Fungal infections

Question 1

How do you treat tinea capitis?

Answer 1

oral terbinafine >4 yo, griseofulvin >2 yo

oral fluconazole or itraconazole are options

Question 2

Do topical agents work on tinea capitis?

Answer 2

they can reduce transmission but cannot treat. Add on top of treatment!
-selenium sulfide, ketoconazole shampoo!

Question 3

How do you treat a kerion formation in tinea capitis?

Answer 3

griseofulvin

Question 4

How do you treat tinea barbae?

Answer 4

terbinafine, griseofulvin, fluconazole
+ topical agents

Question 5

How do you treat tinea corporis?

Answer 5

topical terbinafine, butenafine, -zoles, and continue treatment 1-2 weeks post clearance

Question 6

What if your patient has extensive lesions of tinea corporis?

Answer 6

oral regimen - itraconazole or terbinafine work!

Question 7

How do you treat tinea cruris?

Answer 7

topical terbinafine or -zoles

severe - oral itraconazole or terbinifine

Question 8

How do you treat tinea pedis in the macerated stage?

Answer 8

aluminum acetate solution soaks + topical cream (azoles/ciclopirox)
OR
terbinafine/butenafine

Question 9

How do you treat tinea pedis in the dry/scaly stage?

Answer 9

broad spectrum antifungal cream (urea lotion)

Question 10

How do you treat tinea pedis in the severe stage?

Answer 10

itraconazole or terbinafine + topical maintenance powders/creams

Question 11

How do you treat onychomycosis in the fingernail?

Answer 11

griseofulvin, terbinafine, itraconazole, fluconazole

Question 12

How do you treat onychomycosis in the toenail?

Answer 12

terbinafine or itraconazole

Question 13

How do you treat tinea versicolor?

Answer 13

oral fluconazole + topical treatments for maintenance/ addition!

Question 14

What’s the presentation of oropharyngeal candidiasis?

Answer 14

itching, burning/sore throat, dysphagia/odynophagia, possible pain at lips

Thick, white plaques on tongue that CAN be scraped away, beefy, red appearance

Question 15

What should you test for when you see thrush in a healthy young person?

Answer 15

HIV

Question 16

How do you treat oropharyngeal candidiasis?

Answer 16

fluconazole, ketoconazole, clotrimazole, nystatin mouth rinse

Nystatin powder for dentures

Question 17

What is cheilitis?

Answer 17

cracked lips, red swollen corners of the mouth, white patches

Question 18

How do you treat cheilitis?

Answer 18

nystatin, ketoconazole, clotrimazole

Question 19

What’s vulvovaginal candidiasis?

Answer 19

white discharge, itching, irritation, dysuria dyspareunia

Question 20

How do you treat vulvovaginal candidiasis?

Answer 20

• single dose fluconazole
• intravaginal clotrimazole
• miconazole
• terconazole
• nystatin

Recurrent = itraconazole

Question 21

What’s balanitis?

Answer 21

itching around glans penis, red swollen foreskin, white discharge
purulent - bacterial

Question 22

What’s the treatment for balanitis?

Answer 22

topical nystatin ointment
soaking with dilute aluminum acetate can help
Refer!

Question 23

REVIEW: intertrigo

Answer 23

beefy red, macerated plaques; scrape and double check, many causes – topical antifungal tx!

Question 24

What is a candidal cystitis?

Answer 24

UTI but cannot differentiate from symptoms on bacterial vs yeast –need to do a UA!
General UTI symptoms

Question 25

How do you manage recurrent candidal cystitis?

Answer 25

PO fluconazole remove bladder catheter, discontinue abx!

Question 26

How does esophageal candidiasis present?

Answer 26

substernal odynophagia, gastroesophageal reflux, maybe thrush

Question 27

How do you diagnose esophageal candidiasis?

Answer 27

endoscopy with biopsy and culture

Question 28

How do you manage esophageal candidiasis?

Answer 28

swallow = fluconazole or itraconazole severe = IV fluconazole, echinocandin or voriconazole

Question 29

What is invasive candidiasis?

Answer 29

candida in the blood - diagnose with blood culture, and treat with IV therapy

Question 30

What are the four types of histoplasmosis?

Answer 30

1. acute pulmonary 2. progressive disseminated 3. chronic pulm 4. complications of pulm

Question 31

What is acute pulmonary histoplasmosis?

Answer 31

mild influenza to severe PNA

Question 32

What is progressive disseminated histoplasmosis?

Answer 32

fever, multi-organ involvement w/ dyspnea, cough, weight loss, prostration (HIV, TNF) septic shock, hepatosplenomegaly, adrenal involvement, GI, CNS involvement CT shows miliary pattern

Question 33

Where is histoplasmosis most common **Hint hint for test**?

Answer 33

eastern tennesse, eastern midwest - think high acidity and humidity in soil!

Question 34

What indicates histoplasmosis in labs?

Answer 34

low everything - all is effected

Question 35

What's the best way to diagnose histoplasmosis?

Answer 35

combo of 1st morning urine + serum polysaccharide antigen assays

Question 36

How do you treat histoplasmosis?

Answer 36

mild-moderate = itraconazole severe/meningitis = IV amphotericin B followed by oral itraconazole

Question 37

What is a lumbar puncture important for?

Answer 37

to check CNS

Question 38

What's the clinical presentation of the cryptococcosis?

Answer 38

cough, sputum, hemoptysis, dyspnea, chest pain, fever, malaise, night sweats, weight loss

Question 39

What's a risk with immunocompromised and cryptococcosis?

Answer 39

often develop tumors that spread to brain

Question 40

What's the MCC of fungal meningitis?

Answer 40

cryptococcosis

Question 41

How do you diagnose cryptococcosis?

Answer 41

culture of respiratory secretions/pleural fluid, lumbar puncture CXR & CT = pulmonary nodule

Question 42

How do you manage cryptococcosis?

Answer 42

depends on severity & comorbidities -> CNS involvement is essential to check

Question 43

What is coccidiodomycosis?

Answer 43

primary = fever, chills, headache, body aches erythema nodosum 2-20 days after onset of symptoms disseminated = verrucous skin lesions & abscesses, pulmonary findings pronounced, meningeal signs if CNS involvement

Question 44

Where is coccidiodomycosis found?

Answer 44

SW USA, south america

Question 45

What helps coccidiodomycosis diagnosis?

Answer 45

labs - CBC, ELISA, CSF Imaging - variable findings, hilar lymphadenopathy

Question 46

How do you manage coccidiodomycosis?

Answer 46

symptomatic for limited disease w/ progression - itraconazole, fluconazole progressive = IV amphotericin B meningitis = high dose fluconazole/amphotericin B

Question 47

In who is blastomycosis most common?

Answer 47

immunocompetent outdoor activity people

Question 48

What are the symptoms of blastomycosis?

Answer 48

* abrupt onset fever * chills * body aches * pleuritic chest pain * cough * dysuria * headache and neck pain (CNS) * epididymitis, prostatitis * respiratory distress w/ tachypnea cutaneous has verrucous lesions and bones are often involved

Question 49

Where is blastomycosis most common?

Answer 49

eastern midwest area; often presenting after failed abx therapy

Question 50

How can you diagnose blastomycosis?

Answer 50

CBC, sputum/tissue biopsy, culture, UA Imaging - look for lobar consolidation (tumor?)

Question 51

How do you treat blastomycosis?

Answer 51

mild - itraconazole long-term moderate/CNS/treatment failure = IV amphotericin B followed by oral -azoles