Tags: Miconazole

Pathogenic Amebas

ENTAMOEBA HISTOLYTICA & ENTAMOEBA DISPAR Essentials of Diagnosis Patient living in or having traveled to endemic area increases risk. Frequent loose stools with blood and mucus. Demonstration of cyst or trophozoite on stool wet mount or in biopsy specimen. Serology positive within 7-10 days of infection, may remain positive for years after infection resolved. Monoclonal antibodies and polymerase chain reaction emerging; may help differentiate E histolytica and E dispar. General Considerations A. Epidemiology. There are numerous distinct species of ameba within the genus Entamoeba, and the majority of these do not cause disease in humans. E histolytica is a pathogenic species that is capable of causing disease, such as colitis or …

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Dermatophytes

Essentials of Diagnosis Characteristic pattern of inflammation on glabrous skin surfaces. The active border of infection is scaly, red, and slightly elevated. Wet mount preparation with potassium hydroxide (10-20%). Skin scraping of the active border shows branching, translucent, rod-shaped filaments (hyphae) in keratinized material under low-power microscopy (10-40×). Hyphae are uniformly wide and regularly septated. Wood’s light examination (UV light at 365 nm) shows blue-green fluorescence for Microsporum canis and Microsporum audouinii. Trichophyton schoenleinii is pale green, and tinea versicolor shows white-yellow fluorescence. Culture should be performed with hair, nail, and skin specimens from particularly inflammatory lesions, to make a definitive mycologic diagnosis. General Considerations Dermatophytes are molds that infect keratinized …

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Aspergillus, Pseudallescheria, & Agents of Mucormycosis

ASPERGILLUS INFECTION Essentials of Diagnosis Filamentous fungus with septate hyphae 3-6 um in diameter. Branching of hyphal elements typically at 45° angle. Specific IgG antibodies generally of no use diagnostically since most patients are immunosuppressed and will not generate antibody response. Pulmonary lesions, localized or cavitary in susceptible host. General Considerations A. Epidemiology. Aspergillus spp. are found worldwide and grow in a variety of conditions. They commonly grow in soil and moist locations and are among the most common molds encountered on spoiled food and decaying vegetation, in compost piles, and in stored hay and grain. Aspergillus spp. often grow in houseplant soil, and such soil may be a source of …

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Pseudallescheria Boydii Infection

Essentials of Diagnosis Filamentous fungus that is morphologically similar to Aspergillus spp. Most serious infections occur in immunosuppressed patients. Recovery from culture must be distinguished from colonization or contamination. General Considerations P boydii is a mold that is capable of causing infection in immunosuppressed patients and less frequently in immunocompetent patients. Overall, infection with P boydii is rare. A. Epidemiology. Although a relatively common environmental mold, P boydii is a rare cause of human disease. It can be easily recovered from soil, water, and manure. Both community and nosocomial acquisition have been documented. In most instances, its recovery from culture specimens will reflect colonization or contamination; however, it is capable of …

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Candida Species

Essentials of Diagnosis Characteristic appearance of yeast and hyphae on KOH preparations. Formation of germ tubes in serum is presumptive diagnosis for Candida albicans. Cultures must be interpreted with caution because positive culture may represent colonization rather than infection. Serology not useful. General Considerations A. Epidemiology. Candida organisms are commensal with humans and, in the absence of alterations in host defense mechanisms, usually do not cause disease. Candida exists as normal flora within the oral cavity, throughout the gastrointestinal (GI) tract, in expectorated sputum, in the vagina, and in the bladder of patients with indwelling catheters. There are >150 species within the genus Candida, although the majority are not known to …

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Candida Vulvovaginitis

Clinical Findings A. Signs and Symptoms. Risk factors for Candida infection of the vagina include pregnancy, oral contraceptive use, diabetes mellitus, HIV infection, and antimicrobial therapy, although the majority of infections occur in the absence of these risks. Typical complaints are vulvar pruritus and vaginal discharge (Box 1), although a wide range of symptoms exists. Pruritus, the most common complaint, is often intense, and the discharge, classically described as cottage cheese-like, may range from a thin, white, scant discharge to homogeneously thick. Odor, if present, is mild. Other symptoms may include vulvar burning, external dysuria, vaginal irritation and soreness, and dyspareunia. Symptoms may peak the week prior to menses and wane …

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Candida Dermatitis (Candida rash)

Clinical Findings A. Signs and Symptoms. Skin infections with Candida are common and may manifest in a variety of forms. Intertrigo occurs in warm, moist areas of skin, such as under the breast, in the groin, and in the axilla. Initially pustular or vesicular, lesions eventually become confluent to form an erythematous, macerated area of skin with a scalloped border and satellite lesions (Box 1). Erosio interdigitalis blastomycetica is similar to intertrigo but involves the areas between the fingers and toes. Paronychia is infection of the nail bed, seen more commonly in diabetics and people who frequently immerse their hands in water. Candida spp. may cause onychomycosis, particularly in HIV-infected patients. …

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Management of Tinea Manuum (Terbinafine, Itraconazole)

Definition of Tinea Manuum The term tinea manuum is used to refer to dermatophyte infections of one or both hands. Geographical distribution of Tinea Manuum The condition is worldwide in distribution. Causal organisms The anthropophilic dermatophytes E. floccosum, T. mentagrophytes var. interdigitate and T. rubrutn are the most common causes of tinea manuum. Less commonly, the condition is caused by zoophilic dermatophytes, such as M. canis and T. verrucosum, or geophilic dermatophytes, such as M. gypseum. Hand infection may be acquired as a result of contact with another person, with an animal, or with soil, either through direct contact, or via a contaminated object such as a towel or gardening tool. Autoinoculation from …

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Management of Tinea Pedis (Terbinafine, Itraconazole)

Definition of Tinea Pedis The term tinea pedis is used to refer to dermatophyte infections of the feet. These infections often involve the interdigital spaces, but chronic diffuse desquamation can affect the entire sole. Geographical distribution of Tinea Pedis The condition is worldwide in distribution. Causal organisms The anthropophilic dermatophytes E. floccosum, T. mentagrophytes var. interdigitale and T. rubrutn are the commonest causes of tinea pedis in the UK and North America. T. rubrutn is the principal cause of chronic tinea pedis. T. mentagrophytes usually causes more inflammatory lesions. Tinea pedis is a very widespread condition that appears to be increasing in prevalence. It often begins in late childhood or young adult life …

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Management of Tinea Corporis (Griseofulvin, Terbinafine, Itraconazole)

Definition of Tinea Corporis The term tinea corporis is used to refer to dermatophyte infections of the trunk, legs and arms, but excluding the groin, hands and feet. Geographical distribution of Tinea Corporis The condition is worldwide in distribution, but is most prevalent in tropical and subtropical regions. Causal organisms Tinea corporis is caused by E. floccosum and many species of Trichophyton and Microsporum. Infection with anthropophilic species, such as E. floccosum or T. rubrum often follows autoinoculation from another infected body site, such as the feet. Tinea corporis caused by T. tonsurans is sometimes seen in children with tinea capitis and their close contacts. Tinea corporis commonly occurs following contact …

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