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840 > Superficial Fungal Infections > Flashcards

Superficial Fungal Infections Flashcards

1
Q

Mucocutaneous Candidiasis

A
  • Vulvovaginal candidiasis (VVC)
  • Oropharyngeal candidiasis (OPC)
  • Esophageal candidiasis (EPC)
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2
Q

VVC

A
  • Normal vaginal environments protect against infections

- Up to 75% of women believed to experience 1 episode of symptomatic VVC in lifetime

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3
Q

VVC Pathogens

A
  • Candida albicans (most common, 80-90%)

- C. glabrata (second most common)

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4
Q

VVC Risk Factors

A
  • Contraceptives
  • Sexual Activity
  • Antibiotic use
  • SGLT2-i
  • Host characteristics
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5
Q

VVC Risk + Contraceptives

A
  • Diaphragms with spermicide
  • Contraceptive sponge
  • Intrauterine device
  • Vaginal ring
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6
Q

VVC Risk + Sexual Activity

A
  • Not considered STI
  • Risk increases with increased sexual activity
  • Oral-genital contact may increase risk
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7
Q

VVC Risk + Host Characteristics

A
  • Pregnancy
  • Diabetes
  • Immunosuppression
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8
Q

VVC Presentation

A
  • Intense vulvar itching
  • Soreness, irritation, erythema, edema
  • Curdy “cheese”-like discharge
  • Burning with urination
  • Painful sexual intercourse
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9
Q

Diagnosing VVC

A
  • Positive clinical presentation

- Wet preparation OR culture

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10
Q

VVC Classifications

A
  • Mild: mild/mod. sxs, =<3 episodes/year, immunocompetent, non-pregnant
  • Complicated: patients with at risk host characteristics
  • Recurrent: >=4 episodes within 12 months
  • Antifungal-resistant: positive yeast cultures but fail to respond to antifungal therapy with adherence
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11
Q

Treating Uncomplicated VVC

A
  • Azole antifungals
  • No significant difference in clinical outcomes between topical azoles
  • Choose based on cost, therapy length, formulation, convenience
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12
Q

Topical VVC Treatment Counseling

A
  • Use applicator given by manufacturer
  • Insertion should be as far as possible without discomfort
  • Don’t use tampons
  • Lying down, night-time administration, and use of pads may decrease mess
  • Treatment can decrease efficacy of latex condoms/diaphragms
  • Don’t use for 72 hours
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13
Q

Immunocompromised VVC Treatment

A

-Oral fluconazole 150 mg Q72h for 2 doses
OR
-Topical azole antifungal therapy for 10-14 days

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14
Q

Pregnancy VVC Treatment

A
  • Topical clotrimazole or miconazole for at least 7 days

- Avoid oral agents

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15
Q

Recurrent VVC Treatment

A

Induction
-Fluconazole 150 mg q72h x 3 doses (or daily x10 days)
OR
-Topical azole antifungal x 10-14 days

BOTH followed by maintenance

Maintenance
-Fluconazole 150 mg qweek x 6mo

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16
Q

VVC Non-pharm Recommendations

A
  • Avoid harsh soaps/perfumes in vaginal area
  • Genital area should be kept clean/dry
  • Avoid constrictive clothing
  • Douching NOT recommended
  • Cool baths to soothe skin
  • Benefits of lactobacillus is unclear
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17
Q

OPC

A
  • Aka Thrush
  • Involves buccal mucosa, tongue, and gums
  • Presentation: creamy white, plaque-like lesions that are easily scraped off
  • Sxs: erythema, burning tongue, metallic taste
18
Q

EPC

A
  • Same presentation as OPC but in esophagus

- May cause retrosternal burning pain/discomfort or dysphagia

19
Q

OPC/EPC Pathogens

A
  • Candida albicans (most common, 70-80%)
  • C. glabrata
  • C. tropicalis
20
Q

OPC/EPC Risk Factors

A
  • Steroids (inhaled)
  • Antibiotic use
  • Radiation therapy
  • Dentures
  • Xerostomia
  • Smoking
  • Disruption of oral mucosa
  • Age (extremes)
  • Immunocompromised
  • Diabetes
  • Nutritional deficiencies
21
Q

OPC/EPC + HIV

A
  • Common
  • Increased risk when CD4<200 cells/uL
  • ART reduces likelihood of infection
  • No measures available to reduce exposure
  • Primary prophylaxis not recommended
22
Q

