Chapter 161 Yeast Infections

Question 1

Favored areas of involvement of Candidiasis (6)

Answer 1

Oral mucosa
Lips
Fingers
Nails
Intertriginous zones
Genitalia

Question 2

Most common culprit in fatal fungal sepsis

Answer 2

Candida

Question 3

Risk factors for Candida infection (5)

Answer 3

Extremes of age
Malnutrition
Obesity
Diabetes
Immune deficiency

Question 4

Candidal colonization has been reported in more than ___ of oral mucosa of heathy adults with higer rates of carriage in (2)

Answer 4

40%
Women
Smokers

Question 5

Majority of invasive candidiasis and candidemia

Answer 5

Non albicans species

Question 6

Seen on the third webspace of hands, macerated whitish plaque on erythematous background

Answer 6

Erosio interdigitalis blastomycetica

Question 7

Distinguishing features of candida onychomycosis vs tinea unguium (2)

Answer 7

More often seen in fingernails than toenails
Pain on pressure or movement of nail plate
Affects dominant hand

Question 8

Ddx for chronic mucocutaneous candidiasis

Answer 8

Plaque psoriasis

Question 9

Classic clinical triad of candidemia

Answer 9

Fever
Rash
Myalgia

Question 10

Complications of candidemia

Answer 10

Multiorgan failure (liver, spleen, kidneys, heart, meninges)

Question 11

Mutations in ___ results in inabilty to induce TH 17 resulting in defect in ability of neutrophils to kill Candida

Answer 11

Caspase recruitment domain containing protein 9 (CARD9)

Question 12

Risk factors for oral candidiasis (6)

Answer 12

Xerostomia
Wearing of dentures or other oral hardware
Inhaled and systemic corticosteroids
Vitamin deficiencies
Radiation therapy to head and neck
Hypothyroidism

Question 13

Risk factors for invasive candidiasis and candidemia (6)

Answer 13

Neutropenia and neutrophil dysfunction (CARD9 mutations)
Hematologic malignancy
Stem cell transplantation
In dwelling intravascular catheters
ICU placement
Immunosuppressive medications

Question 14

Risk factors for localized/superficial Candida infections (6)

Answer 14

Extremes of age
Obesity
DM
Pregnancy
HIV/AIDS
Broad spectrum antibiotics, corticosteroids, immunosuppressive medications

Question 15

Rapid demonstration of Candida infection

Answer 15

KOH preparation of pseuddohyphae and budding

Question 16

Gold standard for diagnosis of Candida infection

Answer 16

Blood cultures

Question 17

HPx of localized mucocutaneous candidiasis vs disseminated candidiasis

Answer 17

Localized, seen in epidermis with GMS or PAS

Dermal, seen in and aroun dermal blood vessels

Question 18

First line treatment for cutaneous candidiasis

Answer 18

Topical imidazole

Topical nystatin

Question 19

First line treatment for chronic paronychia

Answer 19

Avoid wet work
Topical corticosteroids
Topical calcineurin inhibitors

Question 20

First line treatment for onychomycosis

Answer 20

Oral itraconazole 400mg PO monthly for 4 weeks for fingernails
For 12 weeks for toenails
Oral fluconazole 50mg PO daily
Or 300mg weekly

Question 21

First line treatment for severe/immunosuppressed thrush

Answer 21

Fluconazole 150mg PO three times weekly

Question 22

First line treatment for oral thrush

Answer 22

Clotrimazole 10mg troches five times daily
Miconazole 50mg buccal tablets 1-2 weeks
Disinfect dentures
Alternative: Nystatin suspension 100,000 units/ml 4-6ml QID for 1-2 weeks

Question 23

First line treatment for Candidal vulvovaginitis

Answer 23

Topical miconazole

Topical clotrimazole

Question 24

First line treatment for chronic mucocutaneous candidiasis

Answer 24

Oral imidazole

Oral triazole for long courses

Question 25

First line treatment for disseminated candidemia for hemodynamically stable immunocompetent patients

Answer 25

Echinocandin | Fluconazole

Question 26

First line treatment for disseminated candidemia for neutropenic patients

Answer 26

``` Empiric echinocandin (caspofungin, micafungin, anidulafungin) Switch to fluconazole once stable ```

Question 27

Colonization of malassezia occurs by age of __ with earlier colonization if associated with length of neonatal ICU stays

Answer 27

3-6 months

Question 28

MC isolated species in pityriasis versicolor and Malassezia folliculitis

Answer 28

Malassezia globosa

Question 29

MC pathogen of catheter related fungemia in neonates

Answer 29

Malassezia pachydermatitis

Question 30

Follicular based erythematous monomorphic papules and pustules on face, trunk, and upper arms

Answer 30

Malassezia folliculitis

Question 31

Comedones are also a feature of Pityrosporum folliculitis | True or False

Answer 31

False, not

Question 32

Hypopigmentation of P. Versicolor is due to production of

Answer 32

Azelaic acid

Question 33

Hyperpigmentation of P. Versicolor is due to production of

Answer 33

Increased melanosomes | Thickening of stratum corneum

Question 34

In both PV and Malassezia folliculitis, illumination with a Wood lamp may reveal

Answer 34

Yellow green fluorescence

Question 35

In both PV and Malassezia folliculitis, KOH may reveal

Answer 35

Ziti and meatball sign | Short hyphae and yeast forms

Question 36

Stains to improve visualization of yeast

Answer 36

Calcofluor white | May-Grunwald-Giemsa stain

Question 37

Malassezia produces ___ which provokes inflammation in host

Answer 37

Free fatty acids

Question 38

Malassezia produce variety of diseases (5)

Answer 38

``` Pityriasis versicolor Malassezia folliculitis Seborrheic dermatitits Atopic dermatitis Neonatal cephalic pustulosis ```

Question 39

Higher risk for disseminated infection (3)

Answer 39

Preterm neonates Immunosuppressed Parenteral lipid infusions

Question 40

First line treatments for pityriasis versicolor

Answer 40

Topical shampoos with Zn pyrithione and Selenium sulfide Propylene glycol in aqueous solution Topical imidazole (ketoconazole)

Question 41

Treatment for prophylaxis of pityriasis versicolor

Answer 41

Periodic use of topical shampoos | Itraconazole 200mg BID/monthly for 6 months

Question 42

First line treatment for Malassezia folliculitis

Answer 42

Itraconazole 200mg daily for 1-3 weeks