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Senior - Derm 3 > 14 - Yeasts And Fungal > Flashcards

14 - Yeasts And Fungal Flashcards

1
Q

Yeast and fungal infections?

A

Candida
Tinea versicolor
Dermatophytosis
Sporotricosis

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2
Q

When does candida become pathogenic?

A

Damage to stratum corneum or pre-existing condition/disease

  • pregnancy
  • sugar aids
  • contraceptives
  • abx therapy
  • topical steroids
  • immunosuppression
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3
Q

Morphology of candida?

- mouth

A

Oral (thrush)
- white adherent plaques, erosions on tongue

Angular chelitis
- erosion, flaking at corners of mouth

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4
Q

Morphology of candida

- genital

A

Vulvovaginitis

  • thick, white discharge
  • erosions satellite lesions
  • pruritic, tender edematous

Intertriginous (skin folds)

  • diaper dermatitis
  • erosion interdigitalis blasto
  • inframammory
  • balanitis
  • paronychia (nail folds)
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5
Q

Presentation of paronychia candida?

A

Erythema
Maceration and erosion
Papule and satellite pustules

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6
Q

Dx of candida?

A

Clinical
- suspect -> tx

KOH prep
- pseudohyphae w budding spores

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7
Q

Tx of vaginal candida?

A

Oral DOC

  • fluconazole (diflucan)
  • not for preggos

Topical - azoles or nystatin

  • safe in pregnancy
  • clotrimazole and miconazole (MC)
  • creams, vaginal tabs, suppositories etc
  • 3 day regime
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8
Q

Txt of oral candida?

A

Fluconazole
Clotrimazole
Ketoconazole

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9
Q

What is tinea/pityriasis versicolor?

A

Over growth of yeasts

  • pityrosporum orbiculare and P. Ovale
  • normal skin flora

Seen in hot, humid climates
- causes yeasts to change

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10
Q

Morphology of tinea/pityriasis versicolor

A

Individual lesions and distrobution are highly characteristic

Begin

  • multiple small circular macule of various colors (white, brown, pink)
  • enlarge rapidly
  • superficial flaking
  • typically turns darker in LPP and lighter in DPP
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11
Q

Clinical manifestation of tinea/pityriasis versicolor?

A

Asymptomatic (usually)
- may itch w inflammation

Concern is appearance

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12
Q

Dx for tinea/pityriasis versicolor?

A

Powdery scale upon scraping

KOH

  • numerous short, broad hypahe and clusters of budding cells
  • spaghetti and meatballs
  • bats and balls

Woods light
- pale yellow to white fluorescence

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13
Q

Distribution of tinea/pityriasis versicolor?

A

MC site
- mid chest and upper back

Antecubital fossa
Neck
Extensive eruptions
- upper arms and lower face

Face lesions ore MC in kids

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14
Q

Tx for tinea/pityriasis versicolor

A

Topical agents

  • ketaconazole (nizoral) shampoo
  • selenium sulfide suspension 2.5%

Oral agents

  • ketoconazole (nizoral)
  • itraconazole
  • Fluconazole (diflucan)

Prevent recurrences
- ketaconazole shampoo AAA weekly

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15
Q

Where is dermatophytes (tinea) commonly found

A

On anyone

MC in hot, humid areas

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16
Q

Etiology of dermatophytes (tinea)

A

Infects and survives only on dead keratin (stratum corneum, nails, hair)

Sources: animals, soil, humans

Inhabits the skin w/o infection

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17
Q

Dermatophytes normal flora?

A

No

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18
Q

Distribution of dermatophytes (tinea)

A

Tinea capitis - scalp
Tinea pedis - feet
Tinea corporis - trunk, face, limbs

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19
Q

Morphology of dermatophytes (tinea)

A

Ringed annular lesion
Raised scaly borders
Expanding central clearing

Normally 
- papules/plaques 
occasionally 
- pustules
- vesicles 
- erythema w flaking
20
Q

Workup for dermatophytes?

A

Dermatophytosis (not clinical dx)
KOH - use active border, branching hyphae
DTM culture (turns red)
Woods light
- no fluorescence except w tinea versicolor

21
Q

Tinea corporis is aka?

A

Ring worm

22
Q

Tx for ringworm?

A

Superficial lesions (use topicals)

  • clotrimazole
  • miconazole
  • ketaconazole
  • terbinifine

Extensive/deep (oral agent)

  • fluconazole
  • terbinafine
  • itraconazole
  • griseofulvin
  • ketoconazole
23
Q

Tinea pedis is aka?

A

Athletes foot

24
Q

Tx for tinea pedis?

A

Topicals, interdigital

  • terbinafine
  • clotrimazole

Oral if moccasin type

  • terbinafine
  • itraconazole
  • fluconazole
25
Q

Tinea manuus?

A

Hand infection
- 1 hand 2 feet
More common in men
Tx like tinea pedis

26
Q

Tinea barbae tx

A

Oral agents

27
Q

What is tinea incognito?

A

Fungal infection tx w topical steroids

MC on groin, face and dorsal hands

28
Q

Problem w tinea incognito?

A

Steroids alter characteristics of fungi

  • marginal scaling absent
  • diffuse erythema, scale, pustules
  • absence of boarder
29
Q

What does the steroid do to dermatophytes?

A

Inflammation gets better while fungus flourishes

30
Q

Tinea cruris is aka?

A

Jock itch

31
Q

Diagnosis of tinea cruris?

A

No fluorescence w woods lamp

32
Q

Txt for tinea cruris?

A

Keep clean and dry

Meds that cover fungus and candida
Topical
- clotrimazole
- miconazole

Oral agents for extensive infection

33
Q

Presentation of tinea capitis?

A

Ranges from

  • mild scaling and broken hairs
  • extensive alopecia
34
Q

MC Pattern of infection w tinea capitis?

A

Black dot type

- hairs broken at orifice

35
Q

Dx of tinea capitis?

A

Sterile toothbrush rubbed over affected scalp -> inoculate fungal culture medium

36
Q

Txt for tinea capitus?

A

Systemic oral agents

Kids
- griseofulvin

Adults

  • griseofulvin (DOC)
  • terbinafine
  • itraconazole
37
Q

What is kerion?

A

Inflammatory tinea capitis

  • alopecia
  • adenopathy
  • fever

KOH may be neg due to local destruction of fungal structures

38
Q

Kerion tx?

A

Tx w oral antifungal

  • griseofulvin
  • terbinafine
  • oral steroid (maybe)
39
Q

What is onychomycosis?

A

Fungal infection of the nails

40
Q

MC and least serious deep fungal infection?

A

Sporotrichosis

41
Q

What causes sporotrichosis?

A

Saprphytic fungus
- inoculation by trauma

This is the rose thorn disease from ID
- MC found in florists, farmers and hunters

42
Q

Diagnosis of sporotrichosis?

A

Punch or excision biopsy

  • 1/2 for special stains/microscopic exam
  • 1/2 for culture
43
Q

Morphology and distribution for sporotrichosis?

A

Initial lesion - painless papule/nodule/ulcer

Lesions increase in number over weeks

Lymphatic pattern - sporotrichoid

LAD common

44
Q

MC site of sporotrichosis?

A

Finger

45
Q

Sporotrichosis tx?

A

Itraconzole (sporanox)
- q 3-6 months

Classic (older) txt

  • potassium iodide until clear then 1 month more
  • bad SE and doesnt work well
46
Q

How does the lion greet the other animals in the field?

A

Pleased to eat you!

Senior - Derm 3 (7 decks)

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