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 |
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- Burn wound victims |
Fungal Infection Treatments
Superficial 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%) |
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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 |
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Antifungal: Mechanisms of Action
Classes of Antifungal Treatment
Amphoteracin 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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