14 - Yeasts And Fungal Flashcards by michael english

Yeast and fungal infections?

Candida
Tinea versicolor
Dermatophytosis
Sporotricosis

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When does candida become pathogenic?

Damage to stratum corneum or pre-existing condition/disease

pregnancy
sugar aids
contraceptives
abx therapy
topical steroids
immunosuppression

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Morphology of candida?

- mouth

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

Angular chelitis
- erosion, flaking at corners of mouth

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Morphology of candida

- genital

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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Presentation of paronychia candida?

Erythema
Maceration and erosion
Papule and satellite pustules

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Dx of candida?

Clinical
- suspect -> tx

KOH prep
- pseudohyphae w budding spores

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Tx of vaginal candida?

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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Txt of oral candida?

Fluconazole
Clotrimazole
Ketoconazole

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What is tinea/pityriasis versicolor?

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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Morphology of tinea/pityriasis versicolor

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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Clinical manifestation of tinea/pityriasis versicolor?

Asymptomatic (usually)
- may itch w inflammation

Concern is appearance

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Dx for tinea/pityriasis versicolor?

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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Distribution of tinea/pityriasis versicolor?

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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Tx for tinea/pityriasis versicolor

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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Where is dermatophytes (tinea) commonly found

On anyone

MC in hot, humid areas

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Etiology of dermatophytes (tinea)

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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Dermatophytes normal flora?

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Distribution of dermatophytes (tinea)

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

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Morphology of dermatophytes (tinea)

Ringed annular lesion
Raised scaly borders
Expanding central clearing

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

Workup for dermatophytes?

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

Tinea corporis is aka?

Ring worm

Tx for ringworm?

Superficial lesions (use topicals)

clotrimazole
miconazole
ketaconazole
terbinifine

Extensive/deep (oral agent)

fluconazole
terbinafine
itraconazole
griseofulvin
ketoconazole

Tinea pedis is aka?

Athletes foot

Tx for tinea pedis?

Topicals, interdigital

terbinafine
clotrimazole

Oral if moccasin type

terbinafine
itraconazole
fluconazole

Tinea manuus?

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

Tinea barbae tx

Oral agents

What is tinea incognito?

Fungal infection tx w topical steroids MC on groin, face and dorsal hands

Problem w tinea incognito?

Steroids alter characteristics of fungi - marginal scaling absent - diffuse erythema, scale, pustules - absence of boarder

What does the steroid do to dermatophytes?

Inflammation gets better while fungus flourishes

Tinea cruris is aka?

Jock itch

Diagnosis of tinea cruris?

No fluorescence w woods lamp

Txt for tinea cruris?

Keep clean and dry Meds that cover fungus and candida Topical - clotrimazole - miconazole Oral agents for extensive infection

Presentation of tinea capitis?

Ranges from - mild scaling and broken hairs - extensive alopecia

MC Pattern of infection w tinea capitis?

Black dot type | - hairs broken at orifice

Dx of tinea capitis?

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

Txt for tinea capitus?

Systemic oral agents Kids - griseofulvin Adults - griseofulvin (DOC) - terbinafine - itraconazole

What is kerion?

Inflammatory tinea capitis - alopecia - adenopathy - fever KOH may be neg due to local destruction of fungal structures

Kerion tx?

Tx w oral antifungal - griseofulvin - terbinafine - oral steroid (maybe)

What is onychomycosis?

Fungal infection of the nails

MC and least serious deep fungal infection?

Sporotrichosis

What causes sporotrichosis?

Saprphytic fungus - inoculation by trauma This is the rose thorn disease from ID - MC found in florists, farmers and hunters

Diagnosis of sporotrichosis?

Punch or excision biopsy - 1/2 for special stains/microscopic exam - 1/2 for culture

Morphology and distribution for sporotrichosis?

Initial lesion - painless papule/nodule/ulcer Lesions increase in number over weeks Lymphatic pattern - sporotrichoid LAD common

MC site of sporotrichosis?

Finger

Sporotrichosis tx?

Itraconzole (sporanox) - q 3-6 months Classic (older) txt - potassium iodide until clear then 1 month more - bad SE and doesnt work well

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

Pleased to eat you!