Chapter 161 :: Yeast Infections

Question 1

Candida yeasts are found throughout the environment and are also common commensals of the human skin, oropharyngeal, respiratory, GI, and genital mucosa. Candidal colonization has been reported in the oral mucosa of more than 40% of healthy adults, with higher rates of carriage in women and smokers

Question 2

In the diaper area

Answer 2

the classic presentation is beefy-red erythematous plaques with satellite papules and pustules

Question 3

Risk factors for localized/superficial Candida infections

Answer 3

extremes of age; diabetes; obesity; pregnancy; HIV/AIDS (although prevalence has decreased significantly in the era of highly active antiretroviral therapy)18 ; and use of broad-spectrum antibiotics, corticosteroids, or immunosuppressive medications, specifically anti–IL-17-blocking medications

Question 4

Risk factors for invasive candidiasis/candidemia

Answer 4

neutropenia and neutrophil dysfunction (including CARD9 mutations); hematologic malignancy; stem cell transplantation; indwelling intravascular catheters (including patients on hemodialysis); intensive care unit placement; and immunosuppressive medications

Question 5

potassium hydroxide (KOH) Candida

Answer 5

scraping from an intact pustule, or a touch preparation from a punch biopsy specimen) demonstrating pseudohyphae and budding yeast

Question 6

considered the “gold standard” however with poor sensitivity (approximately 50%)

Answer 6

positive blood cultures

Question 7

Treatment for Oral Candidiasis

Answer 7

Clotrimazole 10-mg troches 5 times daily or miconazole 50-mg buccal tablets for 1 to 2 weeks is first-line treatment, with nystatin suspension 100,000 units/mL, 4 to 6 mL 4 times daily for 1 to 2 weeks as an alternative.

Question 8

First-line treatment of Candida onychomycosis

Answer 8

itraconazole given orally as pulsed dosing at 400 mg daily for 1 week monthly or 200 mg daily continuous dosing, for a total minimum duration of 4 weeks for fingernail and 12 weeks for toenail disease

Question 9

presents as follicularly based erythematous monomorphic papules and pustules on the face, trunk, and upper arms

tends to spare the centrofacial areas

Answer 9

Malassezia folliculitis

Question 10

short hyphae and yeast forms (the “ziti and meatballs” sign

Answer 10

Malassezia folliculitis

Question 11

hypopigmentation seen especially in darker-skinned patients is thought to be a result of the production of

Answer 11

Azelaic acid

Question 12

Malassezia folliculitis

Answer 12

itraconazole being the best-studied treatment (200 mg daily for 1 to 3 weeks)