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FUNGAL INFECTIONS Flashcards

1
Q

Tinea capitis

A

scalp

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2
Q

Tinea corporis

A

body (commonly known as ringworm due to ring-shaped lesions with clear centers and red, scaly borders)

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3
Q

Tinea cruris

A

groin (commonly known as jock itch)

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4
Q

Tinea pedis

A

feet (commonly known as athlete’s foot)

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5
Q

Tinea unguium

A

nails

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6
Q

Tinea capitis prevalence

A

Most common in children

Black female children > black males & white children

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7
Q

Tinea corporis prevalence

A

Most common in prepubescent individuals

Increased risk: hot & humid climates, under stress or overweight

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8
Q

Tinea cruris prevalence

A

Men > women; rare in children

Most common during warm weather

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9
Q

Tinea pedis prevalence

A

Most prevalent in HUMANS
More likely in adults due to increased exposure to pathogens
Common in Caucasians
Rare in blacks

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10
Q

Tinea unguium

A

Many cases are untreated/unsuccessfully treated

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11
Q

Etiology

A

Transmission: can occur through contact with infected human, infected animals, fomites, e.g. infected towels, clothing, hats, toys or telephones
Trauma to skin- especially blisters, e.g. from wearing poorly fitted footwear
Environmental factors:
footwear- occlusive, summer, tropical/subtropical weather, tight-fitting shoes
Moisture- sweat + warm + long period of time promote fungal growth
Public pools/bath
Chronic issues:
Chronic medical conditions- DM & HIV
Medications that suppress the immune system, e.g. corticosteroids
Impaired circulations
Poor nutrition & hygiene

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12
Q

General Manifestations

A

Location: areas with excessive moisture, e.g. scalp, under arms, groin & feet
Signs: presents as soggy, malodorous, thickened skin: acute vascular rash; or fine scaling with varying inflammation, cracks & fissures may also be present
Symptoms: Most commonly pruritis, painful burning/stinging if fissures are present, e.g. between toes, weeping/oozing may occur in areas that are inflamed
Quantity/severity: Usually limited to one area but can spread
Timing: Onset usually variable

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13
Q

Manifestations: Tinea Capitis

A

Has both non-inflammatory presentations
Infected areas may appear as black dots; cause hairs to break off at level of scalp
Can advance and become patches of hair loss and yellowish crusts & scales

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14
Q

Manifestations: Tinea Corporis

A

Can occur on any part of the body
Begin as small, circular, erythematous, scaly areas. Lesions spread peripherally and borders may contain vesicles/pustules

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15
Q

Manifestations:Tinea Cruris

A

Presents medial & upper parts of the thighs & pubic area, usually bilaterally with significant pruritis
Lesions & small vesicles may be seen
Chronic cases & pain can develop

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16
Q

Tinea pedis

A

Most common in interdigital spaces
Toe web appears either 1) dry, scaly & fissured or 2) white, macerated and soggy
Excessive sweating of interdigital spaces & sole of foot is common; can lead to infections

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17
Q

Tinea Unguium Manifestations

A

Nails gradually lose their normal shiny luster and become opaque

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18
Q

Complications

A

range from secondary infections to permanent hair loss or scarring may occur if tinea infections are not treated successfully
Nails affected by tinea unguium may become thick, rough, yellow, opaque and friable; separated from nail bed if infection progress; ultimately lost

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19
Q

unknown cause for infection

A

Exclusion for self-care; REFER

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20
Q

Initial treatment is unsuccessful or symptoms worse

A

REFER

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21
Q

Fungal infection of Scalp or nails

A

Exclusion; REFER

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22
Q

Face, mucous membrane or genitalia are infected

A

REFER

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23
Q

Secondary bacterial infection suspected (e.g. oozing purulent material)

A

REFER

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24
Q

Excessive & continuous exudation (to ooze out like sweat, come out through pores)

