Oral Mycotic Lesions /dental courses

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Oral Mycotic Lesions
INDIAN DENTAL ACADEMY
Leader in continuing Dental Education
www.indiandentalacademy.com

Learning Objectives
At the end of the lecture the student should
describe
Clinical features, histopathology & treatment of
Histoplasmosis
Blastomycosis
Cryptococcosis
Zygomycosis
2www.indiandentalacademy.com

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Histoplasmosis
 Most common fingal infection in US caused
by histoplasma capsulatum
 Humid areas with soil enriched by bird or bat
excrement are suited for growth
 Endemically seen in fertile river valleys

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Clinical feature
 Most patient produce either no symptoms or
mild symptoms
 Acute histoplasmosis self limited pulmonary
infection with acute symptoms
 Chronic histoplasmosis also primarily affects
the lungs, clinically it appears similar to
tuberculosis

 Disseminated histoplasmosis less common
 Most oral lesions occurs with the
disseminated form of disease
 Tongue, palate and buccal mucosa most
commonly affected site

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 Solitary variably painful ulceration of several
weeks duration
 Some lesions may appear erythematous or white
with an irregular surface
 Ulcerated lesions have firm, rolled margins, and
may indistinguishable clinically from malignancy

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Histopathological features
 Either a diffuse infiltrate of macrophages or more
commonly, collections of macrophages organized
into granulomas
 Multinucleated giant cells with granulomatous
inflamation
 Special staining PAS and Grocott-Gomori
methenamine silver methods

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 Diagnosis
1. Histopathological identification of oraganism
2. By culture
3. Serological testing
 Treatment
 Disseminate histoplasmosis is very serious
condition 90% death if untreated
 Amphotericin B indicated

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Blastomycosis
 Dimorphic fungus (Blastomyces dermatitidis) (thermal)
 Cutaneous form / systemic form
 C/F- middle aged, men (9:1)
 Painless seen on exposed areas.
 Acute blastomycosis – Pulm. infection Flu-like symptoms
- pneumonia
 Chronic blastomycosis more common mimic tuberculosis.

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 Cutaneous (Only sign of disease) – small red
papules- tiny abscesses- pustules & ulcerate
 Oral lesions because of dissemination or local
inoculation with organism
 Oral lesion similar to histoplasmosis

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Histopathological feature
 Typically shows mixture of acute inflammation
and granulomatous inflammation surrounding
variable no. of yeast
 8 to 10 um in diameter
 Characterized by doubly retractile cell wall and a
broad attachment between daughter cell and parent
cell
 Benign reaction of the overlying mucosal or skin
lesion called pseudoepitheliomatous hyperplasia

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 Diagnosis
1. Histopathological identification of oraganism
2. By culture
3. A specific DNA probe
4. Serological testing
Treatment
 Systemic antifungal therapy
 Prognosis is reasonably good in disseminated
disease

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Paracoccidioidomycosis
 Paracoccidioidomycosis brasiliensis
 Mostly south and central america
 Middle age Men : female – 25:1
 Initially as pulmonary infection
 Spread by hematogenous or lymphatic rout

 O/M- mulburry like ulcerations mostly affect
alveolar mucosa, gingiva and palate.
 Difference between the 2 organisms is their size.
Histopathological features
 Pseudoepitheliomatous hyperplasia

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 Granulomatous inflammatory host response
collection of epithelioid macrophages and
multinucleated giant cells
 Scattered large (up to 30 um ) yeasts
 Organism show multiple daughter buds on the
parent cell resembling ‘mickey mouse ears’

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Diagnosis
 Demonstration of yeast- Sputum, BAL
(presence of multiple buds)
 India ink--ve stain-stains extracellular
polysaccharides


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Cryptococcosis (C.neoformans)
 No problem in immunocompetent people
 Most common life threatening in AIDS
 Often an opportunistic infection
 World wide distribution because its association with
pigeon
 Primarily lung affected - nonspecific pneumonitis
 Middle aged men

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 First seen on skin later disseminates.
 Skin of head and neck often involved
 Mutiple brown errythematous papules pustules –
ulcerate
 O/M- rere crater like, nonhealing ulcers - single /
multiple ulcers
 H/F- granulomatous like reaction
 -multinucleated giant cells are commonwww.indiandentalacademy.com

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 Diagnosis is by demonstration of capsules - india
ink
 Sabouraud’s media-smooth,mucoid colonies
which later become cream coloured
 Hydrolyses urea

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Zygomycosis (Mucormycosis; Phycomycosis)
 Opportunistic, frequently fulminant fingal infection
(Absidia, mucor, Rhiaomucor & Rizopus)
 Found throughout the world
 Rhinocerebral form is most relevent to the oral health
care provider
 Specially in insulin dependant diabetics and
immunocomprimized patient

 Nasal obstruction, bloody nasal discharge, facial
pain or headache, faciall swelling or cellulitis
 Facial paralysis if cranial nerve involved.
 If maxillary sinus involved – intraoral swelling of
the maxillary alveolar process, the palate or both

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 Palatal ulcer with black necrotic areas, massive
tissue destruction
 Radio graphically opacification of the sinuses in
conjunctions with patchy effacement of the bone
walls of the sinuses
 H/F :- extensive necrosis with numerous large
branching nonseptate hyphae with granulomatous
inflammation

Summary
Clinical features, histopathology & treatment of
Histoplasmosis
Blastomycosis
Cryptococcosis
Zygomycosis

BIBLIOGRAPHY
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 Text Book of Microbiology Ananthanarayan R 7th
Edition
 Text book of oral pathology Shafer's, 5 & 6th
edition
 Oral Candiosis, Samarnayak L P Ist
edition
 Color Atlas of Oral Diseases Cawson, R. 2nd
edition
 Oral and Maxillofacial Pathology Neville, Brad
W. 2nd
 Lucas’s Pathology Of Tumor’s of the Oral Tissues
 Cawson, R. A., Bennie, W. H 5th
edition

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