2. Candidiasis and Immunity Quiz

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Questions and Answers

Which type of immunity is primarily responsible for controlling systemic candidiasis?

Adaptive immunity via B lymphocytes

Adaptive immunity via T lymphocytes

Innate immunity via phagocytes (correct)

Humoral immunity

Which type of immunity is essential for managing mucosal candidiasis?

Adaptive immunity via T lymphocytes (correct)

Innate immunity via phagocytes

Innate immunity via natural killer cells

Humoral immunity

What visual characteristic is associated with oral thrush?

Dry, scaly, and leathery plaques

Small, red, blister-like lesions.

Creamy white, curd-like patches on mucous membranes (correct)

Deep, dark, ulcerated sores

What is the term used for a chronic inflammatory reaction under dental plates?

Chronic atrophic candidiasis Signup and view all the answers

Which of these conditions is NOT directly linked to Candida or its sequelae?

Angular cheilitis Signup and view all the answers

What is the main cause of increased oral thrush cases observed in recent times?

Widespread use of inhaled steroids for asthma treatment Signup and view all the answers

What is the term for firm, white plaques on the cheek, lips, or tongue that progress slowly and may rarely become precancerous?

Candida leukoplakia Signup and view all the answers

What is the main cause of the raw and bleeding surface when scraping patches in Thrush?

The removal of the patches and the associated raw inflamed surface Signup and view all the answers

What is the most common symptom of Candida esophagitis?

Substernal chest pain Signup and view all the answers

In severely immunocompromised patients, Candida esophagitis can occur simultaneously with which other infections?

Herpes simplex virus and Cytomegalovirus Signup and view all the answers

Which diagnostic procedure is preferred for the definitive diagnosis of both Candida and herpetic esophagitis?

Endoscopy Signup and view all the answers

What is the primary finding of a KOH test that is indicative of Candida?

Budding yeasts, hyphae, and pseudohyphae Signup and view all the answers

At what temperature do Candida species form yeast cells and pseudohyphae?

20-25°C Signup and view all the answers

What is the best confirmatory test for Candida esophagitis?

Blood or tissue culture Signup and view all the answers

What specific structure does Candida albicans form at 37°C?

Germ tubes Signup and view all the answers

Which of the following is NOT a common symptom associated with Candida esophagitis?

Light sensitivity Signup and view all the answers

What is the diameter range of the Herpesviridae family viruses?

120 to 260 nm Signup and view all the answers

Which condition is the most frequent initial clinical manifestation of HSV-1 infection?

Orofacial infection (gingivostomatitis and pharyngitis) Signup and view all the answers

What are the most frequent clinical manifestations of first-episode HSV-1 infection?

Gingivostomatitis and pharyngitis Signup and view all the answers

Which of the following herpesviruses is less than 3% prevalent among adults in the United States?

KSHV Signup and view all the answers

What condition is associated with more severe herpesvirus infections in patients?

Impaired T-cell immunity Signup and view all the answers

Which structure is characteristic of the Herpesviridae family?

Icosahedral protein nucleocapsid Signup and view all the answers

What is true about many encounters with herpesviruses in humans?

Most infections are asymptomatic or mild. Signup and view all the answers

How are herpesviruses typically spread?

By direct contact with infected individuals Signup and view all the answers

What symptom is NOT commonly associated with orofacial herpes simplex virus infections?

Rash on extremities Signup and view all the answers

Which herpesvirus is most commonly associated with recurrent lesions on the vermilion border of the lip?

HSV-1 Signup and view all the answers

What viral component exists between the capsid and the envelope of herpesviruses?

Tegument Signup and view all the answers

Which percentage of adults in the United States are estimated to be infected with HSV-2?

15% to 25% Signup and view all the answers

Which virus is classified as human herpesvirus 4 and is linked to infectious mononucleosis?

Epstein-Barr virus Signup and view all the answers

Which characteristic is true of herpesviruses concerning symptom severity?

They cause infections that are rarely fatal, except in immunocompromised persons. Signup and view all the answers

Which symptom is commonly associated with first-episode HSV-1 infections in children?

Fever and malaise Signup and view all the answers

Which viral characteristic is true for all herpesviruses?

They contain a double-stranded DNA genome. Signup and view all the answers

What is the typical threshold for a platelet count to be classified as mild thrombocytopenia in patients with infectious mononucleosis?

Less than 140,000/mm3 Signup and view all the answers

Which of the following is a rare but severe complication of infectious mononucleosis?

Splenic rupture Signup and view all the answers

Oral hairy leukoplakia is primarily associated with what type of infection?

Epstein-Barr Virus Signup and view all the answers

Which of the following is a recognized manifestation of HHV-8 infection in AIDS patients?

Kaposi Sarcoma Signup and view all the answers

In which geographic areas is HHV-8 more prevalent among AIDS patients?

Italy, Greece, and Africa Signup and view all the answers

What is a common hepatic manifestation associated with infectious mononucleosis?

Elevated hepatocellular enzyme levels Signup and view all the answers

What is a significant renal manifestation that can occur with infectious mononucleosis?

