Chapter 161 Yeast Infections Flashcards
Favored areas of involvement of Candidiasis (6)
Oral mucosa Lips Fingers Nails Intertriginous zones Genitalia
Most common culprit in fatal fungal sepsis
Candida
Risk factors for Candida infection (5)
Extremes of age Malnutrition Obesity Diabetes Immune deficiency
Candidal colonization has been reported in more than ___ of oral mucosa of heathy adults with higer rates of carriage in (2)
40%
Women
Smokers
Majority of invasive candidiasis and candidemia
Non albicans species
Seen on the third webspace of hands, macerated whitish plaque on erythematous background
Erosio interdigitalis blastomycetica
Distinguishing features of candida onychomycosis vs tinea unguium (2)
More often seen in fingernails than toenails
Pain on pressure or movement of nail plate
Affects dominant hand
Ddx for chronic mucocutaneous candidiasis
Plaque psoriasis
Classic clinical triad of candidemia
Fever
Rash
Myalgia
Complications of candidemia
Multiorgan failure (liver, spleen, kidneys, heart, meninges)
Mutations in ___ results in inabilty to induce TH 17 resulting in defect in ability of neutrophils to kill Candida
Caspase recruitment domain containing protein 9 (CARD9)
Risk factors for oral candidiasis (6)
Xerostomia Wearing of dentures or other oral hardware Inhaled and systemic corticosteroids Vitamin deficiencies Radiation therapy to head and neck Hypothyroidism
Risk factors for invasive candidiasis and candidemia (6)
Neutropenia and neutrophil dysfunction (CARD9 mutations) Hematologic malignancy Stem cell transplantation In dwelling intravascular catheters ICU placement Immunosuppressive medications
Risk factors for localized/superficial Candida infections (6)
Extremes of age Obesity DM Pregnancy HIV/AIDS Broad spectrum antibiotics, corticosteroids, immunosuppressive medications
Rapid demonstration of Candida infection
KOH preparation of pseuddohyphae and budding
Gold standard for diagnosis of Candida infection
Blood cultures
HPx of localized mucocutaneous candidiasis vs disseminated candidiasis
Localized, seen in epidermis with GMS or PAS
Dermal, seen in and aroun dermal blood vessels
First line treatment for cutaneous candidiasis
Topical imidazole
Topical nystatin
First line treatment for chronic paronychia
Avoid wet work
Topical corticosteroids
Topical calcineurin inhibitors
First line treatment for onychomycosis
Oral itraconazole 400mg PO monthly for 4 weeks for fingernails
For 12 weeks for toenails
Oral fluconazole 50mg PO daily
Or 300mg weekly
First line treatment for severe/immunosuppressed thrush
Fluconazole 150mg PO three times weekly
First line treatment for oral thrush
Clotrimazole 10mg troches five times daily
Miconazole 50mg buccal tablets 1-2 weeks
Disinfect dentures
Alternative: Nystatin suspension 100,000 units/ml 4-6ml QID for 1-2 weeks
First line treatment for Candidal vulvovaginitis
Topical miconazole
Topical clotrimazole
First line treatment for chronic mucocutaneous candidiasis
Oral imidazole
Oral triazole for long courses
First line treatment for disseminated candidemia for hemodynamically stable immunocompetent patients
Echinocandin
Fluconazole
First line treatment for disseminated candidemia for neutropenic patients
Empiric echinocandin (caspofungin, micafungin, anidulafungin) Switch to fluconazole once stable
Colonization of malassezia occurs by age of __ with earlier colonization if associated with length of neonatal ICU stays
3-6 months
MC isolated species in pityriasis versicolor and Malassezia folliculitis
Malassezia globosa
MC pathogen of catheter related fungemia in neonates
Malassezia pachydermatitis
Follicular based erythematous monomorphic papules and pustules on face, trunk, and upper arms
Malassezia folliculitis
Comedones are also a feature of Pityrosporum folliculitis
True or False
False, not
Hypopigmentation of P. Versicolor is due to production of
Azelaic acid
Hyperpigmentation of P. Versicolor is due to production of
Increased melanosomes
Thickening of stratum corneum
In both PV and Malassezia folliculitis, illumination with a Wood lamp may reveal
Yellow green fluorescence
In both PV and Malassezia folliculitis, KOH may reveal
Ziti and meatball sign
Short hyphae and yeast forms
Stains to improve visualization of yeast
Calcofluor white
May-Grunwald-Giemsa stain
Malassezia produces ___ which provokes inflammation in host
Free fatty acids
Malassezia produce variety of diseases (5)
Pityriasis versicolor Malassezia folliculitis Seborrheic dermatitits Atopic dermatitis Neonatal cephalic pustulosis
Higher risk for disseminated infection (3)
Preterm neonates
Immunosuppressed
Parenteral lipid infusions
First line treatments for pityriasis versicolor
Topical shampoos with Zn pyrithione and Selenium sulfide
Propylene glycol in aqueous solution
Topical imidazole (ketoconazole)
Treatment for prophylaxis of pityriasis versicolor
Periodic use of topical shampoos
Itraconazole 200mg BID/monthly for 6 months
First line treatment for Malassezia folliculitis
Itraconazole 200mg daily for 1-3 weeks