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5112 > FUNGAL INFECTIONS > Flashcards

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
Q

Involve extensive area, severely inflamed or debilitating

A

REFER

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26
Q

Fever and/or malaise

A

REFER

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27
Q

Concomitant conditions such as DM, asthma, immune deficiency or systemic infection

A

REFER

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28
Q

The only medication indicated for BOTH prevention and treatment of fungal infections

A

Tolnaftate (Tinactin) 1%

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29
Q

Non-pharmacologic Treatment

A

Remove oils & other substances that promote growth of fungi
Prevent spreading infection to other areas
Reduce risk of infection

30
Q

Pharmacologic Treatment

A 
Allyamines: Butenafine, Terbinafine
Imidazoles: Clotrimazole, Miconazole
Tolnaftate (Tinactin)
Hydrocortisone
Providone/Iodine
Undecylenic acid (Fungi-Nail)
31
Q

Why are Allyamines preferred?

A

Lower relapse rate with daily application & shorter duration necessary with twice daily use

32
Q

Allylamine medications

A

Butenafine (Lotrimin Ultra) 1%
Terbinafine (Lamisil AT) 1%
Once daily for 2-4 weeks or twice daily for 1 week

33
Q

Imidazoles

Why use imidazoles and what is MOA

A

(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
Q

Imidazole drugs

A

Clotrimazole (Lotrimin, Desenex) 1%
Miconazole (Micatin) 2%
Twice daily for 2-4 weeks

35
Q

Tolnaftate (Tinactin) 1%

MOA & How to use

A

Distorts the hyphae and stunts mycelial growth in susceptible fungi
USE: twice daily for 2-4 weeks (similar to imidazoles)

36
Q

Hydrocortisone 1%

A

if needed to reduce itching & inflammation; limit to a few days because it can prevent skin healing

37
Q

Povidone/iodine

A

safe & effective but does not carry an approved indication

38
Q

Undecylenic acid (Fungi-Nail)

A

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
Q

Creams & Solutions

A

Most efficient and effective

Apply sparingly and massage into skin

40
Q

Sprays & powders

A

Less effective because they often are not rubbed into the skin
More useful as adjuncts to a cream/solution or as prophylaxis

41
Q

Apply an astringent aluminum salt solution to the area before applying antifungal

A

For Oozing Lesions

42
Q

Aluminum acetate solution

A

(Burow’s solution)

available as a concentrated solution for further dilution or in dry forms (Domeboro powder packets)

43
Q

Oozing lesions- aluminum salt solutions

Directions

A

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
Q

Complementary Therapy

A

Bitter orange, tea tree oil and garlic may have some roles

Based on small studies (<60 patients)

45
Q

Itching and signs of infection for tinea pedis and tinea cruris should resolve within

A

1-2 weeks

46
Q

The following patients should not attempt to self-treat funhal skin infections

A

Immunocompromised patients
Patients with diabetes
Patients with circulatory problems

47
Q

Tissue necrosis can be cause by

A

Prolonged or continuous use of aluminum acetate solution. Limit use to 1 week

48
Q

Lotrimin Ultra 1%

A

Butenafine HCl

49
Q

Terbinafine HCl indication

A

indicated for interdigital tinea pedis, tinea cruris, and tinea corporis

50
Q

Indicated as a cure for tinea pedis between the toes, tinea cruris, and tinea corporis

A

Butenafine HCl

51
Q

Terbinafine side effects

A

itching/dryness, irritation, burning

52
Q

Tolnaftate side effects

A

Stinging

53
Q

Prevalence of women that will have at least one episode of fungal candida (“yeast”) infection in their lifetime

A

75%

54
Q

40-45%

A

prevalence of women that will have 2 or more episodes of fungal candida infection

55
Q

When is vaginal fungal candida common?

A

During the week prior to menstruation and during pregnancy

56
Q

Diagnostic tests for yeast infection

A

Vaginal culture for fungal growth or pH test (OTC test kits)

57
Q

At what pH indicates presence of either a candida or trichomoniasis infection

A

> 4.5

58
Q

Fungal Candida Exclusions for self-care

A

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
Q

Risk Factors for Fungal Candida

A

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
Q

Soak/bathe with sodium bicarbonate (10-15 minutes) may provide external relief is a form of what type of treatment

A

Non-pharmacologic treatment

61
Q

Sitz bath

A

Add 1/2 to 1 tablespoon of baking soda to water pouch

62
Q

Bathtub (non-pharmacologic treatment)

A

Add 1/2 cup of baking soda to warm water ~ 5 inches deep

63
Q

This type of non-pharmacologic treatment may be beneficial for prevention of recurrent infections

A

Daily yogurt/probiotics

64
Q

After treatment completion, avoid use of these 3 things for how long?

A

Avoid use of lubricants, spermicides, and barrier contraceptives for ~3 days

65
Q

Wear loose fitting clothing and cotton underwear is an example of what

A

Non-pharmacologic treatment

66
Q

Butoconazole

A

Mycelex 3-2% cream

67
Q

Clotrimazole

A

Gyne-Lotrimin 3-2% (cream)
Gyne-Lotrimin 7-1% (cream)
Mycelex 7 -100 mg (vaginal tablet)

68
Q

Miconazole

A

Monistat 1- 1200 mg (ovule)
Monistat 3- 200 mg or 4% (cream, ovule, suppository)
Monistat 7- 100 mg or 2% (cream)

69
Q

Tioconazole

A

Monistat 1/Vagistat 1 - 6.5% (ointment)

70
Q

What is preferred if there is extensive vulvar inflammation

A

Creams

5112 (2 decks)

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