OPC Initial Mild Treatment

A
  • Clotrimazole 10 mg troches
  • Miconazole 50mg mucoadhesive buccal tablets
  • Nystatin 100,000 u/mL suspension

Duration: 7-14 days

23
Q

OPC Mod-Severe Treatment

A

-Fluconazole 100mg or 200 mg orally, daily

Duration: 7-14 days

24
Q

Non-pregnant + HIV Patient

A

Preferred drug = fluconazole

25
Q

Fluconazole-Refractory OPC Treatment

A
  • Itraconazole 10 mg/mL solution
  • Posaconazole 40 mg/mL suspension
  • Voriconazole 200 mg tablets

Duration 14-28 days

26
Q

OPC Counseling

A
  • Use topical antifungals after meals to increase contact time
  • Troches should dissolve slowly in mouth
  • Suspension should be swished at least 1 minute in mouth, gargled and swallowed
  • Remove dentures while medication is applied
  • Disinfect dentures every night
  • Avoid troches in xerostomia patients
  • Maintain good oral hygiene
  • Stop smoking
  • Avoid alcohol
27
Q

EPC Treatment

A

-Fluconazole 200-400 mg

Duration: 14-21 days

28
Q

Fluconazole-Refractory EPC Treatment

A
  • Itraconazole 10 mg/mL solution
  • Posaconazole 40 mg/mL suspension
  • Voriconazole 200 mg tablets

Duration: 14-21 days

29
Q

EPC Treatment + No Orals

A
  • IV fluconazole 400 mg
  • IV micafungin 150 mg
  • IV caspofungin 70 mg
  • IV anidulafungin 200 mg
30
Q

Mycotic Infections of Skin/Hair/Nails

A
  • Affects 20-25% of global population
  • Usually pathogens are dermatophytes
  • Pathogens: trichophyton, epidermophyton, microsporum
31
Q

Dermatophyte Infection Risk Factors

A
  • Moist environments, exposure to water
  • Skin breakdown
  • Skin folds
  • Sharing of personal belongings
  • Close living quarters
32
Q

Dermatophyte Infection Diagnosis

A
  • Patient history/exam
  • Microscopic examination
  • Culture used less frequently
33
Q

Tinea Pedis

A
  • “Athlete’s Foot”
  • Most common dermatophytosis
  • Treatment duration for 2-4 weeks using topicals
34
Q

Tinea Pedis Presentation

A
  • Fissuring, scaling, skin breakdown between toes
  • Plantar surface form chronic scales on heels/side of feet
  • Vesiculobulous form: vesicles, pustules, and occasionally bullae on soles of feet
35
Q

Tinea Pedis Non-Pharm

A
  • Disinfect footwear
  • Avoid walking barefoot in public places
  • Wear absorbent socks
  • Use non-occlusive shoes
  • Decrease hyperhidrosis
36
Q

Tinea Cruris

A
  • Often occurs concurrently with tinea pedis
  • High humidity/warm temperatures along with wet/tight clothing
  • Presents: red scales with raised borders, itching, burning
  • Treat with topicals for 1-2 weeks after symptom resolution
  • Non-pharm: keep area dry, examine feet
37
Q

Tinea Corporis

A
  • “Ringworm”
  • Infection of skin on trunk, extremities, or face
  • Lesions may be singular or multiple
  • Round, scaly lesions with central clearing
  • Pruritis and pustules are variable
  • Treatment: topical therapy
38
Q

Dermatophyte Treatment

A
  • Typically lasts 2-4 weeks
  • Topicals are first line
  • Fluconazole orally is an alternative
39
Q

Tinea Unguium or Onychomycosis

A
  • Infection of nail apparatus

- Affects ~8% of population

40
Q

Nail Infection Risk Factors

A
  • Increased age (>40)
  • Immunodeficient
  • Diabetes
  • Peripheral vascular disease
  • Smoking
  • Tinea pedis
  • Nail trauma
  • Certain sports (swimming)
41
Q

Onychomycosis Treatment

A

First line: Terbinafine 250 mg orally

  • Other oral options: Fluconazole or Itraconazole
  • Topical options: Ciclopirox nail lacquer, efinaconazole, tavaborole
  • Not treating is also an option

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