Obstetrics & Gynaecology Flashcards
Learning objectives
Answer
Define candidiasis
• Infection caused by Candida.
Explain the aetiology/risk factors of candidiasis
• Caused by 15 different Candida species • Candida albicans is the MOST COMMON cause of candidiasis in humans • Main types of candidiasis: o Oral candidiasis o Oesophageal candidiasis o Candidal vulvovaginitis o Candidal skin infections o Invasive candidal infections • Risk Factors o Broad-spectrum antibiotics o Immunocompromise (e.g. HIV, corticosteroids) o Central venous lines o Cushing's disease o Diabetes mellitus o GI tract surgery
Summarise the epidemiology of candidiasis
- 60% of the healthy adult population are carriers
- Candidiasis occurs in over 80% of people with HIV
- Candida is one of the most common causes of invasive fungal infections in the Western world
Recognise the presenting symptoms and signs of candidiasis
• Oral Candidiasis
o Oral Thrush (pseudomembranous oral candidiasis) - curd-like white patches in the mouth, which can be removed easily revealing an underlying red base. Most common in neonates
o There are lots of subtypes of oral candidiasis with slightly different features but the main features are: redness of the tongue and mouth, white plaques
• Oesophageal Candidiasis
o Dysphagia
o Pain on swallowing food or fluids
o It is an AIDS-defining illness
• Candidal Skin Infections
o Soreness and itching
o Skin appearance can be variable
o Red, moist skin area with ragged, peeling edge and possibly papules and pustules
Identify appropriate investigations for candidiasis
- Oral Candidiasis - swabs and cultures are not particularly useful because a lot of normal people have candida in their mouth
- Swabs may be relevant to check for drug-resistance
- Therapeutic trials of antifungal (e.g. fluconazole) can help with diagnosis
- Oesophageal Candidiasis: definitive diagnosis is by endoscopy
- Invasive Candidiasis: blood cultures required if candidaemia is possible
Define mastitis/breast abscesses
Define breast abscess • Abscess formation in breast tissues. o TWO main forms: • Lactational • Non-Lactational
Explain the aetiology / risk factors of mastitis/breast abscesses
• Caused by INFECTION • Causative organisms defer based on whether the abscess is: o Lactational • Staphylococcus aureus o Non-Lactational • Staphylococcus aureus • Anaerobes • Risk Factors o Lactation o SMOKING o Mammary duct ectasia o Periductal mastitis o Wound infections (e.g. from breast surgery)
Summarise the epidemiology of mastitis/breast abscesses
- Lactational breast abscess are COMMON and tend to occur soon after starting breast feeding or weaning
- Non-lactational breast abscesses are more common in 30-60 yo smokers
Recognise the presenting symptoms of mastitis/breast abscesses
- Breast discomfort
- Painful swelling
- Generally unwell and feverish
- Non-lactational - tend to present with a history of previous infections with less pronounced systemic upset
Recognise the signs of mastitis/breast abscesses on physical examination
• Local
o Swollen, warm and tender area of the breast
o Overlying skin may be inflamed
o The nipple may be cracked
o Non-Lactational
• Scars or tissue distortion from previous episodes
• Signs of duct ectasia (e.g. nipple retraction)
• Systemic
o Pyrexia
o Tachycardia
Identify appropriate investigations for mastitis/breast abscesses and interpret the results
- Ultrasound
* MC&S of pus samples
Generate a management plan for mastitis/breast abscesses
• Medical
o Antibiotics
• Lactational: flucloxacillin
• Non-Lactational: flucloxacillin + metronidazole
• Surgical
o Lactational: Incision and drainage
o Non-Lactational: open drainage should be avoided. The involved duct system should be excised once the infection has settled
Identify the possible complications of mastitis/breast abscesses and its management
- Mammary fistula
* Overlying skin may (rarely) undergo necrosis
Summarise the prognosis for patients with mastitis/breast abscesses
- If untreated, a breast abscess may discharge onto the skin surface
- Non-lactational breast abscesses tend to recur