Candidiasis in children: clinical diagnosis and treatment. Oral manifestations of common infectious diseases in childhood icon

Candidiasis in children: clinical diagnosis and treatment. Oral manifestations of common infectious diseases in childhood




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Practice 6. Candidiasis in children: clinical diagnosis and treatment. Oral manifestations of common infectious diseases in childhood

 

Importance of the subject. Oral candidasis is common disease of the mucous membrane in children. Clinical appearances of candidasis vary widely. Some forms don’t have specific clinical features, so that it’s difficult to make the diagnosis of oral candidasis and may result in following progression, lead to more serious form (mucocutaneous or disseminated candidasis). First oral manifestations of common infectious diseases (chickenpox, scarlet fever, measles, infectious mononucleosis, etc.) are not infrequent in children. Therefore, an accurate clinical diagnosis should be made timely to avoid following progression of infections.

The main goal: to be able to make clinical and differential diagnosis, to develop a treatment plan for candidasis and oral lesions, associated with common infectious diseases in childhood

 

^ Specific Objectives

Pre-practice Knowledge and Skills

To develop skills in:

1. Determining etiologic and risk factors for candidasis and common infections in children while taking history and presenting complaints.

1. 1. Finding out the signs of the candidasis and common infections while taking history and complaints in children.

2. Interpreting clinical findings to select the most informative symptoms associated with candidasis and common infections in children.

2. Finding out the most informative symptoms of the candidasis and common infections in children during intraoral examination.

3. Making a differentional diagnosis of the candidasis and common infections in children on the base clinical manifestations and added investigations

3. Developing a target plan to diagnose and making a differential diagnosis for candidasis and common infections in children

4. Making a tentative diagnosis of the candidasis and common infections in children

4. Making a tentative diagnosis of the candidasis and common infections in children

5. Deciding on a treatment plane of the candidasis and common infections in children.

5. Deciding on a treatment plane of the specific oral lesions in adults.

 

Questions for self-assessment of prerequisite knowledge and skills ′′candidasis and common child′s infections′′

 

Q.1. 12-year-old patient complains of the pain and that the tongue feels burned. Case history: biliary duct dysfunction. The patient is staying in the hospital and treating with systemic steroids for reason of asthma. Intraoral examination: oral mucosa is swollen, there are a tooth prints on the occlusal plane of the mucous membrane. Some separated areas of white plaques are seen on the dorsal surface of the red, enlarged tongue. The patient also complains of an unpleasant taste. The tentative diagnosis is acute oral candidasis (glossitis). What findings of clinical examination indicate the oral candidasis?

A. Systemic steroid treatment.

B. Asthma.

C. Red tongue with white plaques.

D. Tooth prints on the lateral tongue.

E. Unpleasant taste.

 

Q.2. 11-year-old girl complains about burning sensation in the tongue. Case history: she used antibiotics prescribed by gynecologist during one week. Intraoral examination: oral mucosa is swollen, there are a tooth prints on the occlusal plane of the mucous membrane. Some separated areas of white plaques are seen on the dorsal surface of the red, enlarged tongue. The patient also complains of an unpleasant taste. The tentative diagnosis is acute oral candidasis (glossitis). What is the main important syndrome in this case?

A. Swelling of the oral mucosa.

B. Red colour of the tongue.

C. White plaques on the dorsal tongue.

D. Tooth prints on the lateral tongue.

E. Unpleasant taste.

 

Q.3. 8-year-old boy had the contact with the man who had herpes Zoster and complains of the miserable conditions, pain in the mouth and itching sensation. Examination: submandibular lymph nodes are enlarged, painful; the vesicular lesions on the skin are near 4mm. in diameter; there are a numerous small ulcers (aphtous) on the oral mucosa. The initial diagnosis is Varicella (Chickenpox). What additional investigation should confirm the diagnosis?

A. Blood analysis.

B. Urinalysis.

C. Cytological smear.

D. Needle biopsy.

E. Bacterial investigation.

 

Q.4. 17-year-old girl is sick and staying in the hospital caused by acute bronchitis. Some antibiotics are used for her treatment. After fifth day of therapy the pseudomembranous plaques has arisen on the inflamed oral mucosa. These plaques resembling curdled milk can be difficult scraped off, leaving the painful erosive areas behind. What is the tentative diagnosis likely to be?

