fungus Flashcards
Whats most common opportunistic fungal infection
candidiasis
rash by candidiasis between skin folds
intertrigo
candidiasis cutaneous symptoms
pruritic, erythematous tender rash with satellite lesions, area can be fissured, women have white clumpy d/c
candidiasis diagnosis
wet mount with KOH prep from vaginal discharge to ID yeast.
Pathognomonic for pseudohyphae- budding yeast or epithelial cells
candidiasis oral tx
nystatin suspension for oral thrush, or chlorhexidine gluconate for denture stomatitis
candidiasis genital tx
vaginal: topical OTC gone-lotrimin, monistic, or oral fluconazole
balanitis (foreskin of penis): clotrimazole cream or oral fluconazole
candidiasis cutaneous tx
topical clotrimazole ketoconazole or terbinafine cream. Or miconazole or tolnaftate powders
Tinea definition
ringworm infection caused by dermatophyte infxn most commonly Trichophyton rubrum (reside in soil)
What are types of tinea
tinea captious, tinea corporis, tinea cruris, tinea pedis, tinea versicolor
difference between dermatophyte (tinea) and candida
dermatophyte consumes outer layer of skin, superficial- digests skin protein keratin. Candida tends to reside in human cavities as normal flora, infects when immune system weak, cannot digest skin protein.
Tinea capitus pathophys
genus Trichophyton- at site, fungus grows circularly on outer layer of skin. Fungus grows downward into skin invading keratin- infected hairs are brittle and break off– ‘exclamation point hair’ - black dots
tinea capitus s/sx
erythematous scaly plaque that rapidly enlarges, circle, can be itchy, regional lymphadenopathy. Contagious by contact. black dots- exclamation point
tinea capitus diagnosis
clinical, or can do wet mount of broken hairs (see spores) or can do wood’s lamp
tinea capitus tx
mild: topical selenium sulfide lotion or shampoo, topical ketoconazole
tinea corporis pathophys
genus Trichophyton, inhabits nonliving cornified layers of skin, hair, nail. Invades deeper into skin. Loves warm moist environment conducive to fungal proliferation
tinea corporis s/sx
can be asymptomatic. Burn, itch, erythematous, scaly, annular plaque. Distinct lesion or clusters. Contagious- transmitted as fomites (stays in linen)
tinea corporis diagnosis
clinical dx, or wet mount skin scrapings –> spaghetti and meatballs!. Or wood’s lamp
tinea corporis tx
topical therapy at least 2 wk- ketoconazole, clotrimazole, miconazole
tinea cruris pathophys
Trichphyton genus, pruritic fungal infection of groin. Can be mistaken for genital candida RF: tight fitting clothes, wet clothes, obesity
tinea cruris s/sx
can be asymptomatic. Burn, itch, erythematous scaly plaque, annular, distinct lesion or clusters, contagious by contact or clothes
tinea cruris dx
clinical, or wet mount with KOH prep scrapings
tinea cruris tx
topical therapy- ketoconazole, clotrimazole, miconazole. Prevention is essential
tinea pedis pathophys
Trichophyton genus, athletes foot, made worse by occlusive footwear, warm moist environments
tinea pedis s/sx
can be asymptomatic, burn, itch, erythematous, tender, scaly fissures, contagious- by socks, showers, etc
tinea pedis dx
clinical, or wet mount with KOH prep scrapings show branching hyphae
tinea pedis tx
mild: topical therapy ketoconazole, clotrimazole, miconazole
moderate: oral therapy itraconazole, terbafine, fluconazole
fungal oral meds SE
headache, nausea, URI, cough, elevated LFT, hepatotoxicity. Check LFT before start therapy. Photosensitivity, anosmia
tinea versicolor pathophys
Malassezia genus. Commonly naturally occurring on skin, can be opportunistic in weak hosts. RF- high temp humid environments, age 15-24yo
tinea versicolor s/sx
usually asymptomatic, scaly macule or papules, hyper or hypo-pigmented patches. NOT contagious bc naturally occurs on skin
tinea versicolor dx
clinical, or wet mount KOH prep– spaghetti and meatballs. Or woods lamp
tinea versicolor tx
often no tx- pt ed. Selenium sulfide lotion, can do oral anti fungal: fluconazole or itraconazole
onychomycosis definition
fungal infection of toenails or fingernails- nail bed, matrix, or plate. Pain, discomfort, disfigurement
onychomycosis s/sx
yellow, thickened nails, white specks, powdery patches on nails. Nail rough, crumbles easily
onychomychosis RF
increased age, poor health, prior trauma, warm climate, immunosuppressed
onychomycosis pathophys
fungus spreads from plantar skin and invites nail bed via hyponychium (under nail)
onychomycosis dx
clinical, or wet mount KOH prep scarpings– boxcar hyphae
onychomycosis tx
oral therapy- itraconazole, terbinafine
whats most common opportunistic infection in HIV+
pneumocystis pneumonia– pneumocystis jiroveci
pneumocystis jiroveci s/sx
insidious mono-like symptoms: fever, dry cough, SOB, fatigue
pneumocystis pneumonia dx
CXR, sputum cx, bronchoalveolar lavage, PCR testing
pneumocystis pnemonia tx
TMP/SMX– does not respond to anti fungal meds
