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Fungal Infections Flashcards

1
Q

Define: dermatophytoses

A

superficial mycotic infections of the skin

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2
Q

Where do fungi live?

A

Within keratin layers of the epidermis, in nails, and in hair

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3
Q

What typically causes fungal infections?

A
  1. Trichophyton
  2. Epidermophyton
  3. Microsporum
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4
Q

What are the three main reservoirs for exposure to fungal infections?

A
  1. Humans
  2. Animals
  3. Soil
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5
Q

What are the risk factors for fungal infections?

A
  1. Sweating/sweaty clothing
  2. Many skinfolds
  3. High humidity
  4. Not bathing regularly
  5. Sedentary lifestyle
  6. Bed confinement
  7. Compromised immune system
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6
Q

Describe the general appearance of fungal infection

A

central clearing surrounded by advancing red, scaly, elevated border

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7
Q

Describe the general appearance of fungal infections of the nail

A

chalky, dull, yellow or white discoloration, and thick but brittle nail

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8
Q

What are the diagnostic tools?

A

KOH test or fungal cultures (usually for when systemic meds are needed)

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9
Q

What is tinea pedis?

A

Athlete’s foot

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10
Q

What is the most common type of external fungal infection?

A

Athlete’s foot

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11
Q

What are the common sources of tinea pedis?

A

locker room floors and occlusive footwear

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12
Q

What are the four different types of tinea pedis?

A
  1. interdigital type (most common)
  2. chronic hyperkeratotic
  3. Vesiculobulous
  4. Acute ulverative
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13
Q

What is the general treatment for athlete’s foot?

A

topical therapies for 2-4 weeks for mild cases

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14
Q

About what percentage of tinea pedis cases reoccur?

A

About 70%

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15
Q

Preventative measures for tinea pedis

A
  1. avoid heat, moister, and maceration
  2. dry areas thoroughly
  3. talc or antifungal powder
  4. loose and non-occlusive footwear
  5. frequent laundry with hot water
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16
Q

What is tinea manuum?

A

involves palmar surface of hands

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17
Q

What is the treatment for tinea manuum?

A

similar to tinea pedis

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18
Q

What is tinea cruris?

A

jock itch

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19
Q

What is the treatment for jock itch?

A

topical treatment for 1-2 weeks after symptom resolution (usually 2-4 weeks)

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20
Q

What is tinea corporis?

A

ringworm

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21
Q

What is the treatment for tinea cruris?

A

Similar to jock itch

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22
Q

Which topical fungals may better prevent recurrence?

A

butenafine, terbinafine, and naftifine

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23
Q

Which antifungal can only be used for athlete’s foot?

A

Sertaconazole

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24
Q

Which antifungals can’t be used for tinea versicolor?

A

Luliconazole, naftifine, and sertaconazole

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25
What is tinea capitis?
infection of the scalp, hair follicles, and surrounding skin
26
What are the two presentations of tinea capitis?
Grey patch and black dot
27
What type of therapy is recommended for tinea capitis?
Topical plus oral therapy
28
What are the oral therapies for tinea capitis?
1. griseofulvin 2. terbinafine 3. itraconazole 4. fluconazole
29
What has been the gold standard for treatment of tinea capitis?
griseofulvin
30
What are the side effects of griseofulvin?
photosensitivity, HA, and GI upset
31
What does griseofulvin do to metabolism?
strong inducer of CYP450
32
Which type of fungus is griseofulvin more effective in compared to terbinafine?
microsporum
33
Which type of fungus is terbinafine more effective in compared to griseofulvin?
trichophyton
34
What are the shampoos used to treat tinea capitis?
selenium sulfide, zinc pyrithione, povidone iodine, and ketoconazole
35
What is tinea barbae
infection of facial hair
36
What is the treatment of tinea barbae?
similar to tinea capitis
37
What is tinea versicolor?
chronic, asymptomatic, superficial fungal infection
38
What fungus causes tinea versicolor?
malassezia
39
What is the treatment for tinea versicolor?
topical treatment applied from neck to waist
40
What are the topical treatments for tinea versicolor?
1. selenium sulfide shampoo applied for 10-15 minutes followed by a shower for a week 2. ketoconazole 2% shampoo applied to affected area for 10-15 minutes for a week 3. antifungal creams
41
What is tinea unguium?
fungal infection of the nail
42
What are the risk factors for tinea unguium?
1. age > 40 2. family hx 3. immunodeficiency 4. diabetes 5. psoriasis 6. PVD 7. smoking 8. nail trauma 9. tinea pedis
43
What is the clinical presentation of tinea unguium?
yellow or white, thickened nails. starts on the distal edge and progresses. the nail becomes brittle and begins to crumble
44
When is it ok not to treat onychomycosis?
when minimal toenail is involved and there are no associated symptoms
45
What are the first line options for onychomycosis?
itraconazole and terbinafine
46
What is the black box warning on ketoconazole?
hepatotoxicity
47
What is the PK profile of itraconazole?
fungiostatic, lipophilic, and keratinophilic
48
How long does itraconazole stay in the nail after therapy?
27 weeks
49
When is itraconazole contraindicated?
heart failure
50
What are the adverse effects of itraconazole?
N/V/D, abdominal pain, edema, rash, HA, abnormal LFTs
51
What are the adverse effects of fluconazole?
HA, N/V, abdominal pain, diarrhea, and dyspepsia
52
When do you reduce the dose of fluconazole by 50%?
In CrCl < 50 mL/min
53
What is the MOA of terbinafine?
blocks the synthesis of ergosterol via squalene epoxidase
54
When is terbinafine not recommended?
in active hepatic disease or CrCl < 50 mL/min
55
What has terbinafine been known to cause?
hepatic failure, neutropenia, and serious skin reactions
56
What are the adverse effects of terbinafine?
rash, pruritus, diarrhea, dyspepsia, abdominal pain, nausea, HA, liver enzyme abnormality, and taste disturbance
57
What two labs should be used to monitor terbinafine?
a CBC and serum transaminase
58
What are the three topical options for onychomycosis?
ciclopirox, efinaconazole, and tavaborole
59
What is the MOA of tavaborole?
inhibits aminoacyl-transfer ribonucleic acid synthetase which inhibits fungal protein synthesis
60
What are the adverse effects of tavaborole?
erythema, dermatitis, and ingrown toenails
61
What is the adverse effect of efinaconazole?
dermatitis
62
What is the adverse effect of ciclopirox?
erythema

Integumentary (5 decks)

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