A. Allergic reaction caused by medications.

B. Acute Atrophic Candidasis.

C. Acute Oral Candidasis.

D. Primary Herpes Simplex infection.

E. Oral lesions caused by Diphtheria

.

Q.5. In 30-year-old patient was found to have acute oral candidasis, middle degree of progression. What topical drug’s group should you use first of all?

A. Antibiotics.

B. Hypoallergenic medication.

C. Antifungal drugs.

D. Anesthetics.

E. Topical drugs are favorable for epithelization

 

Q.6. The parents of 1,5 month-old baby complain of presence whitish deposits on the oral mucosa of the cheeks and lips. Exam: oral mucosa of the affected sites is swollen, erythematous and covered with curdled-like plaque, which can be easily scraped off. What is the causative agent of that disease?

A. Fusospirillar symbiosis

B. Candida albicans

C. Herpes simplex virus

D. Loeffler's bacillus

E. Neisser′s diplococci

 

Q.7. A bacterial disease with oral manifestation is:

A. Herpes

B. Measles

C. Diphtheria

D. Leishmaniasis

E. Infectious mononucleosis

 

Q.8. A case presenting with a gray colored pseudomembrane whose removal is difficult and painful can be;

A. Acute necrotizing ulcerative gingivitis (ANUG)

B. Diphtheritic lesions

C. Secondary stage of syphilis

D. Desquamative gingivitis

E. Candidasis

 

Q.9. ′′Strawberry tongue′′ is associated with:

A. Syphilis

B. Measles

C. Scarlet fever

D. Typfoid

E. Diphtheria

 

 Q.10. Early tongue change seen in scarlet fever is:

A. Geographic tongue

B. Strawberry tongue

C. Auspitz′s sign

D. Nikolsky′s sign

E. Black hairy tongue

 

Q.11. Koplik spots are:

A. Oral manifestation of measles

B. Rarely seen in measles

C. Seen 2-3 days after skin rashes

D. First oral manifestation of measles but seldom seen

E. Oral manifestation of infectious mononucleosis

 

Q.12. Candidasis is a complication of all the following except:

A. Antibiotic therapy

B. Steroid therapy

C. Immune compromised diseases

D. Aspiration pneumonia

E. Bacterial misbalances

 

Key answers ′′candidasis and common child′s infections′′ (pre-practice)

Q.1.-C; Q.2-C; Q.3-C; Q.4.-C; Q.5.-C; Q.6- B; Q.7.-C; Q.8.-B; Q.9.-C; Q.10.- B; Q.11.-D; Q.12.-D

 

Recommended reading

1. ORAL AND MAXILLOFACIAL PATHOLOGY/ Robert E. Marx, Diane Stern. 1st Ed., 2003- p. 39-44, 70-77, 90-95.

2. PAEDIATRIC DENTISTRY/ Edited by Richard R. Welbury. Second edition. Oxford, 2001- p.341-343.

3. Materials of the ‘Candidasis and common infections in children’ Lecture (Pediatric Dental Therapy).

Theory Topics For Target Activity Use.

 

  1. Acute candidiasis. Etiology, pathogenesis, clinical diagnosis, and treatment.

  2. Chronic candidiasis. making a clinical diagnosis and treatment.

  1. Chicken-pox in children. Etiology, pathogenesis. Manifestations in oral cavity. Clinical diagnosis. Treatment plan of pediatric dentist.

