplasmosis Histoplasma capsulatum
Paracoccidioidomycosis Paracoccidioides brasiliensis
Deep by Opportunistics
pathogenic fungi
Aspergillosis Aspergillus spp
Systemic Candidiasis Candida spp
Cryptococcosis Cryptococcus neoformansgattii
Zygomycoses Rhizopus Absidia Mucor etc
4
CANDIDOASIS
Candidosis vs candidiasis
(ORAL CANDIDOSIS)International
Society for Human and
Animal Mycology
1980
(ORAL CANDIDIASIS)
Council for International Organizations
for Medical Sciences1982
8
ldquoosisrdquo ndash fungal infections
eg histoplasmosis
ldquoiasisrdquo ndash parasitic infestations egfilariasis
9
Biology of candida species
bull Classified as fungi imperfecti (absence of sexual
stage) in the class Deuteromyctes
bull Seven species
ndash C albicans - C tropicalis
ndash C glabrata - C parapsilosis
ndash C stellatoidea - Cguilliermondi
ndash C krusei
Habitat amp transmission
bull Normal commensals in
Oral cavity GIT vagina skin eyesProsthesis tissue surface of denture
bull 78 of all is C albicans
bull Age childhood to old age
bull Cross infection from mother to baby
10
Morphological formsDimorphic trimorphic
11
Yeast form
Hyphae Chlamydospoe
Pseudopyphae
Below 33degC
( lower incubation temperature amp
nutritionally poor media)
gt 33 degC and neutral pH
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
CONTENTSbull Introductionbull Classificationbull Candidosisbull Histoplasmosisbull Rhinosporidiosis bull Aspergillosis bull Mucormycosisbull Cryptococcosis bull Conclusionbull References
Introduction
bull Eukaryotic grows predominantely by budding
bull They are extremely common organism and widely distributed Fungai (mainly candida) is also a normal oral flora
Pattern of infection Fungal infection Etiological agent
Superficial and cutaneous
Pityriasis versicolor Malassetia furfurTinea nigra Exophiala werneckiiWhite piedra Trichosporon beigeliiBlack piedra Piedraia hortaeDermatophytosis Microsporum spp
Trichophyton sppCandidiasis of skin nail mucosa
Candida spp
Sub ndash cutaneous
Chromoblastomycosis Fonsecaea pedrosoiPhialophora verrucosa etc
Mycetoma Madurella mycetomatisExophiala FusariumAspergillus etc
Sporotrichosis Sporothrix schenckii
CLASSIFICATION
Deep by Dimorphic fungi
Blastomycosis Blastomyces dermatitidis
Coccidioidomycosis Coccidioides immitis
Histoplasmosis Histoplasma capsulatum
Paracoccidioidomycosis Paracoccidioides brasiliensis
Deep by Opportunistics
pathogenic fungi
Aspergillosis Aspergillus spp
Systemic Candidiasis Candida spp
Cryptococcosis Cryptococcus neoformansgattii
Zygomycoses Rhizopus Absidia Mucor etc
4
CANDIDOASIS
Candidosis vs candidiasis
(ORAL CANDIDOSIS)International
Society for Human and
Animal Mycology
1980
(ORAL CANDIDIASIS)
Council for International Organizations
for Medical Sciences1982
8
ldquoosisrdquo ndash fungal infections
eg histoplasmosis
ldquoiasisrdquo ndash parasitic infestations egfilariasis
9
Biology of candida species
bull Classified as fungi imperfecti (absence of sexual
stage) in the class Deuteromyctes
bull Seven species
ndash C albicans - C tropicalis
ndash C glabrata - C parapsilosis
ndash C stellatoidea - Cguilliermondi
ndash C krusei
Habitat amp transmission
bull Normal commensals in
Oral cavity GIT vagina skin eyesProsthesis tissue surface of denture
bull 78 of all is C albicans
bull Age childhood to old age
bull Cross infection from mother to baby
10
Morphological formsDimorphic trimorphic
11
Yeast form
Hyphae Chlamydospoe
Pseudopyphae
Below 33degC
( lower incubation temperature amp
nutritionally poor media)
gt 33 degC and neutral pH
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Introduction
bull Eukaryotic grows predominantely by budding
bull They are extremely common organism and widely distributed Fungai (mainly candida) is also a normal oral flora
Pattern of infection Fungal infection Etiological agent
Superficial and cutaneous