A

REFER

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25
Involve extensive area, severely inflamed or debilitating
REFER
26
Fever and/or malaise
REFER
27
Concomitant conditions such as DM, asthma, immune deficiency or systemic infection
REFER
28
The only medication indicated for BOTH prevention and treatment of fungal infections
Tolnaftate (Tinactin) 1%
29
Non-pharmacologic Treatment
Remove oils & other substances that promote growth of fungi Prevent spreading infection to other areas Reduce risk of infection
30
Pharmacologic Treatment
``` Allyamines: Butenafine, Terbinafine Imidazoles: Clotrimazole, Miconazole Tolnaftate (Tinactin) Hydrocortisone Providone/Iodine Undecylenic acid (Fungi-Nail) ```
31
Why are Allyamines preferred?
Lower relapse rate with daily application & shorter duration necessary with twice daily use
32
Allylamine medications
Butenafine (Lotrimin Ultra) 1% Terbinafine (Lamisil AT) 1% Once daily for 2-4 weeks or twice daily for 1 week
33
Imidazoles | Why use imidazoles and what is MOA
(slightly less expensive than Allylamines, but twice daily administration & longer duration needed) MOA: binds to phospholipids in the fungal cell membrane, altering cell wall permeability and resulting in loss of intracellular elements
34
Imidazole drugs
Clotrimazole (Lotrimin, Desenex) 1% Miconazole (Micatin) 2% Twice daily for 2-4 weeks
35
Tolnaftate (Tinactin) 1% | MOA & How to use
Distorts the hyphae and stunts mycelial growth in susceptible fungi USE: twice daily for 2-4 weeks (similar to imidazoles)
36
Hydrocortisone 1%
if needed to reduce itching & inflammation; limit to a few days because it can prevent skin healing
37
Povidone/iodine
safe & effective but does not carry an approved indication
38
Undecylenic acid (Fungi-Nail)
MOA: inhibits conversion of yeast to the hyphal form (active form) & inferferes with fatty-acid biosynthesis Available as solution form Apply bid for 4 weeks High alcohol concentrations may cause burning
39
Creams & Solutions
Most efficient and effective | Apply sparingly and massage into skin
40
Sprays & powders
Less effective because they often are not rubbed into the skin More useful as adjuncts to a cream/solution or as prophylaxis
41
Apply an astringent aluminum salt solution to the area before applying antifungal
For Oozing Lesions
42
Aluminum acetate solution
(Burow's solution) | available as a concentrated solution for further dilution or in dry forms (Domeboro powder packets)
43
Oozing lesions- aluminum salt solutions | Directions
Immerse the affected area in the aluminum salt solution for 20 minutes up to 3 times a day (every 6 to 8 hours), apply the solution to AA in the form of a wet dressing using clean compresses (washcloths or small towels)
44
Complementary Therapy
Bitter orange, tea tree oil and garlic may have some roles | Based on small studies (<60 patients)
45
Itching and signs of infection for tinea pedis and tinea cruris should resolve within
1-2 weeks
46
The following patients should not attempt to self-treat funhal skin infections
Immunocompromised patients Patients with diabetes Patients with circulatory problems
47
Tissue necrosis can be cause by
Prolonged or continuous use of aluminum acetate solution. Limit use to 1 week
48
Lotrimin Ultra 1%
Butenafine HCl
49
Terbinafine HCl indication
indicated for interdigital tinea pedis, tinea cruris, and tinea corporis
50
Indicated as a cure for tinea pedis between the toes, tinea cruris, and tinea corporis
Butenafine HCl
51
Terbinafine side effects
itching/dryness, irritation, burning
52
Tolnaftate side effects
Stinging
53
Prevalence of women that will have at least one episode of fungal candida ("yeast") infection in their lifetime
75%
54
40-45%
prevalence of women that will have 2 or more episodes of fungal candida infection
55
When is vaginal fungal candida common?
During the week prior to menstruation and during pregnancy
56
Diagnostic tests for yeast infection
Vaginal culture for fungal growth or pH test (OTC test kits)
57
At what pH indicates presence of either a candida or trichomoniasis infection
> 4.5
58
Fungal Candida Exclusions for self-care
Recurrent infections: >4 infections in a year or infection in <2 months Symptoms recur within 2 months No previous diagnosis Age <12 years old Pregnancy Fever or pain in lower abdomen, back, or shoulder Medical conditions: diabetes, HIV Medications: corticosteroids, immunosuppressants (transplant)
59
Risk Factors for Fungal Candida
High-dose estrogen in birth control or hormonal replacement therapy Antibiotic use Pregnancy Menstruation or menopause (pH changes) Tight fitting clothing/underwear- warm and moist environment Use of intrauterine device or vaginal sponge Immunodeficiency conditions: HIV, diabetes Immunosuppressant medications, corticosteroids Food or medications that increase urinary glucose
60
Soak/bathe with sodium bicarbonate (10-15 minutes) may provide external relief is a form of what type of treatment
Non-pharmacologic treatment
61
Sitz bath
Add 1/2 to 1 tablespoon of baking soda to water pouch
62
Bathtub (non-pharmacologic treatment)
Add 1/2 cup of baking soda to warm water ~ 5 inches deep
63
This type of non-pharmacologic treatment may be beneficial for prevention of recurrent infections
Daily yogurt/probiotics
64
After treatment completion, avoid use of these 3 things for how long?
Avoid use of lubricants, spermicides, and barrier contraceptives for ~3 days
65
Wear loose fitting clothing and cotton underwear is an example of what
Non-pharmacologic treatment
66
Butoconazole
Mycelex 3-2% cream
67
Clotrimazole
Gyne-Lotrimin 3-2% (cream) Gyne-Lotrimin 7-1% (cream) Mycelex 7 -100 mg (vaginal tablet)
68
Miconazole
Monistat 1- 1200 mg (ovule) Monistat 3- 200 mg or 4% (cream, ovule, suppository) Monistat 7- 100 mg or 2% (cream)
69
Tioconazole
Monistat 1/Vagistat 1 - 6.5% (ointment)
70
What is preferred if there is extensive vulvar inflammation
Creams

5112 (2 decks)

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