  2. Scarlet fever. Etiology, pathogenesis, clinical diagnosis. Manifestations in oral cavity. Treatment planning.

  3. Measles. Clinical diagnosis. Manifestations in oral cavity. Treatment tactic of pediatric dentist.

  4. Clinical diagnosis of infectious mononucleosis. Manifestations in oral cavity.

  5. Diphtheria. Etiology, clinical diagnosis. Manifestations in oral cavity.

 

Test questions for final control of the practice: ′′candidasis and common child′s infections′′

 

Q.1. 9-year-old child complains of the pain and a burning sensation in the tongue. Case history: the child was found to have a chronic colitis. The patient had pneumonia and was treating with antibiotics in the hospital two weeks ago. Examination: oral mucosa is swollen; the tongue is red and enlarged. There are some separated areas of white plaques can be easily scraped off on the dorsal tongue and cheek. The atrophy of the filiform papillae is clinically determined. The patient also complains of an unpleasant taste. The tentative diagnosis is acute oral candidasis. What findings of the case history and complaints indicate oral candidasis in this patient?

A. Dysfunction of the biliary ducts.

B. The tongue is enlarged and red.

C. White plaques and the atrophy of the filiform papillae.

D. Swelling and redness of the oral mucosa.

E. Chronic colitis, treatment with antibiotics.

 

Q.2. 1-year-old infant is staying in the hospital for reason of the acute bronchitis and treating with systemic antibiotics. The pseudomembranous plaques have arisen on the swollen oral mucosa of the cheek and tongue. These plaques resembling curdled milk can be difficult scraped off, leaving the painful erosive areas behind. What is the tentative diagnosis likely to be?

A. Allergic reaction caused by medications.

B. Acute Atrophic Candidasis.

C. Hyperplastic Candidiasis.

D. Leukoplakia.

E. Acute pseudomembranous Candidasis.

 

Q.3. 1-year-old infant is staying in the hospital for reason of the acute bronchitis and treating with systemic antibiotics. The pseudomembranous plaques have arisen on the swollen oral mucosa of the cheek and tongue. These plaques resembling curdled milk can be difficult scraped off, leaving the painful erosive areas behind. What is the etiologic treatment?

A. Antibiotics.

B. Hypoallergenic medication.

C. Antifungal drugs.

D. Anesthetics.

E. Topical drugs are favorable for epithelization

 

Q.4. A 1,8-year-old boy was under treatment in the infectious disease department. He was given ampicillin. On the 6-th day of treatment there appeared white deposits in form of caseous films that were revealed on the hyperemic mucous membrane in the area of gingival torus, cheeks and on the tongue. The films can be removed leaving hyperemic surface underneath them. General condition is satisfactory. Body temperature is 36,7 ºC. What is the provisional diagnosis?

A. Acute candidous stomatitis.

B. Drug-induced stomatitis.

C. Chronic candidous stomatitis.

D. Acute herpetic stomatitis.

E. Mild case of Leukoplakia.

 

Q.5. A 12-year-old girl complains about burning and painfulness of her tongue, especially during eating spicy food. Objectively: there are oval red spots on the tip and dorsum of tongue. Filiform papillae are not present on the affected area. The girl mentions that spots become periodically larger and have migratory nature. What is the most probable diagnosis?

A. Raspberry tongue.

B. Median rhomboid glossitis.

C. Glossitis areata exfoliativa.

D. Glossotrichia.

E. Lingua plicata.

 

Q.6. A 2 year old child was brought to a dentist to consult about oral lesions and painfulness during eating that appeared yesterday. Objectively: body temperature is 37,5oC, skin is clean, submandibular lymph nodes are painful. Examination of oral cavity revealed on the mucous membrane of lips and tongue roundish painful erosions 1-3 mm in diameter covered with whitish deposit. The gums on both upper and lower jaws are hyperemic, edematous, bleed when touched. What is the most probable diagnosis?

^ A. Recurrent aphthous stomatitis

B. Stevens-Johnson syndrome

C. Multiform exudative erythema

D. Acute herpetic stomatitis

E. Recurrent herpetic stomatitis

 

Q.7. A 5 year old child has temperature rise up to 39,2oC, sore throat, nausea. Objectively: mucous membrane of soft palate and palatine arches is brightly hyperemic, it can be distinctly distinguished among the surrounding tissues. The tongue is dry, edematous, bright-red, its lateral surfaces have no furs on them, and fungiform papillae are evidently enlarged. Face skin is hyperemic, apart of pale nasolabial trigone, is covered with spotty rash. Submaxillary lymph nodes are palpatory painful. What is the causative agent of this disease?

