Question

A 25 year old woman who was being treated for breast cancer went to her doctor complaining of a sore mouth and difficulty swallowing. The doctor examines her mouth and found white patches on the inside as well as on her tongue. The white patches looked like cottage cheese or milk curds.

The doctor was able to make his diagnosis based on the physical examination, but decided to take a culture and send it to the clinical laboratory for definitive identification.

The Laboratory made a wet mount of the sample and observed clusters of budding yeast cells, and pseudohyphae. Pseudohypahe are a series of buds remaining attached to the print cell and appearing as filamentous hypha. The laboratory was able to make a presumptive identification of the type of yeast so the doctor could start treatment. The doctor prescribed a topical imidazole treatment. The Patient noticed improvement after two weeks.

ANSWER 1-6

1. What was the diagnosis that the doctor could make based on his observation?
2. What was the name of the yeast that was identified? (GENUS SPECIES)
3. Where is this yeast normally found?
4. What is the most likely reason this cancer patient got the disease?
5. What is the drug of choice if the topical treatment did not work?
6. List the references used to answer these questions.

Answer 1

1. The doctor diagnosed the disease as oral thrush.

White patches in the mouth and tongue are due to the fungal growth as the immune system is weak due to chemotherapy. It is common in people undergoing chemotherapy.

2. Candida albicans. It is yeast commonly found in human body.

3. Candida albicans can be normally found in the human body. It can be found in our gut, mouth ,urinogenital system and skin.

4. Most likely reason is chemotherapy induced. Because of the chemotherapy, innate immunity gets depressed and the epithelial barriers of the first line defense also become weak and do not defend the body. So the opportunistic infections can pose a great threat to such individuals. That is why the person suffered from oral thrush.

5. If topical treatment does not function, intravenous antifungal drugs can be administered in people with weak immune system.

Amphotericin B is used as last resort if other treatments are not working. This drug has some side effects.