Fungal Infections Flashcards by Dylan Null

Fungal infection that usually occurs in children but can occur in adults. Dry, crusting scalp with flaking. Typically well defined and a plaque like lesion and absence of hair.

Tinea Capitis

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What is a kerion?

Fungal Abscess
- seen in tinea capitis

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What are the first line treatments for Tinea Capitis?

Oral Terbinafine (Kids over 4)
Griseofulvin (Kids over 2)

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What is the treatment for a Kerion?

Griseofulvin

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Inflamed dry patches or plaques in the beard. May cause hitching or have a yellow crusting due to secondary bacterial infection.

Tinea Barbae

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What is the treatment for Tinea Barbae?

Terbinafine
Griseofulvin
Fluconazole
ORAL MEDICATION REQUIRED
topicals can be used as an adjunct therapy

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Annular lesion with advancing scaly border and central clearing. Often comes from an infect pet and itches. Found on the body.

Tinea Corporis

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How do you prevent Tinea Corporis?

Treat infected pets
Foot powder
Keep feet dry
Wear clean socks

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How do you treat Tinea Corporis?

Terbinafine (topical)
Butenafine (topical)
continue treatment for 1-2 weeks after clearing

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Itching and burning sensation of the skin of genitals, inner thighs, and buttocks. Annular shaped erythematous lesions with raised scaly borders and a clear center.

Tinea Cruris (Jock Itch)

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How can you prevent Tinea Cruris?

Miconazole Nitrate powder

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How do you treat Tinea Cruris?

Terbinafine (topical)
Azoles

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Most often presents as asymptomatic scaling which may progress to fissuring or maceration in toe web spaces. Can also be itchy or have a burning sensation.

Tinea Pedis (Athlete’s Foot)

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How do you treat Tinea Pedis in the Macerated Stage?

Aluminum Acetate soak for 20 minutes 2x a day
+ Topical Cream (Azoles or Ciclopirox)

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How do you treat Tinea Pedis in the Dry and Scaly Stage?

Any broad spectrum anti-fungal cream
- urea lotion to increase efficacy in thick soles

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Thickened, yellow and brittle nail that is deformed. Can lead to partial or complete loss of the nail.

Onychomycosis

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How do you treat onychomycosis?

Terbinafine (oral) for 12 weeks
- monitor kidneys
Itraconazole (oral)

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Velvety tan, pink, or white macule that do not tan with sun exposure. Often seen in young adults or teenagers in the central upper trunk. Can also be seen in the upper arms, neck, and groin.

Tinea Versicolor
(Pityriasis Versicolor)

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When looking at a scraping of Tinea Versicolor under the microscope, what would you see?

Yeast and short Hyphae
(Spaghetti and Meatballs)

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How do you treat Tinea Versicolor?

Fluconzaole (oral)
Selenium Sulfide or Ketoconzale (adjunct therapy)

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Itching or burning sore throat with thick white plaques on the tongue or oropharyngeal mucosa. May have a beefy red appearance.

Thrush
(Candida albicans)

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Occurrence of thrush in a young, otherwise healthy appearing person warrants the testing of what?

HIV

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How do you treat oral thrush?

Fluconazole
Ketoconazole
Nystatin Mouth Rinse

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Cracked lips with red and swollen corners of the mouth. Possible white patches are present.

Cheilitis
(Candida albicans)

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How do you treat cheilitis caused by Candida albicans?

Nystatin Ketoconazole Clotrimazole

Common cause of white discharge from the vagina that may cause itching, irritation, dysuria, and dyspareunia.

Vulvovaginal candidiasis

How do you diagnose vulvovaginal discharge?

Swab Vaginal Sidewall and Discharge

How do you treat vulvovaginal candidiasis?

Fluconazole (oral) - single dose

Itching around the glans penis. The foreskin or glans may be red and swollen with a white discharge.

Balanitis

What is the treatment for Balanitis?

Nystatin (topical) - aluminum acetate soak for itching relief

Skin condition caused by maceration of skin due to heat, moisture, and friction. May lead to secondary infections of Candidiasis or bacteria.

Intertrigo

Often located in skin folds and caused by exposure to urine, feces, or sweat. Itching and burning or stinging. Beefy or bright red appearance. Possible white discharge or malodor.

Intertrigo

What must you watch for with Intertrigo?

Secondary Bacterial Infections

How do you treat Intertrigo?

Imidazole (topical) Clotrimazole (topical) - Hydrocortisone

Fungal infection that usually occurs in patients with an indwelling catheter. Presents with fever and chills. May have dysuria, urgency, or hesitancy or no symptoms at all. May also have pain in the flanks or abdomen.