^ A. Loffler’s bacillus

B. Herpes virus

C. Coxsackie virus

D. Bordet-Gengou bacillus

E. Haemolytic streptococcus

 

Q.8. A 7 month old child was brought to a dentist because of an ulcer in the oral cavity. The child was born prematurely. She has been fed with breast milk substitutes by means of a bottle with rubber nipple. Objectively: on the border between hard and soft palate there is an oval ulcer 0,8х1,0 cm large covered with yellowish-grey deposit and surrounded with a roll-like infiltration. Make a provisional diagnosis:

^ A. Acute herpetic stomatitis

B. Acute candidous stomatitis

C. Setton's aphtha

D. Bednar's aphtha

E. Tuberculous ulcer

 

Q.9. A 4-year-old child presents with headache, nausea, painful swallowing. Body temperature is 39 oC examination of oral cavity revealed extremely hyperemic mucous membrane and tonsils. On the first day of disease the child′s tongue was furred with grayish coating; on the second day the tongue was found to be self-purified. On the third day the tongue was smooth, of crimson color, with hyperemic fungiform papillae. What is presumptive diagnosis?

A. Measles

B. Scarlet fever

C. Herpangina

D. Varicella

E. Diphtheria

 

Q.10. 15-year-old patient complains about raised body temperature, weakness, pain induced by eating and deglutition. Objectively: oral mucosa is erythematous with multiple petechiae. Pharynx is hyperemic. Regional lymph nodes are enlarged, mobile, and painful. In blood: leukocytosis, monocytosis, atypical mononuclears, ERS IS 30mm/h. what is the causative factor?

  1. Hypersensitivity reaction (immediate)

  2. Viral infection

  3. Hypersensitivity reaction (delayed)

  4. Autoimmune disorders

  5. Bacterial infection

 

Q.11. 6-year-old girl had raised temperature, skin and oral lesions 2 days ago. Exam: malaise, body temperature is 38,2 C. There are numerous vesicles with transparent fluid inside, on the face skin, extremities, trunk, and on the hair covering of the head. Erosions with well-demarked, rounded contours are seen on the cheeks, tongue, hard and soft palate. Submandibular lymph nodes are enlarged and painful during palpation. Your proposed diagnosis is:

  1. Oral manifestation of scarlet fever

  2. Primary herpetic stomatitis

  3. Erythema multiforme

  4. Oral manifestation of measles

  5. Varicella (chickenpox)

 

Q.12. A2-month-old baby is anxious, sleeps badly, refuses food, has subfebrile body temperature. Objectively: hyperaemic mucous membrane of the child′s tongue, lips, cheeks, and palate has a caseous coating, that can be easily removed with a tampon. Regional lymph nodes are slightly enlarged and painful on palpation. What disease are these symptoms typical for?

A. Chronic atrophic candidous stomatitis

B. Acute pseudomembranous candidous stomatitis

C. Acute herpetic stomatitis

D. Measles –associated stomatitis

E. Diphtheria

 

Q.13. Preventive examination of 7-year-old schoolboy revealed irremovable grey-and-white layering on the mucous membrane of cheeks along the line of teeth joining. Mucous membrane is slightly hyperaemic, painless on palpation. The boy is emotionally unbalanced, bites his cheeks. What is the most likely diagnosis?

A. Chronic candidasis

B. Lichen planus

C. Recurrent aphthous minor

D. Mild leukoplakia

E. Erythema multiforme

 

Q.14. A 12-year-old girl complains about swelling, reddening and itching of lips. She has a history of bronchial asthma. Such condition has been observed in the child for 3 years in winter period. Objectively: red border of lips and adjacent skin exhibit a well-defined erythema and edema, small cracks. There ars signs of lip lichenification. There are also marks of scratches on the skon of lips, cheeks and forehead in form of abrasions and crusts. Mucous membrane exhibit no pathologic changes. What is the most likely diagnosis?

A. Contact allergic cheilitis

B. Atopic cheilitis

C. Microbial cheilitis

D. Meteorogical cheilitis

E. Exfoliative cheilitis

 

 

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