Genital Disorders and Fungal Skin Infections Flashcards
Describe yeast
Typically round and reproduce by budding.
Species: Candida spp. or Cryptococcus neoforms
Describe dimorphic fungi.
Can grow as yeast at higher temperatures and wold aat lower temperatures.
Species: Histoplasma, capsultaum, blastomyces, dermatitids, coccidioides immitis
Describe mold
Grow as multicellular tubular structures called hyphae that branch.
Species: Aspergillus spp. and dermatophytes (cause infection in humans and animals)
Dermatophytes–> Trichophyton, Microsporum, Nannizzia, Epidermophyton
What are the primary sources of infection for dermatophytes?
- Anthropophilic- natural pathogens of humans
- Geophilic- originates from soil
- Zoophilic- primarily an animal pathogen
What is the most common anthropophilic species?
T. rubrum
Most common cause of human infections
What is the most common geophilic species?
N. gypseum
Uncommon cause of humas infections
What is the most common zoophilic species?
M. canis (primary source: cats and dogs)
How are dermatophyte infections transmitted?
- Symptoms typically start 4-14 days after exposure.
Transmission
* Direct skin contact with infected animals or people
* Sharing personal items (clothes, bedding, towels, combs
* Contact with moist surfaces (shower or locker room)
How are dermatophyte infections named?
- Tinea capitis (scalp)
- Tinea corporis (trunk or legs)
- Tinea cruris (groin)
- Tinea pedis (feet)
What tests do we use to detect dermatophyte infections?
KOH preparation process
1. Collect a scraping from infected area and place on slide
2. Add KOH to the slide
3. Visualize under the microscope
KOH dissolves skin cells and leaves fungal elements behind for visualization.
Other method: culture
Describe tinea corporis fungal infections.
Clinical presentation
* Legions with a prominent edge typically on the trunk and legs
* The center is often less inflamed
* Called ringworm due to sometimes having a ring shape
Symptoms
* Itching
* Papules (bumps)
* Scaly
Epidemiology
* More common in tropical climates
Risks
* Sharing personal items
Causative pathogens
* T. rubrum
* M. canis
Describe tinea capitis fungal infections.
Clinical presentation
* Scaling of the scalp
* Variable amounts of erythema, inflammation, and alopecia
* Also called scalp ringworm
Symptoms
* Itching
* Alopecia (hair loss)
Epidemiology
* Most common in children
Risks
* Sharing personal items
Causative pathogens
* T. tonsurans
Describe tinea cruris fungal infections.
Clinical Presentation
* Starts with irritation in the groin
* Rash can spread to inner thighs, buttocks, and waste
* Also called jock itch
Symptoms
* Itching
Epidemiology
* Most common in young men but can impact women
Risks
* Not changing underwear daily
Causative pathogens
* T. rubrum
* E. floccosum
Describe tinea pedis fungal infections.
Clinical presentation
* Infection starts between toes or under toes
* Can spread to top or bottom of the foot
* Athlete’s foot= scaling between toes
Symptoms
* Itching
* Cracking skin
* Blisters
Epidemiology
* Typically occurs in young adults or teens
Risks:
* Sharing personal belongings
* Wearing tight shoes and socks
* Barefoot in public bathing areas
Causative pathogens
* T. rubrum
* T. interdigitale
Describe onychomycosis fungal infections.
Clinical presentation
* Fungal infection of the nails
* Typically spreads to the nail from adjacent skin
Symptoms
* thickening of the nail
* Nail discoloration (can turn yellow, white, or brown)
Epidemiology
* More common with increasing age
Risks
* Sharing personal iteams
* Wearing tight shoes and socks
* Adjacent dermatophyte infection
Causative pathogens
* T. rubrum
* T. mentagrophytes
What are exclusions for self treatment for dermatophyte infections?
