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Details Descriptions About :: Fungal Infections

 Fungal infections of the skin are often regarded as superficial infections affecting the hair, nails, and stratum corneum (the dead top layer of the skin). Fungi infect and survive only on the nonviable keratin within these structures. The most common fungal infections are dermatophyte infections (tineas) and candidiasis (moniliasis). Tinea infections are classified by the body location in which they occur—for example: capitis, scalp corporis, body pedis, foot cruris, groin. Some forms infect one gender more commonly than the other. For example, tinea cruris is more common in males. Obesity and diabetes predispose to tinea and candida infection. Age Alert Children develop tinea scalp infections, young adults more commonly develop infection in the interiginous areas, and older adults develop onchomycosis. Candidiasis of the skin or mucous membranes is also classified according to the infected site or area: intertrigo—axilla or inner aspect of thigh balanoposthities—glans penis and prepuce vulvitis diaper dermatitis paronychia—folds of skin at the margin of a nail onychia—nail bed thrush—mouth. Candida organisms may be normal flora of the skin, mouth, GI tract, or genitalia. The prognoses for tinea infection and candidiasis are very good. They usually respond well to appropriate drug therapy and resolve completely. It’s important to reduce risk factors to obtain a good outcome from the infection. Antifungal therapy usually resolves candidiasis, but if risk factors aren’t avoided, a chronic condition can develop.

Causes for Fungal Infections

Causes Tinea infection Microsporum, Trichophyton, or Epidermophyton organisms Contact with contaminated objects or surfaces Risk factors for tinea infection Obesity Atopy, immunosuppression Antibiotic therapy with suppression of normal flora Softened skin from prolonged water contact, such as with water sports or diaphoresis Candidiasis Overgrowth of Candida organisms and infection due to depletion of the normal flora (such as with antibiotic therapy) Neutropenia and bone marrow suppression in immunocompromised patients (at greater risk for the disseminating form) Candida albicans, normal GI flora (causes candidiasis in susceptible patients) Candida overgrowth in the mouth (thrush)

Pathophysiology Fungal Infections

Pathophysiology Dermatophytes, which grow only on or within keratinized structures, make keratinases that digest keratin and maintain the existence of fungi in keratinized tissue. The pathogenicity of dermatophytes is restricted by the cell-mediated immunity and antimicrobial activity of the polymorphonuclear leukocytes. Clinical presentation depends on fungal species, site of infection, and host susceptibility and immune response. In candidiasis, the organism penetrates the epidermis after binding to integrin receptors and adhesion molecules and then secretes proteolytic enzymes, which facilitate tissue invasion. An inflammatory response results from the attraction of neutrophils to the area and from activation of the complement cascade.

Signs and symptoms Fungal Infections

Signs and symptoms Tinea infection Erythema, scaling, pustules, vesicles, bullae, maceration Itching, stinging, burning Circular lesions with erythema and a collarette of scale (central clearing) Candidiasis Superficial papules and pustules; later, erosions Erythema and edema of epidermis or mucous membrane As inflammation progresses, a white-yellow, curdlike material over the infected area In thrush—white coating of tongue, buccal mucosa, and lips, which can be wiped off to reveal a red base Severe pruritus and pain at the lesion sites (common)

Diagnostic Lab Test results

Diagnostic test results Microscopic examination of a potassium hydroxide-treated skin scraping reveals the offending organism. Culture determines the causative organism and suggests the mode of transmission. Wood’s lamp examination in a darkened room demonstrates fluorescence.

Treatment for Fungal Infections

Treatment Tinea infection Topical fungicidal agents, such as imidazole or an allylamine product If no response to topical treatment—oral agents, such as allylamines or azoles Candidiasis Intertrigo, balanitis, vulvitis, diaper dermatitis, paronychia—nystatin or imidazoles Oral candidiasis (thrush)—azoles, imidazoles Systemic infections—I.V. amphotericin B or oral ketonazole FUNGAL INFECTION OF NAIL


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