FUNGAL INFECTION-CANDIDA

Question 1

A. best in warm, moist environments, so infection is often confined to mucous membranes and intertriginous areas.
B. acts as an opportunistic pathogen when allowed to overgrow and predisposing conditions permit.

Answer 1

Candidiasis

Question 2

Hormonal alterations of the skin microbiome

Answer 2

(1) Pregnancy
(2) Oral contraceptive use
(3) Systemic antibiotic therapy
(4) Diabetes

Question 3

Elimination of competing microorganisms

Answer 3

Systemic antibiotic therapy

Question 4

Physical environment changes

Answer 4

(1) Skin maceration

(2) Increased humidity/temperature

Question 5

Direct/Indirect Immunosuppression

Answer 5

(1) Topical/systemic corticosteroid therapy

(2) Immunosuppression

Question 6

Candidiasis Presentation

Answer 6

n. Occurs most commonly in rubbing (intertriginous)-axillae, groin, digital web spaces, glans penis, and beneath the breasts. Vulvovaginal candidiasis is common among women.
o. manifest as ITCHY (pruiritc), WELL-DEMARCATED, ERYTHEMATOUS PATCHES of varying size and shape**
p. Primary patches may have adjacent satellite papules and pustules; dissect horizontally under the stratum corneum and then peel it away.
q. Oral candidiasis in adults (can be) first sign of HIV

Question 7

Treatment

Answer 7

(1) Affected skin should be kept dry and exposed to air as much as possible.
(2) Topical Azole class antifungals:
(a) Miconazole (Monistat)
(b) Clotrimazole (Lotrimin-AF)
(c) Ketoconazole (Nizoral)
(3) Allylamine class antifungals:
(a) Terbinafine (Lamisil)
(b) Relief is almost immediate, but treatment should be continued for 10 days.
(4) Vaginal Candidiasis:
(a) Patient should be advised to avoid sexual contact until the infection resolves.
(b) First Line (Topical)
1) Clotrimazole Vaginal Cream (Gyne-Lotrimin)
2) Miconazole Nitrate Vaginal Cream (Monistat)
(c) Second Line (Oral)
1) Fluconazole (Diflucan)
(5) Topical steroid preparations give temporary relief by suppressing inflammation, but eruption rebounds and worsens. These preparations are NOT recommended!

Question 8

Dx based on:

Answer 8

(a) Clinical appearance of lesions
(b) Location of infection
(c) Presence of predisposing factors

Question 9

Labs

Answer 9

(a) Typically not required as clinical diagnosis is sufficient.
(b) Lab diagnosis based on identification of yeast and pseudohyphae in potassium hydroxide wet mounts of scrapings from a lesion.
(c) Positive culture alone is usually meaningless because Candida is omnipresent.