Candidiasis Flashcards
What is candidiasis?
Group of yeast infections, usually C. albicans
Where is C. albicans found?
often part of normal flora in the mouth, GI tract, and vagina
Risk factors for candidiasis?
- neonates and adults >65 yo
- pregnancy
- occlusion of epithelial surfaces
- warm/humid environment
- immunodeficiency
- diabetes
- obesity
- use of medications such as oral glucocorticoids and antibiotics
Which species is MCC (most common cause) of fungal infection?
Candida sp.
What will you see on KOH prep?
budding yeast and pseudohyphae (strings of connected budding cells)
Define mucocutaneous candidiasis
Acute pseudomembranous candidiasis or thrush- MC form of oral candidiasis
What are predisposing factors of mucocutaneous candidiasis?
- diabetes mellitus
- systemic steroid (topical also) and antibiotic use
- pernicious anemia
- malignancy
- radiation to head and neck
- cell-mediated immunodeficiency
How does oral candidiasis present?
- often asymptomatic
- burning or pain on eating spices/acidic foods, diminished taste sensation
Oral candidiasis on PE
- discrete white patches on the buccal mucosa, tongue, palate, gingivae, and pharynx extending down into the esophagus and tracheobronchial tree
- removal of pseudomembrane with a dry gauze leaves erythematous mucosal surface
What is atrophic candidiasis?
- on tongue, depapillated atrophic patches with minimal pseudomembrane formation
- most often in the setting of broad-spectrum antibiotic or systemic glucocorticoid therapy and human immunodeficiency virus infection
- denture stomatitis- 24%–60% of denture wearers
- chronic erythema and edema of the palatal mucosal surface in contact with the dentures
Tx of mucocutaneous candidiasis
- for mild to moderate infections in the mouth or throat: nystatin or fluconazole in form of lozenges or a liquid to swish and swallow for 7 to 14 days
- for severe infections or immunocompromised- usually oral fluconazole
Explain the angular cheilitis/ candidal cheilosis/ perleche
- erythema, fissuring, maceration, and soreness at the angles of the mouth.
- white colonies of candida at time
Who is at risk for angular cheilitis/ candidal cheilosis/ perleche?
- habitual lip lickers and in elderly patients with deeper furrows at the oral commissures
- loss of dentition, poorly fitting dentures, malocclusion, andriboflavindeficiency also predispose
Tx of angular cheilitis/ candidal cheilosis/ perleche
- tx with both topical antifungal and mild topical steroid.
- emphasize very frequent application of emollient ointment
- tx vitamin deficiencies if present
What are the risk factors for vaginal and vulvovaginal candidiasis?
- systemic antibiotic or steroid use
- diabetes mellitus
- presence of an intrauterine device
- wearing of tight-fitting and synthetic clothing
- immunosuppression
How does vaginal/vulvovaginal candidiasis occur?
Disruption of vaginal flora of lactobacilli that inhibits overgrowth ofCandida
S/sx of vaginal/vulvovaginal candidiasis and PE
- pt presents with a vaginal discharge associated with vulvar pruritus, burning, and occasional dysuria or dyspareunia
- on PE: thick curd-like whitish plaques on the vaginal wall, erythema, edema
Tx of vaginal/vulvovaginal candidiasis
- OTC: clotrimazole or miconazole
- Rx: Butoconazole, terconazole, oral fluconazole
What is balanitis?
inflammation of the glans penis d/t yeast overgrowth
Predisposing factors for balanitis
diabetes mellitus, an uncircumcised state, and candidal vaginal infection in sexual partners
S/sx of balanitis
C/o pruritus and burning, dysuria
PE of balanitis
White patches, fragile vesiculopustules, erythematous erosions with a collarette of whitish scale on the glans or prepuce
Tx of balanitis
Tx same as for vulvovaginal
What is cutaneous Candidiasis/Moniliasis?
intertriginous candidiasis
C. albicans predilection for colonizing skin folds, intertriginous zones, where moist and warm
What areas are affected by intertriginous candidiasis?
- genitocrural
- gluteal
- interdigital
- inframammary areas
- beneath the pannus and axillary areas
Predisposing factors to intertriginous candidiasis
obesity, diabetes mellitus, wearing of occlusive clothing
S/sx and PE of intertriginous candidiasis
S/sx: pruritus, tenderness, and pain
PE:macerated erythematous plaques with satellite vesiculopustules
Tx of intertriginous candidiasis
Tx with topical antifungals (including econazole, ketoconazole, oxiconazole, naftifine, terconazole, ciclopirox), or oral for severe or nonresponsive
Define intertrigo
Superficial inflammatory dermatitis where skin surfaces in opposition, esp hot humid weather
What causes intertrigo?
Friction, heat, moisture
S/sx of intertrigo
Burning and itching with erythematous, macerated plaques and possibly secondarily infected with candida or bacteria
**NO satellite lesions
What is streptococcal intertrigo?
- favors neck, axillary and inguinal folds of children.
- presents as fiery red, moist shiny surface with foul smell
***NO satellite lesions
Tx of intertrigo
- low potency topical steroids/tacrolimus to reduce inflammation but in combo with antifungal or antimicrobial
- eliminate maceration: Drysol, zeasorb powder; application gentian violet
Define tinea versicolor/pityriasis versicolor
- caused by group of yeasts, Malassezia ssp.
- mainly Malassezia globose
- Malassezia normal inhabitant to skin of 90% adults not causing sxs
- proliferates causing skin disorder
Predisposing factors for tinea versicolor/pityriasis versicolor
- humidity, sweating, oily skin
- may clear in the winter months and recur each summer
tinea versicolor/pityriasis versicolor on PE
- hypo- or hyperpigmented oval to round mildly scaly macules/patches that coalesce
- patches coppery brown, paler than surrounding skin, or pink
What areas are commonly affected by tinea versicolor/pityriasis versicolor?
Trunk, neck, arms, groin, intertriginous
S/sx of tinea versicolor/pityriasis versicolor
Asx to mild itch, especially when hot or out of shower
Dx of tinea versicolor/pityriasis versicolor
- topical azole cream/shampoo/foam (econazole, ketoconazole), Selenium sulfide, Ciclopirox cream/solution/shampoo
- oral itraconazoleandfluconazole for widespread or non responsive
- oral ketoconazole with black box warning d/t liver problems.
- oral Terbinafine not helpful
How does tinea versicolor/pityriasis versicolor look under Wood’s lamp?
pale yellow fluorescence
Define Pityrosporum (Malassezia) folliculitis
- caused by Malassezia
- follicular papules and papulopustules with perifollicular erythema on the upper trunk, neck, and upper arms of young and middle-aged adults
- pruritic
What conditions contribute to Pityrosporum (Malassezia) folliculitis?
- warm humid conditions
- occlusion of the skin and hair follicles with cosmetics, lotions, sunscreens, emollients, olive oil, or clothing
Dx of Pityrosporum (Malassezia) folliculitis
KOH or bx if needed
Tx of Pityrosporum (Malassezia) folliculitis
- Tx topical and oral antifungal agents as with TV
- Recurrences common- consider maintenance meds