Pityriasis versicolor Malassetia furfurTinea nigra Exophiala werneckiiWhite piedra Trichosporon beigeliiBlack piedra Piedraia hortaeDermatophytosis Microsporum spp
Trichophyton sppCandidiasis of skin nail mucosa
Candida spp
Sub ndash cutaneous
Chromoblastomycosis Fonsecaea pedrosoiPhialophora verrucosa etc
Mycetoma Madurella mycetomatisExophiala FusariumAspergillus etc
Sporotrichosis Sporothrix schenckii
CLASSIFICATION
Deep by Dimorphic fungi
Blastomycosis Blastomyces dermatitidis
Coccidioidomycosis Coccidioides immitis
Histoplasmosis Histoplasma capsulatum
Paracoccidioidomycosis Paracoccidioides brasiliensis
Deep by Opportunistics
pathogenic fungi
Aspergillosis Aspergillus spp
Systemic Candidiasis Candida spp
Cryptococcosis Cryptococcus neoformansgattii
Zygomycoses Rhizopus Absidia Mucor etc
4
CANDIDOASIS
Candidosis vs candidiasis
(ORAL CANDIDOSIS)International
Society for Human and
Animal Mycology
1980
(ORAL CANDIDIASIS)
Council for International Organizations
for Medical Sciences1982
8
ldquoosisrdquo ndash fungal infections
eg histoplasmosis
ldquoiasisrdquo ndash parasitic infestations egfilariasis
9
Biology of candida species
bull Classified as fungi imperfecti (absence of sexual
stage) in the class Deuteromyctes
bull Seven species
ndash C albicans - C tropicalis
ndash C glabrata - C parapsilosis
ndash C stellatoidea - Cguilliermondi
ndash C krusei
Habitat amp transmission
bull Normal commensals in
Oral cavity GIT vagina skin eyesProsthesis tissue surface of denture
bull 78 of all is C albicans
bull Age childhood to old age
bull Cross infection from mother to baby
10
Morphological formsDimorphic trimorphic
11
Yeast form
Hyphae Chlamydospoe
Pseudopyphae
Below 33degC
( lower incubation temperature amp
nutritionally poor media)
gt 33 degC and neutral pH
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Pattern of infection Fungal infection Etiological agent
Superficial and cutaneous
Pityriasis versicolor Malassetia furfurTinea nigra Exophiala werneckiiWhite piedra Trichosporon beigeliiBlack piedra Piedraia hortaeDermatophytosis Microsporum spp
Trichophyton sppCandidiasis of skin nail mucosa
Candida spp
Sub ndash cutaneous
Chromoblastomycosis Fonsecaea pedrosoiPhialophora verrucosa etc
Mycetoma Madurella mycetomatisExophiala FusariumAspergillus etc
Sporotrichosis Sporothrix schenckii
CLASSIFICATION
Deep by Dimorphic fungi
Blastomycosis Blastomyces dermatitidis
Coccidioidomycosis Coccidioides immitis
Histoplasmosis Histoplasma capsulatum
Paracoccidioidomycosis Paracoccidioides brasiliensis
Deep by Opportunistics
pathogenic fungi
Aspergillosis Aspergillus spp
Systemic Candidiasis Candida spp
Cryptococcosis Cryptococcus neoformansgattii
Zygomycoses Rhizopus Absidia Mucor etc
4
CANDIDOASIS
Candidosis vs candidiasis
(ORAL CANDIDOSIS)International
Society for Human and
Animal Mycology
1980
(ORAL CANDIDIASIS)
Council for International Organizations
for Medical Sciences1982
8
ldquoosisrdquo ndash fungal infections
eg histoplasmosis
ldquoiasisrdquo ndash parasitic infestations egfilariasis
9
Biology of candida species
bull Classified as fungi imperfecti (absence of sexual
stage) in the class Deuteromyctes
bull Seven species
ndash C albicans - C tropicalis
ndash C glabrata - C parapsilosis
ndash C stellatoidea - Cguilliermondi
ndash C krusei
Habitat amp transmission
bull Normal commensals in
Oral cavity GIT vagina skin eyesProsthesis tissue surface of denture
bull 78 of all is C albicans
bull Age childhood to old age
bull Cross infection from mother to baby
10
Morphological formsDimorphic trimorphic
11
Yeast form
Hyphae Chlamydospoe
Pseudopyphae
Below 33degC
( lower incubation temperature amp
nutritionally poor media)
gt 33 degC and neutral pH
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Deep by Dimorphic fungi
Blastomycosis Blastomyces dermatitidis
Coccidioidomycosis Coccidioides immitis
Histoplasmosis Histoplasma capsulatum