Proteinuria Signup and view all the answers

Which of the following neurologic complications is NOT associated with infectious mononucleosis?

Multiple sclerosis Signup and view all the answers

What are the primary clinical symptoms of infectious mononucleosis caused by Epstein-Barr virus?

Sore throat, fever, and lymphadenopathy Signup and view all the answers

Which serological test is commonly associated with infectious mononucleosis?

Heterophile antibodies test Signup and view all the answers

Which of the following hematological findings is most typical in patients with infectious mononucleosis?

Mononuclear leukocytosis with atypical lymphocytes Signup and view all the answers

What kind of rash is associated with infectious mononucleosis, particularly in patients treated with antibiotics like ampicillin?

Maculopapular eruption Signup and view all the answers

Which statement is true regarding autoimmune hemolytic anemia in the context of infectious mononucleosis?

Cold agglutinins of IgM class are common in 70% to 80% of cases Signup and view all the answers

Which complication is historically considered rare in infectious mononucleosis?

Rash Signup and view all the answers

What is the reported incidence range of autoimmune hemolytic anemia among patients with infectious mononucleosis?

0.5% to 3% Signup and view all the answers

Which type of antibodies is commonly found in patients with cold agglutinins during infectious mononucleosis?

IgM Signup and view all the answers

Study Notes

Upper GI Tract Infections: Oral Cavity/Esophagus

Expert: Dr. Javier Adan Castaneda Moreno, Board-certified Otolaryngologist by the Mexican Society of Otolaryngology-Head and Neck surgery, and Professor of the UAG International Students program.
Contact: [email protected]

Objectives

Identify common oral cavity and upper esophagus infections and their causative agents.
Describe characteristics of common upper esophagus and mouth infections.
Analyze definitions, characteristics, pathology, clinical manifestations, diagnostic methods, complications, and treatments for each infection.

Coxsackie A Virus Infection

Coxsackie viruses (RNA viruses) have over 20 serotypes divided into groups A and B, based on viral characteristics.

Herpangina

A seasonal acute infection.
Symptoms include fever, sore throat, and herpes-like lesions on the posterior oropharynx and tonsils.
Most common in children aged 3-10 years, primarily during summer and fall.

Clinical Features (of Coxsackie-associated infections)

High fever and sore throat
Herpes-like oral lesions
Multiple 1-mm vesicles on the posterior oropharynx and tonsils
Redness of the pharynx and tonsils
Fibrin-covered ulcerations in later stages

Candida Infections

Organisms: Yeasts, fungi existing predominantly in unicellular forms.
Size: Small (4-6 µm), thin-walled, and ovoid cells (blastospores), reproducing by budding.
Yeast forms: Pseudohyphae and hyphae.
Staining: Gram-positive
Species: More than 150 species of Candida, but only a few are frequent human pathogens (e.g., C. albicans, C. guilliermondii, C. krusei, C. parapsilosis, C. tropicalis, etc.).

Candida Infections: Epidemiology and Ecology

Environment: Found in soil, animals, hospital environments, inanimate objects, and food.
Non-albicans species: Can also live in animal and non-animal environments.
Contaminants: Rarely a laboratory contaminant.
Normal commensals: Found on skin, the gastrointestinal (GI) tract, sputum/bronchoalveolar lavage fluid, and the female genital tract.

Candida Infections: Pathogenesis and Immunology

Iatrogenic factors: The most important predisposing factors to Candida infections.
Factors: Antibiotics, myeloablative chemotherapy, and intravenous catheters.
Immune response: Innate immunity (phagocytes) is critical for controlling systemic candidiasis, while adaptive immunity (T lymphocytes) is important for mucosal candidiasis.

Candida Infections: Mucous Membrane Infection (Thrush)

Definition: Oral thrush describes a specific form of oral candidiasis, characterized by creamy white, curd-like patches on the oral mucosa, especially the tongue.
Removable: The patches are removable by scraping and leave a raw, bleeding, and painful surface.
Asthma treatment: Inhaled steroids are strongly associated with oral thrush, especially in children.

Candida Infections: Other Manifestations

Acute atrophic candidiasis: A nonspecific atrophy of the tongue, often a consequence of acute pseudomembranous candidiasis.
Chronic atrophic candidiasis (denture sore mouth): A chronic inflammatory reaction, characterized by epithelial thinning under dental plates.
Angular cheilitis: Inflammatory reaction at the corners of the mouth, not exclusively due to Candida.
Candida leukoplakia: Firm, white plaques on cheeks, lips, and tongue, potentially precancerous.

Candida Esophagitis

Associated conditions: Frequently associated with treatments for malignancies of the hematopoietic or lymphatic systems and in AIDS patients.
Diagnosis: Clinical settings, associated with endoscopic appearance of white patches.
Co-occurring conditions: Can occur simultaneously with herpes simplex virus or cytomegalovirus infection in severely immunocompromised patients.
Diagnostic procedure: Endoscopy is the preferred method for definitive diagnosis.
Symptoms: Painful swallowing, feeling of obstruction on swallowing, and substernal chest pain. Nausea and vomiting may also occur.