- Unsuccessful initial treatment or worsening of symptoms
- Face or mucous membranes involved
- Causative factor unclear
- Involvement of hair or nails
- Signs of potential bacterial infection (pus)
- History of diabetes, asthma, or immunocompromised
- Fever and/or malaise
What are the different classes of antifungal medications? Describe them.
- Azoles- inhibits CYP450 enzymes, inhibiting ergosterol synthesis
- Allylamine- inhibits squalene epocidase, inhibiting ergosterol synthesis
- Benzylamines- inhibits squalene epocidase, inhibiting ergosterol synthesis
- Other antifungal- distorts hyphae and stunts growth
What meds are in the azoles class?
Topical Agents:
* Miconazole
* Clotrimazole
Oral Agents:
* Fluconazole
* Itraconazole
What meds are in the allylamine class?
Oral/Topical agent:
* Terbinafine
What meds are in the benzylamine class?
Butenafine
topical agent
What meds are in the other antifungal class?
- Tolnaftate
What are key counseling points for dermatophytes?
- Reduce moisture to the infected areas
- Good skin hygiene and keep area dry
- Don’t share personal items in contact in the infected area
- Utilize wide shoes and don’t walk barefoot
- Change underwear or socks daily
What is vaginitis?
Disorder of the vagina due to inflammation and infection
Symptoms: vaginal discharge, pruritis (itching), pain (burning), odor
What are infectious causes of vaginitis?
- Vulvovaginal candidiasis
- BV
- Trichomoniasis
What are non-infectious causes of vaginitis?
Chemical irritants
* Soaps
* Vaginal sprays
Antibiotics
Foreign bodies
* Retained tampon or condom
Vaginal washes or douching
Allergies
How is vaginits diagnosed?
- Consider symptoms, sexual history, vaginal hyiene practices
Lab testing
* pH test
* Wet mount
* KOH test
* Micleic acid amplification tests
Describe vulvovaginal candidiasis.
- Yeast infection= fungal infection of the vagina caused by Candida spp.
- Pathogen: Candida albicans
- Risk factos: frequent antibiotic use
- Douching
- Changes in vaginal pH
- Symptoms: itching, erythema, pain during urination/sex, abnormal vaginal discharge (thick, cheesy, malodorous)
Describe bacterial vaginosis.
- BV: Vaginal dysbiosis due to replacement of normal lactobacillus spp. in the vagina
- Pathogens: anaerobic bacteria
- Rick factors: multiple sex partners, douching, lack of condom use
- Symptoms, asymptomatic, abnormal vaginal discharge (thin white/grey), fishy odor
Describe trichomoniasis vaginal infection.
- Trichomoniasis= sexually transmitted infection from penile-vaginal intercause caused by a protozoan parasite.
- Pathogens: Trichomonas vaginalis
- Risk factors: History of incarceration, more than 2 sex partners in the past year, douching
Symptoms
* Women: itching, vulvar irriatation/edema, foamy or purulent, yellow-green to gray vaginal dishcarge, With or without fishy odors
* Men: epididymitis, urethritis, or prostatis
What are exclusions for self treatment for vulvocandidiasis?
- Younger than 12
- Pregnancy
- Allergy to latex, spermicides, feminine hygiene products, soap
- Recurrent infection
- Persistence of symptoms
- History of diabetes or immunocompromising conditions
- Symptoms of fever or pain in the lower abd/back
What are key counseling points for vulvovaginal candidiasis?
- Don’t use tampons during treatment
- Avoid sex
- Finish entire treatment course
- Seek medical care if symptoms persist or return after 2 months
What is primary dysmenorrhea?
presence of lower abd pain and cramps during menses
What is secondary dysmenorrhea?
presence of lower abd pain and cramps due to an underlying pathology (endometriosis_
Describe the pathogenesis of primary dysmenorrhea.
- At the end of the luteal phase of the menstrual cycle, prostaglandins are released.
- This induces uterine contractions
- TF, there are incrased levels of prostaglandins that can lead to strong uterine contractions and vasoconstriction leading to ischemia and pain.