Paracoccidioidomycosis Paracoccidioides brasiliensis
Deep by Opportunistics
pathogenic fungi
Aspergillosis Aspergillus spp
Systemic Candidiasis Candida spp
Cryptococcosis Cryptococcus neoformansgattii
Zygomycoses Rhizopus Absidia Mucor etc
4
CANDIDOASIS
Candidosis vs candidiasis
(ORAL CANDIDOSIS)International
Society for Human and
Animal Mycology
1980
(ORAL CANDIDIASIS)
Council for International Organizations
for Medical Sciences1982
8
ldquoosisrdquo ndash fungal infections
eg histoplasmosis
ldquoiasisrdquo ndash parasitic infestations egfilariasis
9
Biology of candida species
bull Classified as fungi imperfecti (absence of sexual
stage) in the class Deuteromyctes
bull Seven species
ndash C albicans - C tropicalis
ndash C glabrata - C parapsilosis
ndash C stellatoidea - Cguilliermondi
ndash C krusei
Habitat amp transmission
bull Normal commensals in
Oral cavity GIT vagina skin eyesProsthesis tissue surface of denture
bull 78 of all is C albicans
bull Age childhood to old age
bull Cross infection from mother to baby
10
Morphological formsDimorphic trimorphic
11
Yeast form
Hyphae Chlamydospoe
Pseudopyphae
Below 33degC
( lower incubation temperature amp
nutritionally poor media)
gt 33 degC and neutral pH
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
CANDIDOASIS
Candidosis vs candidiasis
(ORAL CANDIDOSIS)International
Society for Human and
Animal Mycology
1980
(ORAL CANDIDIASIS)
Council for International Organizations
for Medical Sciences1982
8
ldquoosisrdquo ndash fungal infections
eg histoplasmosis
ldquoiasisrdquo ndash parasitic infestations egfilariasis
9
Biology of candida species
bull Classified as fungi imperfecti (absence of sexual
stage) in the class Deuteromyctes
bull Seven species
ndash C albicans - C tropicalis
ndash C glabrata - C parapsilosis
ndash C stellatoidea - Cguilliermondi
ndash C krusei
Habitat amp transmission
bull Normal commensals in
Oral cavity GIT vagina skin eyesProsthesis tissue surface of denture
bull 78 of all is C albicans
bull Age childhood to old age
bull Cross infection from mother to baby
10
Morphological formsDimorphic trimorphic
11
Yeast form
Hyphae Chlamydospoe
Pseudopyphae
Below 33degC
( lower incubation temperature amp
nutritionally poor media)
gt 33 degC and neutral pH
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Candidosis vs candidiasis
(ORAL CANDIDOSIS)International
Society for Human and
Animal Mycology
1980
(ORAL CANDIDIASIS)
Council for International Organizations
for Medical Sciences1982
8
ldquoosisrdquo ndash fungal infections
eg histoplasmosis
ldquoiasisrdquo ndash parasitic infestations egfilariasis
9
Biology of candida species
bull Classified as fungi imperfecti (absence of sexual
stage) in the class Deuteromyctes
bull Seven species
ndash C albicans - C tropicalis
ndash C glabrata - C parapsilosis
ndash C stellatoidea - Cguilliermondi
ndash C krusei
Habitat amp transmission
bull Normal commensals in
Oral cavity GIT vagina skin eyesProsthesis tissue surface of denture
bull 78 of all is C albicans
bull Age childhood to old age
bull Cross infection from mother to baby
10
Morphological formsDimorphic trimorphic
11
Yeast form
Hyphae Chlamydospoe
Pseudopyphae
Below 33degC
( lower incubation temperature amp
nutritionally poor media)
gt 33 degC and neutral pH
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
9
Biology of candida species
bull Classified as fungi imperfecti (absence of sexual
stage) in the class Deuteromyctes
bull Seven species
ndash C albicans - C tropicalis
ndash C glabrata - C parapsilosis
ndash C stellatoidea - Cguilliermondi
ndash C krusei
Habitat amp transmission
bull Normal commensals in
Oral cavity GIT vagina skin eyesProsthesis tissue surface of denture
bull 78 of all is C albicans
bull Age childhood to old age
bull Cross infection from mother to baby
10
Morphological formsDimorphic trimorphic
11
Yeast form
Hyphae Chlamydospoe
Pseudopyphae
