Tags: Tinea

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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Borrelia & Leptospira Species

BORRELIA SPECIES RELAPSING FEVER Essentials of Diagnosis The most common presentation is fever with rash, headache, shaking chills, myalgias, arthralgias, and — during the acute phase — hepatosplenomegaly. Louse-borne relapsing fever (LBRF) is epidemic, caused by B. recurrentis, and characterized by one or two relapses. Tick-borne relapsing fever (TBRF) is endemic, caused by several Borrelia species, and characterized by multiple clinical relapses. Organisms can be visualized in blood smears of febrile patients, unlike other spirochetal pathogens, using dark-field microscopy or Giemsa or Wright stains. Helical (3-10 spirals) spirochetes, 8-30 um × 0.3 um, motile (flagella). Weil-Felix reaction: Proteus OX-K agglutinin titers are elevated (this is more common in LBRF). General Considerations …

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Secondary Syphilis

Clinical Findings A. Signs and Symptoms. The secondary stage of syphilis occasionally overlaps with the primary phase but usually begins ~ 6 weeks after resolution of the chancre; however, it can develop as late as 6 months after infection (see Box  1). Most patients have some degree of skin or mucocutaneous involvement. A faint and evanescent macular rash of the trunk and abdomen known as roseola syphilitica is sometimes seen initially. A generalized, symmetric, nonpruritic rash consists of some combination of erythematous or copper-colored macular, papular, papulosquamous, or pustular lesions. These lesions can be found on the palms, soles, genitalia, and oral mucous membranes. The rash of syphilis often provides a …

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Skin & Soft Tissue Infections

Infections caused by P aeruginosa involving the skin may be primary or secondary. Secondary infections have been described above and include ecthyma gangrenosum, subcutaneous nodules, vesicles, bullae, cellulitis, deep abscesses, and necrotizing fasciitis. Primary skin lesions are noted as complications of neutropenia, burns, decubitus ulcers, prematurity, exposure to a moist environment, and hydrotherapy. Burn wound sepsis is a serious complication that may be caused by P aeruginosa. Colonization of the burn may lead to invasive disease. The signs are black, brown, or violet discoloration of the burn eschar; destruction of granulation tissue leading to rapid eschar separation and subcutaneous hemorrhage; erythematous nodules; edema or hemorrhage of adjacent uninfected tissue; black neoeschar …

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Nonpyogenic Skin Infections

Clinical Findings A. Signs and Symptoms. Impetigo and staphylococcal scalded skin syndrome (SSSS) are primarily childhood diseases. More than 70% of cases of impetigo are caused by S aureus, with the remainder attributed to pyogenic streptococci or mixed infection. Impetigo begins as a scarlatiniform eruption in a previously traumatized area that blisters then ruptures to form a wet, honey-colored crust. Common sites for infection are the face and trunk. The primary symptom in impetigo is localized pain; fever and constitutional symptoms are rarely seen (Box 1). Physical exam often reveals regional lymphadenopathy. Staphylococcal scalded skin syndrome encompasses three distinct clinical scenarios: bullous impetigo, staphylococcal scarlet fever, and generalized scalded skin syndrome. …

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Use and Administration of Itraconazole 100 mg (Sporanox)

Therapeutic use of Itraconazole 100 mg Capsules (Sporanox) Itraconazole can be used to treat various superficial fungal infections, including the dermatophytoses, pityriasis versicolor, and mucosal and cutaneous forms of candidosis. It is also effective in patients with subcutaneous infections, such as chromoblastomycosis, sporotrichosis and certain forms of phaeohyphomycosis. It has become the drug of choice for non-life-threatening forms of blastomycosis and histoplasmosis, and is a useful alternative to amphotericin B for invasive aspergillosis. Maintenance treatment with itraconazole has helped to prevent relapse in patients with AIDS with histoplasmosis or cryptococcosis, and prophylactic treatment with this drug has helped to prevent aspergillosis and candidosis in neutropenic patients. However, it has not been …

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Management of Tinea Unguium (Amorolfine, Tioconazole, Itraconazole, Griseofulvin)

Definition of Tinea Unguium The term tinea unguium is used to describe dermatophyte infections of the fingernails or toenails. Geographical distribution of Tinea Unguium The condition is worldwide in distribution. Causal organisms Fungal infection of the nails (onychomycosis) may be caused by a number of dermatophytes as well as by a number of other moulds and Candida species. There is wide geographical and racial variation in the causative agents, but in the UK 85-90% of nail infections are due to dermatophytes and about 5% are due to non-dermatophyte moulds. The dermatophytes most commonly implicated are anthropophilic species, such as T. mentagrophytes var. interdigitate and T. rubrum. Their prevalence differs from one geographical region …

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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 Cruris (Itraconazole, Terbinafine, Griseofulvin)

Definition of Tinea Cruris The term tinea cruris is used to refer to dermatophyte infections of the groin and pubic region. Geographical distribution of Tinea Cruris The condition is worldwide in distribution. Causal organisms The dermatophytes most often encountered in tinea cruris are E. floccosum and T. rubrum. Maceration and occlusion of the skin in the groin give rise to warm moist conditions that favour the development of the infection. Tinea cruris is a common form of dermatophytosis. It is more prevalent in men than women. It usually occurs between the ages of 18 and 60, but is most prevalent between the ages of 18 and 25, and between 40 and …

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