Fungal Infections Information Diagnosis Signs and Symptoms with Treatment

Fungal Infections Superficial fungal infections and Systemic fungal infections

 

Superficial fungal infections are caused by

• numerousfungi that are capable of superficially invadingthe following:
• ▪ Skin , Nail apparatus▪ ,Mucosal sites, Oropharynx•

• Hair/hair follicles, Anogenitalia, Epidermis,

• These fungi are commensural organisms thatfrequently colonize normal epithelium.
• • Dermatophytes, Candida species, Malassezia species,
• Infections can extend more deeply in the immunocompromisedhost.
• Deeper, chronicChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » cutaneous fungal infections canoccur after cutaneous inoculation.
  
• ▪ Mycetoma, Chromomycosis, Sporotrichosis

Fungal Infections

 

Systemic fungal infections with cutaneous dissemination;

• these infections occur most often inthe immunocompromised host.
• ▪ Primary lung infection; can disseminate hematogenouslyto multiple organ systems, includingthe skin
• Histoplasmosis.•
• Cryptococcosis
• • North American blastomycosis
• • Coccidioidomycosis
• Disseminated candidiasis commonly arises inthe GI tract.
  
• • Penicillinosis
• ▪ Primary gastrointestinal (GI) infection; neutropenichost

 

Etiology –

• Three genera of dermatophytes:
• Trichophyton
• M icrosporum
• E pidermophyton .
• • More than 40 species are currently recognized;approximately 10 spp. are commoncauses of human infection.
• • T. rubrum is the most common cause of epidermaldermatophytosis and onychomycosisin industrialized nations.

Under the microscope the fungi appear as rounded or budding forms or hyphae.

• The budding forms are like yeast (round or oval buds).
• The hyphae are molds( elongated rods).
• Yeast-like fungi are Candida and Cryptococcus.
• The mold like fungi are Aspergillus, Rhizopus, Ring worm fungi.

Fungal Infections Dimorphic fungi

 

Fungal Infections Dimorphic fungi (have 2 forms) – are

• histoplasmo­sis,
• blastomycosis,
• sporotrichosis,
• coccidiodomycosis.

Fungal Infections coccidiodomycosis

• They are spherical but grow like molds (hyphae).
• Candida grows like budding yeast called pseudo hyphae.

Fungal Infections Candida grows

• Pneumocystis are also fungi.
• Ring worm, Pityriasis versicolor, and Piedra infect the skin and its appendages.
• Deep mycoses occurs by inhalation.

Fungal Infections Ring worm, Pityriasis versicolor

• Candida albicans is a normal commensal in the mouth but when the mucosa or skin is breached by diseaseAcute Myocardial Infarction Management REGIME FOR MANAGEMENT OF AMI. Read more ... », or surgery, or trauma, then infection occurs.
• Aspergillus and Fusarium infect the host when immu­nologically compromised.

DiagnosisAcute Myocardial Infarction Management REGIME FOR MANAGEMENT OF AMI. Read more ... » Fungal Infections

• · Microscopic examinationHow to take good medical history & examination. Read more ... » of smears or biopsy specimen.
• · Fluorescence microscopy with calcofluor stain­ing is a sensitive technique for sputum, bron­chial lavage fluid, and pus.

India ink smear is used to detect Fungal Infections cryptococci in CSF

• · India ink smear is used to detect cryptococci in CSF.
• · Candida can be seen with Gram-positive stain­ing.
• · Histopathology slides are stained with Gomori methenamine silver staining.
• · Histoplasma is detected by nucleic acid hybrid­ization technique.

ANTIFUNGAL TREATMENTAcute Myocardial Infarction Management REGIME FOR MANAGEMENT OF AMI. Read more ... » Topical agents

 

Fungal Infections cutaneous Candida, Tinea versicolor (pityri­asis) and ring worm

 

Imidazole and Triazoles

• · Cutaneous applications are clotrimazole, ketoconazole_J miconazole.
• · For cutaneous Candida, Tinea versicolor (pityri­asis) and ring worm any of the above may be used.
• .-1- Va inal formulations are miconazole, cIotrimazole.
• · For vaginal candidiasis clotrimazole may be used.
• For ring worm tolnaftate is used.
• Salicylic acid is used for hyperkeratotic lesions of skin.

Fungal Infections Systemic antifungals

• Prevention
• Apply powder containing imidazoles or tolnaftate to areas prone to fungal infectionafter bathing.

Topical antifungal

• These preparations may be effective for treatment of dermatophytoses of skin butpreparations not for those of hair or nails .
• Preparation is applied bid to involved area optimally for 4 weeks including at least1 week after lesions have cleared.
• Apply at least 3 cm beyond advancing margin of lesion.These topical agents are comparable.
• Differentiated by cost, base, vehicle, andantifungal activity.

Imidazoles

• Econazole (Spectazole)
• Oxiconizole (Oxistat)
• Sulconizole (Exelderm)
• Sertaconazole (Ertaczo)Clotrimazole (Lotrimin, Mycelex)
• Miconazole (Micatin)
• Ketoconazole (Nizoral)

Allylamines

• Naftifine (Naftin)
• Terbinafine (Lamisil)

Naphthionates

• Tolnaftate (Tinactin)
• Substituted pyridone
• Ciclopirox olamine (Loprox)

Systemic antifungal agents

• For infections of keratinized skin :
• use if lesions are extensive or if infection hasfailed to respond to topical preparations.
• Usually required for treatment of tinea capitis and tinea unguium.
• Also may berequired for inflammatory tineas and hyperkeratotic moccasin-type tinea pedis.

Terbinafine

• 250-mg tablet.
• Allylamine.
• Most effective oralHow Can Protect Your Oral Health. Read more ... » antidermophyte antifungal; lowefficacy against other fungi.

Azole/imidazoles

• Itraconazole and ketoconazole
• Itraconazole 100-mg capsules;
• oral solution (10 mg/mL):Intravenous.

Triazole.

• Needs acid gastricpH for dissolution of capsule.
• Raises levels of digoxin and cyclosporine.

Fluconazole

• 100-, 150-, 200-mg tablets;
• oral suspension (10 or 40 mg/mL);
• 400 mg IV.

Ketoconazole

• 200-mg tablets.
• Needs acid gastric pH for dissolution of tablet.
• Take with food orcola beverage; antacids and H2 blockers reduce absorption.
• The mosthepatotoxic of azole drugs; hepatotoxicity occurs in an estimated one of every10,000–15,000 exposed persons

Griseofulvin Micronized:

• 250- or 500-mg tablets;
• 125 mg/teaspoon suspension.
• Ultramicronized :

• 165- or 330-mg tablets. Active only against dermatophytes;less effective than triazoles.

Fungal Infections Systemic antifungals

• Griseofulvin for ring worms.
• Terbinafine 250 mg  for onychomycosis (fun­gal nail infection) and ring worm.
• Treatment is given for 3-6 months.
• The Imidazoles and triazoles may be used for systemic use e.g. fluconazole, itraconazole for blastomycosis, histoplasmosis, aspergillosis.
• Fluconazole penetrates CSF and other body flu­ids.
• · It is useful in oropharyngeal and oesophageal candidiasis in adults.
• Amphotericin B and fluconazole may be used for cryptococcal meningitis, in AIDS, and coccidiodal meningitis.