Pathology · patient case question
In this HIV patient, all of the following contribute to candidiasis EXCEPT:
Patient case: Needlestick before patient contact in an HIV-positive patient
Scenario: An HIV patient came for an extraction. During the anaesthetic procedure, the dentist OPENS THE CAP BEFORE CONTACTING THE PATIENT and gets a NEEDLE STICK.
Show answer and explanation
Correct answer: B. Increased vertical dimension of occlusion
- A. Broad-spectrum antibiotics suppress the competing bacterial flora and permit candidal overgrowth.
- B. Correct — this is the EXCEPTION. It is a DECREASED vertical dimension that predisposes to candidiasis, by deepening the labial commissural folds so that saliva pools there and macerates the tissue, producing ANGULAR CHEILITIS. An increased vertical dimension does not promote candidal overgrowth.
- C. Xerostomia removes the flushing action, antimicrobial proteins and immunoglobulins of saliva, allowing candidal overgrowth.
- D. Immunosuppression — particularly a falling CD4 count in HIV — is a major predisposing factor; oral candidiasis is frequently the first clinical sign of HIV progression.
Note: Other predisposing factors worth listing: inhaled corticosteroids without rinsing, denture wear (especially overnight), diabetes, smoking, infancy and old age, and nutritional deficiency.