Below 33degC
( lower incubation temperature amp
nutritionally poor media)
gt 33 degC and neutral pH
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Habitat amp transmission
bull Normal commensals in
Oral cavity GIT vagina skin eyesProsthesis tissue surface of denture
bull 78 of all is C albicans
bull Age childhood to old age
bull Cross infection from mother to baby
10
Morphological formsDimorphic trimorphic
11
Yeast form
Hyphae Chlamydospoe
Pseudopyphae
Below 33degC
( lower incubation temperature amp
nutritionally poor media)
gt 33 degC and neutral pH
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Morphological formsDimorphic trimorphic
11
Yeast form
Hyphae Chlamydospoe
Pseudopyphae
Below 33degC
( lower incubation temperature amp
nutritionally poor media)
gt 33 degC and neutral pH
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
12
Virulence factors
Adherence
Dimorphism
Interference with Phagocytosis
Immune defences
Complement
Synergism with bacteria (helps in growth of candida)
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Candida species are strictly opportunistic pathogens
which mainly cause disease when host defences are
inadequate 2
ldquoDisease of the diseasedrdquo
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Predisposing factors
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
15
Local host factors
bull Mucosal barrierndash Exogenous epithelial
changesbull Traumabull Local occlusionbull Laceration
ndash Endogenous epithelial changes
bull Atrophybull Hyperplasiabull Dysplasia
bull Salivandash Quantitative changesndash Qualitative changes
bull Commensal flora
bull High carbohydrate diet
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
16
Systemic host factors
bull Altered physiological statesndash Infancyndash Old agendash Pregnancy
bull Altered hormonal statesndash Diabetesndash Hypothyroidismndash Hypoparathyroidismndash Hypo-adrenocortism
bull Altered nutritional statesndash Iron folic acid or vitamines
deficiencyndash Malnutrition
bull Altered immune mechanisms
ndash Decreased number of phagocytes
ndash Intrinsic defects in immune cells
ndash Defects in cell mediated immunity
ndash Due to infective states
bull Heavy smoking
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
bull Young infants
bull Old debilitating people
bull Long term antibiotic treatment
bull Immunosuppressants
bull Diabetes
bull Lymphomas Leukemias
Predisposing conditions
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Classification (samaranayake and modified by axell et al)
A Acute form Psedomembranous ErythematousB Chronic form Hyperlastic Nodular Plaque like Erythematous pseudomembranousC Candida-associated lesions Denture stomatitis Angular chelitis Median rhomboid glossitisD Keratinised primary lesions superinfection with candida Leukoplakia Lp Lupus erythematous
Primary oral candidiasis Secondary oral candidiasis
Oral manifestations of systemic mucocutaneous candidiasis as a result of
diseases such as a Thymic aplasia
Candidiasis endocrinopathy syndrome
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Acute pseudomembranous candidiasis
bull Common
bull Infants amp debilitated patients
bull Soft white slightly elevated plaques- buccal
mucosa tongue palate FOM
bull Can be wiped off- leaving erythematous or normal
mucosa
bull Symptoms- mild- burning unpleasant taste
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Acute atrophic (Erythematous) candidiasis
bull Acute atrophic candidiasis
or antibiotic sore mouth
bull Diffuse loss of the filiform
papillae rarr reddened baldldquo
appearance of the tongue
bull Erythroplakia ndash well defined
border
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Chronic Hyperplastic Candidiasis
bull lsquoCandidal leukoplakiarsquo
bull Firm white persistent plaques- lips tongue
cheeks
bull Cannot be scraped
bull Least common form heavy smokers
