Fungal Infections"Opportunistic Infections": | Candidiasis: | - Wide spread use of broad spectrum of Antibiotics | - Elderly | - HIV patients | - Diabetic patients | - Immunosuppressants and cancer chemotherapy patients | - Pregnant women | | | - Burn wound victims |
Fungal Infection TreatmentsSuperficial Fungal Infections:Dermatomycoses: skin, hair, nails (onychomycoses) | - Candidiasis | - Tinea versicolor | - Dermatophytoses |
Dermatophytoses:- Trichophyton, Microsporum, Epidermophyton | - Tinea capitis | - Tinea cruris | - Tinea pedis | - Tinea corporis (Treatment: Clotrimazole 2% cream, apply tds for 2 weeks after lesion has cleared) |
Clinical Features:
- Itchy ring-like patches
- Raised borders
- Patches slowly grow bigger = as patches extend, a clear area develops in the center which may become hyperpigmented in dark skin. Tinea Versicolor:- also implicated for dandruff/ seborrhoeic dermatittis | - Selenium sulphide (Selsun) | - Zinc pyrithoine (Head and Shoulders) | - Soap: Sulphur (10%) and Salicylic acid (3%) |
| | Oral Candidiasis (Thrush):- Presents: painful creamy white patches, can be scraped off tongue and buccal mucosa. | - Common in healthy babies (up to 1mo) | - Risk Factors: Poor Oral Hygiene, Immunosuppression, Prolonged use of broad spectrum antibiotics or corticosteroids (including inhaled), Certain chronic diseases, Trauma | - General Measures: Identify underlying cause, Improve oral hygiene, Ensure proper fitting dentures |
Treatment:
- Nystatin suspension, oral, 100 000 IU/mL, 1ml, 6 hourly after each meal/feed for 7 days.
= Keep in contact with affected area for as long as possible prior to swallowing
= In older children, ask child to swirl in mouth prior to swallowing
= In infants: apply to front of mouth and spread around mouth with clean finger
= continue for 48hrs after cure
Tinea Capitis:Round or patchy bald areas with scales and stumps of broken of hair | Avoid shaving head in children | Don't share combs and hair brushes = Contagious |
Treatment:
- Children: Fluconazole, oral, 6mg/kg once daily for 28 days
- Adults: Fluconazole, oral, 200mg once daily for 28 days Systemic (Disseminated) Fungal Infections:- Cryptococcal meningitis | - Candidiasis | - Pulmonary aspergillosis | - Histoplasmosis |
Candida Oesophagitis:- Oesophageal involement in HIV infected patients with oral candidiasis who have pain or difficulty swallowing | - Maintain hydration | - Fluconazole 200,g po daily for 14 days | - Refer: unable to swallow, poor response to fluconazole |
| | Antifungal: Mechanisms of ActionClasses of Antifungal TreatmentAmphoteracin B:- Drug of Choice of severe systemic mycoses | - pks: administered IV, eliminated slowly in urine | - !!nephrotoxicity, hypokalemia | - High probability of AEs: drugs tox and administration | - NB: toxicity monitoring (dosage and duration NB) |
Nystatin- GI absorption is negligible | - Most of dose excreted in stool | - safe in pregnancy | - MOA: same as amphoteracin B |
Fluconazole:Treatment for: Candidiasis, CCM (maintenance txt) | Pks: D-wide, CFS; Unchanged in urine (DA) | - WEAK INHIBITOR of P450 |
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