Candidiasis

Question 1

What is candidiasis?

Answer 1

Group of yeast infections, usually C. albicans

Question 2

Where is C. albicans found?

Answer 2

often part of normal flora in the mouth, GI tract, and vagina

Question 3

Risk factors for candidiasis?

Answer 3

• neonates and adults >65 yo
• pregnancy
• occlusion of epithelial surfaces
• warm/humid environment
• immunodeficiency
• diabetes
• obesity
• use of medications such as oral glucocorticoids and antibiotics

Question 4

Which species is MCC (most common cause) of fungal infection?

Answer 4

Candida sp.

Question 5

What will you see on KOH prep?

Answer 5

budding yeast and pseudohyphae (strings of connected budding cells)

Question 6

Define mucocutaneous candidiasis

Answer 6

Acute pseudomembranous candidiasis or thrush- MC form of oral candidiasis

Question 7

What are predisposing factors of mucocutaneous candidiasis?

Answer 7

• diabetes mellitus
• systemic steroid (topical also) and antibiotic use
• pernicious anemia
• malignancy
• radiation to head and neck
• cell-mediated immunodeficiency

Question 8

How does oral candidiasis present?

Answer 8

• often asymptomatic

- burning or pain on eating spices/acidic foods, diminished taste sensation

Question 9

Oral candidiasis on PE

Answer 9

• discrete white patches on the buccal mucosa, tongue, palate, gingivae, and pharynx extending down into the esophagus and tracheobronchial tree
• removal of pseudomembrane with a dry gauze leaves erythematous mucosal surface

Question 10

What is atrophic candidiasis?

Answer 10

• on tongue, depapillated atrophic patches with minimal pseudomembrane formation
• most often in the setting of broad-spectrum antibiotic or systemic glucocorticoid therapy and human immunodeficiency virus infection
• denture stomatitis- 24%–60% of denture wearers
• chronic erythema and edema of the palatal mucosal surface in contact with the dentures

Question 11

Tx of mucocutaneous candidiasis

Answer 11

• for mild to moderate infections in the mouth or throat: nystatin or fluconazole in form of lozenges or a liquid to swish and swallow for 7 to 14 days
• for severe infections or immunocompromised- usually oral fluconazole

Question 12

Explain the angular cheilitis/ candidal cheilosis/ perleche

Answer 12

• erythema, fissuring, maceration, and soreness at the angles of the mouth.
• white colonies of candida at time

Question 13

Who is at risk for angular cheilitis/ candidal cheilosis/ perleche?

Answer 13

• habitual lip lickers and in elderly patients with deeper furrows at the oral commissures
• loss of dentition, poorly fitting dentures, malocclusion, andriboflavindeficiency also predispose

Question 14

Tx of angular cheilitis/ candidal cheilosis/ perleche

Answer 14

• tx with both topical antifungal and mild topical steroid.
• emphasize very frequent application of emollient ointment
• tx vitamin deficiencies if present

Question 15

What are the risk factors for vaginal and vulvovaginal candidiasis?

Answer 15

• systemic antibiotic or steroid use
• diabetes mellitus
• presence of an intrauterine device
• wearing of tight-fitting and synthetic clothing
• immunosuppression

Question 16

How does vaginal/vulvovaginal candidiasis occur?

Answer 16

Disruption of vaginal flora of lactobacilli that inhibits overgrowth ofCandida

Question 17

S/sx of vaginal/vulvovaginal candidiasis and PE

Answer 17

• pt presents with a vaginal discharge associated with vulvar pruritus, burning, and occasional dysuria or dyspareunia
• on PE: thick curd-like whitish plaques on the vaginal wall, erythema, edema

Question 18

Tx of vaginal/vulvovaginal candidiasis

Answer 18

• OTC: clotrimazole or miconazole

- Rx: Butoconazole, terconazole, oral fluconazole

Question 19

What is balanitis?

