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Intro to fungi (ii) (Superficial infections (pityriasis versicolor (risk…

- - - - sweating heavy
      - oily skin
      - hot humid climates
    - - clinical appearance
      - skin scrapings
      - wood lamp test (UV light - yellow/green immunofluorescence)
    - - topical azoles (ketoconazole)
      - oral azoles (fluconazole, itraconazole)
  - - - tinea barbae (beard)
      - tinea capitis (head)
      - tinea corporis (groin)
      - tinea faciei (face)
      - tinea manuum (hands)
      - tinea pedis (foot, esp between toes due to sweat)
      - tinea unguium (nails)
    - - appearance
      - KOH (potassium hydroxide - celars debris + keratin from specimens) microscopy
      - culture
    - - oral or topical terbinafine
      - other topical antifungals (e.g. cotrimazole)
      - ketolytic agents
  - - - clinical appearance
      - skin scrapings
      - swabs
    - - sometimes resistance occurs
      - topical clotrimazole or oral fluconazole
- - - - asymptomatic infection
      - acute/chronic resp infection resembling TB, with areas of consolidation
      - disseminated infection in immunosuppressed hosts (involving liver, lungs, spleen)
  - - - clinical suspicion
      - culture + antigen detection in blood + CSF
      - microscopy (India ink) rarely used now
  - - - antibiotics
      - steroids
      - HIV +ve
      - chemo
      - transplant (solid organ or BM)
      - post-op
      - IV catheters/other devices
      - DM
      - burns
      - in ICU
      - parenteral nutrition
    - - clinical suspicion
        
        fever
        
        no response to antibiotics
        
        multi-site colonisation
      - microscopy: dark purple cells (gram +ve large budding yeasts)
      - specimens: blood, tissue, sterile samples
      - germ tube test
        
        outdated
        
        add horse/human serum (proteinaceous) + intubate -> tubes form from cells
      - culture
        
        aerobic, on Sabouraud
        
        if blue: albicans or tropicalis
        
        if white: parapsilosis
        
        if pink: glabrata