fungal infections Flashcards
risk factors for fungal disease
dampness
poor circulation
post menopause
suppressed immune system
nail and skin injury
Abx use
low vitamin D
DM
dry and scaly
tinea
moist and beefy
candida
superficial fungal infection of the skin caused by dermatophytes trichophyton
tinea infections
- pt notices a balding patch
-dry crusting scalp
-dry,flaking well defined around plaque like lesion
tinea capitis
tinea capitis treatment
oral terbinafine (kids per 4)
griseofulvin (kids over 2)
-inflamed dry patches/plaques within the beard
-may itch
-may have yellow crusting
-tender
tinea barbae
tinea barbae treatment
oral terbinafine, griseofulvin,flucanoazole
-often from infected pet
-itchy
-annular lesion with advancing scaly border and central clearing
tinea corporis
tinea corporis prevention
-treat infected pets
-use foot powder
-keep feet dry
-wear clean socks
tinea corporis treatment
topical terbinafine
-itching of skin of genitals, inner thighs and buttock
-intertriginous areas
-burning sensation
-annular shaped erythematous lesions with raised scaly borders and a clear center
tinea cruris (jock itch)
tinea cruris (jock itch) prevention
miconazole nitrate drying powder for excessive perspiration or protection of skin folds
tinea cruris (jock itch) treatment
topical terbinafine
-most often presents with asymptomatic scaling
-may progress to fissuring or maceration in toe web spaces
-itching, burning
-scaling palms and soles
tinea pedis (athletes foot)
tinea pedis treatment (macerated stage)
- aluminum acetate (domeboro) solution soak
- PLUS topical cream (azoles or ciclopirox)
-thickened yellow brittle deformed nail
-possible loss of nail or partial nail
onychomycosis
tinea pedis treatment (dry and scaly stage)
any broad spectrum antifungal cream
how to confirm onychomycosis
clipping
onychomycosis treatment (toenail)
Terbinafine
-velvety,tan,pink,or white macule that do not tan with sun exposure
-fine scales that are not visible but are seen by scraping the lesion
-young adults/teenagers
-central upper trunk
-spaghetti and meatballs seen under microscope (KOH)
tinea versicolor
tinea versicolor treatment
oral fluconazole 300mg 14 days apart
-typically a noninvasive yeast that can be found in stool,urine,mouth,genitalia,skin
-normal part of GI and GU microbiota
candidiasis
risk factors for candidiasis
-Abx
-IV/inhaled/oral steroids
-DM
-burns
-IV/Foley catheter
-itching, burning/sore throat
-dysphagia/odynophagia
-possible pain at sides of lips
-thick,white plaques on the tongue or oropharyngeal mucosa
-beefy red appearance
candidiasis oropharyngeal
hallmark of candidiasis
white plaques that bleed easily and can be scraped away with a tongue depressor (it is friable)
candidiasis oropharyngeal treatment
fluconazole
ketoconazole
nystatin mouth rinse
-cracked lips
-red swollen corners of the mouth
-white patches*
candidiases cheilitis
how to diagnose candidiases cheilitis
clinical
-common
-white discharge, itching, irritation, dysuria, dyspareunia
-risk factors: Abx, intercourse, pregnancy, oral contraceptives, DM
vulvovaginal candidiasis
candidiases cheilitis treatment
nystatin, ketoconazole, clotrimazole
how to diagnose vulvovaginal candidiasis
swab of vaginal sidewall and discharge
vulvovaginal candidiasis treatment
single dose fluconazole
-itching around the glans penis
-red,swollen foreskin/glans penis
-possible white discharge around the glans penis
balanitis
balanitis treatment
topical nystatin ointment
-skin condition caused by maceration of skin due to heat, moisture, and friction
-irritating agents
-in skin folds
-exposure to urine,feces,sweat
-pruritic
-stinging burning
-beefy red rash
-WATCH for secondary bacterial infection
intertrigo
intertrigo treatment
-good hygiene
-keep dry
-drying powders
-topical antifungal (imidazole or clotrimazole with hydrocortisone)
-usually in patients with indwelling catheter
-fever,chills
-dysuria,urgency,hesitancy
-flank or abdominal pain
candidal cystitis: funguria
how to diagnose candidal cystitis
urine analysis: should contain yeasts or pseudohyphae
candidal cystitis treament
usually resolves with discontinuance of Abx or removal of bladder catheter
persistant symptomatic funguria treatment
PO fluconazole
-immunosuppressed pts
-substernal odynophagia
-gastroesophageal reflux
-pts may have thrush, but not always
esophageal candidiasis
how to diagnose esophageal candidiasis
by endoscopy with biopsy and culture
esophageal candidiasis treatment
If patients can swallow: fluconazole
severe illness/inability to swallow: IV fluconazole
-inhaled fungi found in soil from bat and bird droppings
-most prevalent endemic mycosis in north america
-ohio and Mississippi River valley
-eastern Canada,mexico,central America,south America,africa,southeast asia
-soil, humidity, and acidity
histoplasmosis
hallmark of histoplasmosis
activities that stir up dirt: plowing soil, spelunking (cave exploring), excavation,demolition of old homes, cleaning chicken coops, bats
histoplasmosis labs
combination of first morning urine and serum polysaccharide antigen assays has 83% sensitivity for diagnosis of acute pulmonary histoplasmosis
histoplasmosis treatment
mild/moderate: itraconazole
severe: IV amphotericin B
-rare disease thought to be a result of an abnormal immunologic response to antigens released by histoplasma capsulatum
fibrosing mediastinitis
- most common cause of fungal meningitis
-frequently found in soil and bird feces
-inhaled
-pulmonary symptoms
-can be simple nodules or widespread infiltrates and respiratory failure
cryptococcosis
how to diagnose cryptococcosis
-culture of respiratory secretions or pleural fluid
-lumbar puncture for suspected CSF involvement
-chest xray and CT show a solitary pulmonary nodule
-coccidioides immitis or C. posadasii
-fungus that inhabits arid soil of the southwestern US (California, Arizona)***
-an opportunistic organism in immunosuppressed patients
Primary:
-fever,chills,HA,body aches
-erythema nodosum
coccidiodomycosis (valley fever)
hallmark of coccidiodomycosis (valley fever)
soil of southwestern US (California,arizona)
coccidiomycosis labs
CBC- leukocytosis and eosinophilia
ELISA- IgM antibodies
CSF- lymphocytosis, reduced glucose, complement fixing antibodies
coccidioidomycosis treatment
symptomatic for limited disease
with progression–> itraconazole or fluconazole
-inhaled and most commonly infects the pulmonary tissue
-usually occurs in immunocompetent individuals who work outside**
-outdoor activities
-abrupt onset fever, chills,body aches
-pleuritic chest pain
-cough: productive or nonproductive
blastomycosis
blastomycosis labs
-CBC: leukocytosis, anemia
-grows readily in culture
-organism found in expectorated sputum or tissue biopsy
-lobar consolidation*
blastomycosis treatment
mild/moderate: itraconazole
sever: IV amphotericin B