Funguria (Fungal UTI) or Candidal Cystitis

What would you expect to see in a urine analysis of someone with candidal cystitis?

Urine sediment containing yeasts or pseudohyphae

How do you treat candidal cystitis?

Discontinue antibiotics Remove Catheter - persistent cases need Fluconazole

What types of patients usually get esophageal candidiasis?

Immunosuppressed

How do you diagnose esophageal candidiasis?

Endoscopy with Biopsy and Culture

What are the signs and symptoms of esophageal candidiasis?

Substernal odynophagia (pain when swallowing) Gastroesophageal Reflux Possible Thrush

How do you treat esophageal candidiasis?

Fluconazole (oral) - if they can swallow Fluconazole (IV)

Inhaled fungi found in soil from bat and bird droppings. Most prevalent endemic mycosis in North America. Typically shows signs and symptoms in immunocompromised patients.

Histoplasmosis

In histoplasmosis, an organism is recognized as an invader and engulfed by a macrophages building a wall around the pathogen which is known as what?

Granuloma

Where at in North America is histoplasmosis typically seen?

Ohio and Mississippi River Valley

What activities are frequently associated with stirring up histoplasmosis?

Plowing Soil Spelunking Excavation Demolition of Old Homes Cleaning Chicken Coops

Besides the lungs, where else can histoplasmosis spread to in the body?

Mediastinum Adrenals Liver CNS

Histoplasmosis clinical syndrome that may happen in epidemics when infected soil is disturbed. Varies from a mild influenza to severe pneumonia but is almost NEVER fatal. May last 1 week to 6 months.

Acute Pulmonary Histoplasmosis

Histoplasmosis clinical syndrome seen in immunosuppressed populations. Fever and multiple organ system involvement which may progress to septic shock. Adrenals glands are commonly involved as well. CXR may show miliary pattern.

Progressive Disseminated Histoplasmosis

Histoplasmosis clinical syndrome usually seen in older patients with a chronic lung disease. CXR may show apical cavities, infiltrates, and nodules.

Chronic Pulmonary Histoplasmosis

Histoplasmosis labs that have a 83% sensitivity for diagnosis of acute pulmonary histoplasmosis.

First Morning Urine Serum Polysaccharide Antigen Assay

What is the treatment for mild to moderate illness of Histoplasmosis?

Itraconazole Amphotericin B (IV) - Severe

Rare disease thought to be a result of an abnormal immunologic response to antigens by histoplasma capsulatum. Caused by proliferations of collagen, fibrosis tissue and associated inflammatory cells within the mediastinum.

Fibrosis Mediastinitis

MOST COMMON CAUSE OF FUNGAL MENINGITIS. An encapsulated budding yeast that is frequently found in soil and bird feces. Infections are relative rare.

Cryptococcosis (cryptococcus neoformans)

What are the symptoms of Cryptococcosis?

Cough Sputum Production Hemoptysis Dyspnea Chest Pain Fever Malaise Night Sweats Weight Loss

How do you diagnose cryptococcosis?

Respiratory Secretion or Pleural Fluid Culture

Fungus that inhabits arid soil of the SOUTHWESTERN UNITED STATES (California and Arizona). It is an opportunistic infection in immunosuppressed patients.

Coccidiomycosis (Valley Fever)

How does Coccidiomycosis present?

Flu-Like Skin Involvement - Bony Lesions and Skin and Soft Tissue Abscesses

What appears on patients approximately 2-20 days after infection with Coccidioidomycosis

Erythema Nodosum

What are the treatments for Coccidiomycosis

Itraconazole or Fluconazole Amphotericin B (IV) - progressive disease

Only fungal infection that USUALLY OCCURS IN IMMUNOCOMPETENT individuals. It is inhaled and most commonly infects the pulmonary tissue when participating in outdoor activities. Often asymptomatic.

Blastomycosis (Blastomyces dermatitidis)

Where do you most commonly find Blastomycosis?

South Central and Midwestern North America

What are the signs and symptoms of Blastomycosis

Body Aches Lobar Consolidation Antibiotic Failure Skin lesions (verrucous) Tachypnea with Pleuritic chest pain

Where is the Blastomycosis organism found in the body that can be easily tested?

Expectorated Sputum Tissue Biopsy

How do you treat mild to moderate Blastomycosis?

Itraconazole (6-12 months)

How do you treat moderate to severe Blastomycosis?

Amphotericin B (IV) - followed by an -azole for 12 months