bull Candidiasis that is superimposed on a pre-
existing leukoplakic lesion
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Median Rhomboid glossitis
bull Central papillary atrophy of the tongue
Developmental or fungal
bull Developmental defect of the tongue rarr Failure of the embryologic tuberculum impar to be covered by the lateral processes of the tongue
Developmental
Fungal infection
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
23
kissing lesion
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
24
bull Well demarcated erythematous zone affecting
midline of posterior dorsal tongue
bull Often asymptomatic
bull Lesion is usually symmetric
bull Surface may be smooth to lobulated
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
25
Angular cheilitis
bull Peacuterleche
bull Red eroded fissured lesion
bull Occur bilaterally in commissures of
the lip
bull Seen in people with
ndash Reduced vertical dimension of
occlusion
ndash Accentuated folds at the corners of
the mouth
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
26
Chronic atrophic candidiasis
bull Denture sore mouth
bull Denture stomatitis
bull Patient admits to wearing
the denture continuously
bull Rarely symptomatic
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Type Ibull Localized simple inflammation
pinpoint hyperemia
Type IIbull Erythematous or generalized simple
inflammation covering the entire denture bearing surface
Type IIIbull Inflammatory papillary hyperplasia
Classification
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Chronic mucocutaneous candidiasis
It is a persistent superficial candidal infections of
mouth scalp nail and skin beds which may or may not be
associated with cell mediated immunity
Subgroup asbull Familial CMCbull Diffuse CMCbull CESbull Localised CMC
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Candidiasis endocrinopathy syndrome (CES)
bull Females gt Males
bull Multiple organ- specific auto antibodies generated
bull CLASSIC TRAIDndash Candida
ndash Hypoparathyroidism
ndash Addisons disease
bull Associated with enamel hypoplasia
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Investigations
1 Smear examination bull 10- 20 KOH preparation for immediate identification yeast cell
bull Cytological smear PAS stain and Gramrsquos stain
2 Culture bull Sabouraudrsquos dextrose media Moist creamy coloniesbull Corn meal agar Budding cells and chlamydosporesbull Pagano-Levin agar
3 Histological examination4 Germ tube test5 Serological tests
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
31
Sabouraudrsquos agar at 37degC Moist creamy colony
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Differential Diagnosis
bull White
Chemical burns mucous patches white Keratotic lesions
traumatic ulcers
bull Red
Drug reactions thermal burns erosive LP DLE mild EM
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Oral candidiasisIf rectification isnot
possible (AIDS Diabetics)
Systemic candidiasis
Rectify the underlying local systemic causes
Topical route (denture stomatitis angular
chelitis Median rhomboid glossitis)
Physician opinion sought
1 Clotrimazole 1 creamgelsolution 5 times a day 2 wks
2 Nystatin 5 lakhs unit tablets qid 2 wks ndash crushed amp mix in water use as mouth rinse
3 Hamycin and fluconazole
Oral route (pseudomembranous
hyperplastic acute atrophic)
Parental route
Amphotericin B iv infusion 03 mgkg can be infused over 4-8 hrs
1 Fluconazole 150mg BD 2 wks2 Ketoconazole 200mg OD 2
wks3 Itraconazole 100mg OD 2 wks
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Oral thrush in pediatric patient
bull Agent C albicansbull Prevalance
New born 1 in 20 4th week 1 in 7
Then gradually decreases8
bull Signs and symptomsSite tongue may found elsewhere in mouthScrubbing cannot be rubbed off easily if does more likely
to be milk coating