Answer 19

inflammation of the glans penis d/t yeast overgrowth

Question 20

Predisposing factors for balanitis

Answer 20

diabetes mellitus, an uncircumcised state, and candidal vaginal infection in sexual partners

Question 21

S/sx of balanitis

Answer 21

C/o pruritus and burning, dysuria

Question 22

PE of balanitis

Answer 22

White patches, fragile vesiculopustules, erythematous erosions with a collarette of whitish scale on the glans or prepuce

Question 23

Tx of balanitis

Answer 23

Tx same as for vulvovaginal

Question 24

What is cutaneous Candidiasis/Moniliasis?

Answer 24

intertriginous candidiasis

C. albicans predilection for colonizing skin folds, intertriginous zones, where moist and warm

Question 25

What areas are affected by intertriginous candidiasis?

Answer 25

- genitocrural - gluteal - interdigital - inframammary areas - beneath the pannus and axillary areas

Question 26

Predisposing factors to intertriginous candidiasis

Answer 26

obesity, diabetes mellitus, wearing of occlusive clothing

Question 27

S/sx and PE of intertriginous candidiasis

Answer 27

S/sx: pruritus, tenderness, and pain | PE: macerated erythematous plaques with satellite vesiculopustules

Question 28

Tx of intertriginous candidiasis

Answer 28

Tx with topical antifungals (including econazole, ketoconazole, oxiconazole, naftifine, terconazole, ciclopirox), or oral for severe or nonresponsive

Question 29

Define intertrigo

Answer 29

Superficial inflammatory dermatitis where skin surfaces in opposition, esp hot humid weather

Question 30

What causes intertrigo?

Answer 30

Friction, heat, moisture

Question 31

S/sx of intertrigo

Answer 31

Burning and itching with erythematous, macerated plaques and possibly secondarily infected with candida or bacteria **NO satellite lesions

Question 32

What is streptococcal intertrigo?

Answer 32

- favors neck, axillary and inguinal folds of children. - presents as fiery red, moist shiny surface with foul smell ***NO satellite lesions

Question 33

Tx of intertrigo

Answer 33

- low potency topical steroids/tacrolimus to reduce inflammation but in combo with antifungal or antimicrobial - eliminate maceration: Drysol, zeasorb powder; application gentian violet

Question 34

Define tinea versicolor/pityriasis versicolor

Answer 34

- caused by group of yeasts, Malassezia ssp. - mainly Malassezia globose - Malassezia normal inhabitant to skin of 90% adults not causing sxs - proliferates causing skin disorder

Question 35

Predisposing factors for tinea versicolor/pityriasis versicolor

Answer 35

- humidity, sweating, oily skin | - may clear in the winter months and recur each summer

Question 36

tinea versicolor/pityriasis versicolor on PE

Answer 36

- hypo- or hyperpigmented oval to round mildly scaly macules/patches that coalesce - patches coppery brown, paler than surrounding skin, or pink

Question 37

What areas are commonly affected by tinea versicolor/pityriasis versicolor?

Answer 37

 Trunk, neck, arms, groin, intertriginous

Question 38

S/sx of tinea versicolor/pityriasis versicolor

Answer 38

Asx to mild itch, especially when hot or out of shower

Question 39

Dx of tinea versicolor/pityriasis versicolor

Answer 39

- topical azole cream/shampoo/foam (econazole, ketoconazole), Selenium sulfide, Ciclopirox cream/solution/shampoo - oral itraconazole and fluconazole for widespread or non responsive - oral ketoconazole with black box warning d/t liver problems. - oral Terbinafine not helpful

Question 40

How does tinea versicolor/pityriasis versicolor look under Wood's lamp?

Answer 40

pale yellow fluorescence

Question 41

Define Pityrosporum (Malassezia) folliculitis

Answer 41

- caused by Malassezia - follicular papules and papulopustules with perifollicular erythema on the upper trunk, neck, and upper arms of young and middle-aged adults - pruritic

Question 42

What conditions contribute to Pityrosporum (Malassezia) folliculitis?

Answer 42

- warm humid conditions | - occlusion of the skin and hair follicles with cosmetics, lotions, sunscreens, emollients, olive oil, or clothing

Question 43

Dx of Pityrosporum (Malassezia) folliculitis

Answer 43

KOH or bx if needed

Question 44

Tx of Pityrosporum (Malassezia) folliculitis

Answer 44

- Tx topical and oral antifungal agents as with TV | - Recurrences common- consider maintenance meds