fungus

Question 1

Whats most common opportunistic fungal infection

Answer 1

candidiasis

Question 2

rash by candidiasis between skin folds

Answer 2

intertrigo

Question 3

candidiasis cutaneous symptoms

Answer 3

pruritic, erythematous tender rash with satellite lesions, area can be fissured, women have white clumpy d/c

Question 4

candidiasis diagnosis

Answer 4

wet mount with KOH prep from vaginal discharge to ID yeast.

Pathognomonic for pseudohyphae- budding yeast or epithelial cells

Question 5

candidiasis oral tx

Answer 5

nystatin suspension for oral thrush, or chlorhexidine gluconate for denture stomatitis

Question 6

candidiasis genital tx

Answer 6

vaginal: topical OTC gone-lotrimin, monistic, or oral fluconazole
balanitis (foreskin of penis): clotrimazole cream or oral fluconazole

Question 7

candidiasis cutaneous tx

Answer 7

topical clotrimazole ketoconazole or terbinafine cream. Or miconazole or tolnaftate powders

Question 8

Tinea definition

Answer 8

ringworm infection caused by dermatophyte infxn most commonly Trichophyton rubrum (reside in soil)

Question 9

What are types of tinea

Answer 9

tinea captious, tinea corporis, tinea cruris, tinea pedis, tinea versicolor

Question 10

difference between dermatophyte (tinea) and candida

Answer 10

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.

Question 11

Tinea capitus pathophys

Answer 11

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

Question 12

tinea capitus s/sx

Answer 12

erythematous scaly plaque that rapidly enlarges, circle, can be itchy, regional lymphadenopathy. Contagious by contact. black dots- exclamation point

Question 13

tinea capitus diagnosis

Answer 13

clinical, or can do wet mount of broken hairs (see spores) or can do wood’s lamp

Question 14

tinea capitus tx

Answer 14

mild: topical selenium sulfide lotion or shampoo, topical ketoconazole

Question 15

tinea corporis pathophys

Answer 15

genus Trichophyton, inhabits nonliving cornified layers of skin, hair, nail. Invades deeper into skin. Loves warm moist environment conducive to fungal proliferation

Question 16

tinea corporis s/sx

Answer 16

can be asymptomatic. Burn, itch, erythematous, scaly, annular plaque. Distinct lesion or clusters. Contagious- transmitted as fomites (stays in linen)

Question 17

tinea corporis diagnosis

Answer 17

clinical dx, or wet mount skin scrapings –> spaghetti and meatballs!. Or wood’s lamp

Question 18

tinea corporis tx

Answer 18

topical therapy at least 2 wk- ketoconazole, clotrimazole, miconazole

Question 19

tinea cruris pathophys

Answer 19

Trichphyton genus, pruritic fungal infection of groin. Can be mistaken for genital candida RF: tight fitting clothes, wet clothes, obesity

Question 20

tinea cruris s/sx

Answer 20

can be asymptomatic. Burn, itch, erythematous scaly plaque, annular, distinct lesion or clusters, contagious by contact or clothes

Question 21

tinea cruris dx

Answer 21

clinical, or wet mount with KOH prep scrapings

Question 22

tinea cruris tx

Answer 22

topical therapy- ketoconazole, clotrimazole, miconazole. Prevention is essential

Question 23

tinea pedis pathophys

Answer 23

Trichophyton genus, athletes foot, made worse by occlusive footwear, warm moist environments

Question 24

tinea pedis s/sx

Answer 24

can be asymptomatic, burn, itch, erythematous, tender, scaly fissures, contagious- by socks, showers, etc

Question 25

tinea pedis dx

Answer 25

clinical, or wet mount with KOH prep scrapings show branching hyphae

Question 26

tinea pedis tx

Answer 26

mild: topical therapy ketoconazole, clotrimazole, miconazole
moderate: oral therapy itraconazole, terbafine, fluconazole

Question 27

fungal oral meds SE

Answer 27

headache, nausea, URI, cough, elevated LFT, hepatotoxicity. Check LFT before start therapy. Photosensitivity, anosmia

Question 28

tinea versicolor pathophys

Answer 28

Malassezia genus. Commonly naturally occurring on skin, can be opportunistic in weak hosts. RF- high temp humid environments, age 15-24yo

Question 29

tinea versicolor s/sx

Answer 29

usually asymptomatic, scaly macule or papules, hyper or hypo-pigmented patches. NOT contagious bc naturally occurs on skin

Question 30

tinea versicolor dx

Answer 30

clinical, or wet mount KOH prep– spaghetti and meatballs. Or woods lamp

Question 31

tinea versicolor tx

Answer 31

often no tx- pt ed. Selenium sulfide lotion, can do oral anti fungal: fluconazole or itraconazole

Question 32

onychomycosis definition

Answer 32

fungal infection of toenails or fingernails- nail bed, matrix, or plate. Pain, discomfort, disfigurement

Question 33

onychomycosis s/sx

Answer 33

yellow, thickened nails, white specks, powdery patches on nails. Nail rough, crumbles easily

Question 34

onychomychosis RF

Answer 34

increased age, poor health, prior trauma, warm climate, immunosuppressed

Question 35

onychomycosis pathophys

Answer 35

fungus spreads from plantar skin and invites nail bed via hyponychium (under nail)

Question 36

onychomycosis dx

Answer 36

clinical, or wet mount KOH prep scarpings– boxcar hyphae

Question 37

onychomycosis tx

Answer 37

oral therapy- itraconazole, terbinafine

Question 38

whats most common opportunistic infection in HIV+

Answer 38

pneumocystis pneumonia– pneumocystis jiroveci

Question 39

pneumocystis jiroveci s/sx

Answer 39

insidious mono-like symptoms: fever, dry cough, SOB, fatigue

Question 40

pneumocystis pneumonia dx

Answer 40

CXR, sputum cx, bronchoalveolar lavage, PCR testing

Question 41

pneumocystis pnemonia tx

Answer 41

TMP/SMX– does not respond to anti fungal meds