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
When to seek medical advice
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Why does baby have oral thrush
bull Immune systems have not yet fully developed and are less able to resist infection
bull His is particularly the case with babies born prematurely (before 37 weeks of pregnancy)
bull Recently been treated with antibiotics
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Treating oral thrush in babies
bull Miconazole and Nystatinbull four times a day and are most effective if used
after your baby has had a feed or drinkbull Continue to use the medicine for two days
after the infection has cleared up as this will help prevent the infection coming back
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Can oral thrush be prevented
bull Its not clear whether it is possible to prevent oral thrush in babies Following advice may help
1 Clean pacifiers in hot water after use 2 Check nipples before breastfeeding Redness and sorebull It is important to note that some babies are more prone to thrush
than others If you suspect your baby is vulnerable you should do the following in addition to the above to prevent oral thrush in your baby Clean and sterilize bottles feeding equipment dummies and other toys Wash the babyrsquos clothes with hot water about 140 degrees F (60
degrees C) Change diapers frequently After changing babyrsquos nappy wash hands thoroughly
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Histoplasmosis
bull Most common systemic fungal infection
bull Causative agent Histoplasma capsulatum No capsule-- is a
misnomer
bull Dimorphic fungus
bull Natural habitat Humid soil with bird or bat excreta
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
DAAAAAAAR LING
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Clinical features
bull Healthy host no or mild flu (1-2 weeks)
bull Affects RES (spleen LN bone marrow)
Clinical forms
ndash Acute primary histoplasmosis
ndash Chronic cavitary histoplasmosis
ndash Progressive disseminated histoplasmosis
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Acute primary histoplasmosis
bull Self-limited pulmonary
infection (2 weeks)
bull Fever malaise headache
myalgia
bull Pleuritic pain cough
Chronic pulmonary histoplasmosis
bull Lungs
bull Older immunocompromised
bull Cough dyspnoea weight loss chest
pain
RF
Bilateral cavitary lesions in upper
lungs
Mimics chronic cavitary
tuberculosis
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Progressive disseminated histoplasmosis
bull Children elderly and immunocompromised are more
commonly affected
bull Hepatosplenomegaly lymphadenopathy and oropharyngeal
ulcerative lesions are typically encounter
bull Pulmonary radiological abnormality
bull Also affect CNS kidney and adrenal gland
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Oral Manifestation
bull Common in progressive disseminated form
bull Tongue palate gingiva buccal mucosa
bull Papular ulcerative nodulo-ulcerative
bull Ulcers ndash covered by gray membrane raised amp rolled out borders
bull ldquoOral lesions of histoplasmosis can be found in up to two-thirds of the
patients with disseminated diseases and may represent the first sign of
the diseaserdquo[6]
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Diagnosis Prognosis amp Treatment
Diagnosed by culture fungal stain serological test and antigene detection
Untreated disseminated form death is almost 90
Tt analgesic and antipyretics - fever malaise iv amphotericin B others like ketconazole itraconazole
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Rhinosporidiosis
bull Chronic granulomatous disease affecting oro ampnasopharynx
bull Causative agent Rhinosporidium seeberi
bull Affects chiefly- orophraynx nasophraynx larynx skin eyes and
genital mucosa
bull Initially it causes nasal irritation mucoid discharge formation