Diagnostics

Initial test: Potassium hydroxide (KOH) smear on scrapings or smears.
Confirmation tests: Blood or tissue cultures.
Growth conditions: Candida spp. forming yeast cells and pseudohyphae at 20-25°C; Candida albicans forming germ tubes at 37°C.

Herpetic Esophagitis and Glossitis

Co-occurrence: Can concurrently occur with herpes simplex virus or cytomegalovirus infection in severely immunocompromised patients.
Diagnostic method: Endoscopy is frequently the preferred procedure for definitive diagnosis.

Herpesviridae Infections

Virus Type: Double-stranded DNA virus; 120-260 nm in diameter.
Symptom association: Symptomatic disease in herpesviruses is frequently associated with lytic virus replication.
Orofacial infection: Gingivostomatitis and pharyngitis are common initial manifestations of HSV-1 infection.
Recurrent infection: Recurrent lesions (herpes labialis) on the lip vermilion border commonly indicate latent infections.
Epidemiology: Most human herpesvirus encounters are asymptomatic or induce very mild symptoms; many persons infected with HSV-1 or HSV-2 are asymptomatic, and young children and infants infected with CMV and EBV are usually asymptomatic; infections are rarely fatal, except in highly immunocompromised persons.

Herpesviridae Infections 134.1 (Table)

Viral characteristics: Table outlining various Herpesviruses, including subfamilies, size, receptors, and latency sites.

Herpesviridae Infections: Epidemiology

Transmission: Spread through saliva, vaginal secretions, contact with lesion fluid (mucous membrane contact).
Infections: Nearly all adults are infected with HSV-1/VZV/EBV/HHV-6/HHV-7; various percentages for each.
Spread method: Direct contact. Most herpesviruses do not survive long in the environment (except VZV).

Herpesviridae Infections: Clinical Syndromes

Clinical manifestations: Clinical syndromes associated with herpesviruses including vesicular lesions, skin lesions, retinitis, hepatitis, encephalitis, and mononucleosis.
Impaired Immunity: Patients with impaired T-cell immunity (HIV as an example) frequently exhibit more severe herpes virus infection.

Orofacial Herpes Simplex Virus Infection

Frequent manifestations: Gingivostomatitis and pharyngitis are common clinical manifestations of initial HSV-1 infection.
Infection type: Usually results from primary infection.
Common in: Mostly common in children and young adults.
Symptoms: Malaise, myalgias, inability to eat, irritability, and cervical adenopathy.

Therapy in Immunocompromised Patients

Treatment regimen variance: Treatment regimens vary for initial episodes and recurrent episodes and differ in immunocompromised patients (IV acyclovir).

Therapy in Immunocompetent Patients

Typical treatment: Oral acyclovir (or other antiviral drugs) may be used; frequency and dosage depend on the specific condition and individual patient.

Infectious Mononucleosis (Epstein-Barr Virus)

Cause: EBV (human herpesvirus 4) is a gamma-1 herpesvirus.
Genome/structure: Has a double-stranded DNA genome embedded with viral glycoproteins, a lipid envelope, and an amorphous protein layer (tegument).
Clinical traits: Acute illness characterized by sore throat, fever, and lymphadenopathy.
Diagnosis: Diagnosed serologically (heterophile antibodies).

Infectious Mononucleosis (EBV) Hematologic Complications

Hematologic abnormalities: Mononuclear leukocytosis (atypical lymphocytes or Downey cells)

Infectious Mononucleosis: Dermatologic Complications

Rare association: Rash; skin eruptions; associated with maculopapular eruptions.
Antibiotic association: Maculopapular eruptions often occur in response (secondary to) antibiotic administration

Infectious Mononucleosis: Other Complications

Rare manifestations: Splenic rupture, encephalitis, Guillain-Barré syndrome, Bell’s palsy, transverse myelitis, hepatic manifestations (elevated liver enzymes), and renal manifestations (hematuria and/or proteinuria).

Oral Hairy Leukoplakia (Epstein-Barr Virus)

Associated condition: Caused by unchecked lytic replication of EBV, especially in immunodeficient conditions such as AIDS.
Lesion type: Typically manifests as a corrugated or "hairy" white lesion on the lateral tongue, although it can occur elsewhere.
Alternative diagnoses: Differential diagnosis includes oral candidiasis.

Human Herpesvirus 8 (Kaposi Sarcoma-associated Herpesvirus)

Opportunistic infection: Kaposi's sarcoma is an opportunistic infection commonly associated with AIDS.
Target cells: Primary target of HHV-8 is B cells, along with endothelial cells, monocytes, and nerves (epithelial and sensory nerve cells).

Human Herpesvirus 8 (Kaposi Sarcoma-associated Herpesvirus) Epidemiology

Geography: HHV-8 is more prevalent in certain geographic areas like Italy, Greece, and Africa.
High prevalence: Kaposi's sarcoma is the most common cancer in Sub-Saharan Africa.

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Description

Test your knowledge about candidiasis, its types, and associated conditions. This quiz covers important aspects of immunity related to systemic and mucosal candidiasis, as well as visual characteristics of oral thrush. Dive deep into the implications of Candida infections and their clinical significance.