Fungal infections Flashcards
How do you treat tinea capitis?
oral terbinafine >4 yo, griseofulvin >2 yo
oral fluconazole or itraconazole are options
Do topical agents work on tinea capitis?
they can reduce transmission but cannot treat. Add on top of treatment!
-selenium sulfide, ketoconazole shampoo!
How do you treat a kerion formation in tinea capitis?
griseofulvin
How do you treat tinea barbae?
terbinafine, griseofulvin, fluconazole
+ topical agents
How do you treat tinea corporis?
topical terbinafine, butenafine, -zoles, and continue treatment 1-2 weeks post clearance
What if your patient has extensive lesions of tinea corporis?
oral regimen - itraconazole or terbinafine work!
How do you treat tinea cruris?
topical terbinafine or -zoles
severe - oral itraconazole or terbinifine
How do you treat tinea pedis in the macerated stage?
aluminum acetate solution soaks + topical cream (azoles/ciclopirox)
OR
terbinafine/butenafine
How do you treat tinea pedis in the dry/scaly stage?
broad spectrum antifungal cream (urea lotion)
How do you treat tinea pedis in the severe stage?
itraconazole or terbinafine + topical maintenance powders/creams
How do you treat onychomycosis in the fingernail?
griseofulvin, terbinafine, itraconazole, fluconazole
How do you treat onychomycosis in the toenail?
terbinafine or itraconazole
How do you treat tinea versicolor?
oral fluconazole + topical treatments for maintenance/ addition!
What’s the presentation of oropharyngeal candidiasis?
itching, burning/sore throat, dysphagia/odynophagia, possible pain at lips
Thick, white plaques on tongue that CAN be scraped away, beefy, red appearance
What should you test for when you see thrush in a healthy young person?
HIV
How do you treat oropharyngeal candidiasis?
fluconazole, ketoconazole, clotrimazole, nystatin mouth rinse
Nystatin powder for dentures
What is cheilitis?
cracked lips, red swollen corners of the mouth, white patches
How do you treat cheilitis?
nystatin, ketoconazole, clotrimazole
What’s vulvovaginal candidiasis?
white discharge, itching, irritation, dysuria dyspareunia
How do you treat vulvovaginal candidiasis?
- single dose fluconazole
- intravaginal clotrimazole
- miconazole
- terconazole
- nystatin
Recurrent = itraconazole
What’s balanitis?
itching around glans penis, red swollen foreskin, white discharge
purulent - bacterial
What’s the treatment for balanitis?
topical nystatin ointment
soaking with dilute aluminum acetate can help
Refer!
REVIEW: intertrigo
beefy red, macerated plaques; scrape and double check, many causes – topical antifungal tx!
What is a candidal cystitis?
UTI but cannot differentiate from symptoms on bacterial vs yeast –need to do a UA!
General UTI symptoms
How do you manage recurrent candidal cystitis?
PO fluconazole
remove bladder catheter, discontinue abx!
How does esophageal candidiasis present?
substernal odynophagia, gastroesophageal reflux, maybe thrush
How do you diagnose esophageal candidiasis?
endoscopy with biopsy and culture
How do you manage esophageal candidiasis?
swallow = fluconazole or itraconazole
severe = IV fluconazole, echinocandin or voriconazole
What is invasive candidiasis?
candida in the blood - diagnose with blood culture, and treat with IV therapy
What are the four types of histoplasmosis?
- acute pulmonary
- progressive disseminated
- chronic pulm
- complications of pulm
What is acute pulmonary histoplasmosis?
mild influenza to severe PNA
What is progressive disseminated histoplasmosis?
fever, multi-organ involvement w/ dyspnea, cough, weight loss, prostration (HIV, TNF) septic shock, hepatosplenomegaly, adrenal involvement, GI, CNS involvement
CT shows miliary pattern
Where is histoplasmosis most common Hint hint for test?
eastern tennesse, eastern midwest - think high acidity and humidity in soil!
What indicates histoplasmosis in labs?
low everything - all is effected
What’s the best way to diagnose histoplasmosis?
combo of 1st morning urine + serum polysaccharide antigen assays
How do you treat histoplasmosis?
mild-moderate = itraconazole
severe/meningitis = IV amphotericin B followed by oral itraconazole
What is a lumbar puncture important for?
to check CNS
What’s the clinical presentation of the cryptococcosis?
cough, sputum, hemoptysis, dyspnea, chest pain, fever, malaise, night sweats, weight loss
What’s a risk with immunocompromised and cryptococcosis?
often develop tumors that spread to brain
What’s the MCC of fungal meningitis?
cryptococcosis
How do you diagnose cryptococcosis?
culture of respiratory secretions/pleural fluid, lumbar puncture
CXR & CT = pulmonary nodule
How do you manage cryptococcosis?
depends on severity & comorbidities -> CNS involvement is essential to check
What is coccidiodomycosis?
primary = fever, chills, headache, body aches
erythema nodosum 2-20 days after onset of symptoms
disseminated = verrucous skin lesions & abscesses, pulmonary findings pronounced, meningeal signs if CNS involvement
Where is coccidiodomycosis found?
SW USA, south america
What helps coccidiodomycosis diagnosis?
labs - CBC, ELISA, CSF
Imaging - variable findings, hilar lymphadenopathy
How do you manage coccidiodomycosis?
symptomatic for limited disease
w/ progression - itraconazole, fluconazole
progressive = IV amphotericin B
meningitis = high dose fluconazole/amphotericin B
In who is blastomycosis most common?
immunocompetent outdoor activity people
What are the symptoms of blastomycosis?
- abrupt onset fever
- chills
- body aches
- pleuritic chest pain
- cough
- dysuria
- headache and neck pain (CNS)
- epididymitis, prostatitis
- respiratory distress w/ tachypnea
cutaneous has verrucous lesions and bones are often involved
Where is blastomycosis most common?
eastern midwest area; often presenting after failed abx therapy
How can you diagnose blastomycosis?
CBC, sputum/tissue biopsy, culture, UA
Imaging - look for lobar consolidation (tumor?)
How do you treat blastomycosis?
mild - itraconazole long-term
moderate/CNS/treatment failure = IV amphotericin B followed by oral -azoles