of small sessile papillomatous lesion progresses to a large
pedunculated swelling
bull Swelling is soft friable and highly vascular
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Oral manifestation
bull Sites Soft palate uvula tongue tonsils lips
bull Maxillary sinus parotid duct may also get involved
bull Painless slow growing swelling Pink granular
polyploid growth
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Mucormycosis (zygomycosis phycomycosis))
bull Deep fungal infection caused by ldquobread mold fungirdquo
bull Hallmarks angio-invasion thrombosis infraction amp necrosis of
involved tissue 1
bull Predisposing factors Diabetic with ketoacidosis hematological malignancies steroid
therapy preterm birth
Rhizopus sps Thrive well in Fe rich acidic and glucose rich environment 1
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Clinical features amp OM
Manifested as cerebral pulmonary GI cutaneous or disseminated form
Involved tissue red violaceous black as vessel are thrombosed necrosis
OMbull Ulceration of palate sometime oroantral fistulabull Sometime ulcer include lip gingiva amp alveolar mucosabull Gingiva erythematous hyperplasia
strawberry gingivitis
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Management
bull Correction of underlying factors
bull Necrotic lesions surgically debride
bull Drugs Amphotericin B is first line of drug
bull Hyperbaric oxygen inhibit growth of fungal spore
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Aspergillosis
bull A flavus A niger amp A fumigatusbull Primarily affects lungs but in
immunocompromised patient disseminated form eye heart liver kidneys bone oral involvement
bull OM tongue soft and hard palate occasionally pulp amp periodontal tissue and maxillary sinus
bull Palate painful ulcer surrounded by a zone of necrotic black tissue
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Cryptococcosis
bull Agent C Neoformansbull Second most cause of oppertunistic infection
in HIV patientbull Sites primarily lung CNS Cutaneous
CNS headache fever nuchal paincoma dementia hydrocephalousLUNGS Primary pulmonary
comple cough pleral effusion and pneumonia
OCULAR choroidal infection and endopthalmitisCUTANEOUS papules abscesses
cellulitis draining sinues
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
OM
bull Sites hard and soft palate tongue gingiva and may involve extraction sockets
bull Appear nodular or granulomatous lesions which subsequently ulcerated
bull ULCER indurated border and rolled out edges
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
OTHER MYCOTIC INFECTIONS
1 North American blastomycosis
Gilchristrsquos disease
2 South America blastomycosis
Lutzrsquos disease
Paracoccidioidomycosis
3 Coccidiodomycosis
Valley fever
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
Conclusion
bull Fungi are the extremely common organism and widely distributed one of the most common habitat is oral cavity
bull Since candidal infection are opportunistic ie immuno-compromised and pediatric patient are more susceptible to infection
bull Proper diagnosis is a prime important in fungal infection and mostly dentist are the one who firstly know fungal infection in patient
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
REFERENCES1 Text book of oral medicine oral diagnosis and oral radiology by RAVIKIRAN
ONGOLE2 Textbook of oral pathology by SHAFER 3 Textbook of oral pathology by ANIL GHOM4 NELSON textbook of pediatrics5 Oral medicine and oral pathology by COWEN6 A gingival manifestation of histoplasmosis leading diagnosis
Marco Tullio Brazatildeo-Silva Grabriela Wagner Mancusi Francine Vilar Bazzoun Gleyce Yakushijin Ishisaki1 and Marcelo Marcucci
7 Fatal rhino-orbito-cerebral mucormycosis in a healthy individualRama Krishna Angali Anunayi Jeshtadi1 Vivek Anand Namala1 and Ashalata
Gannepalli8
9 httpwwwemedicinehealthcomhistoplasmosispage4_emhtm
