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Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
Oral candidiasis is an infection of the oral cavity caused by Candida Albicans and in the majority of cases is associated with immunosuppression. Typical causative factors include age, diabetes, HIV/AIDS and steroid usage. Users of inhaled steroids are recommended to rinse their mouth out with water after every use. Clinically, oral candidiasis typically presents with painless, white pseudomembranous plaques. Diagnosis is generally clinical but plaques can be cultured. Testing for the underlying cause, based on the history is often required. Antifungal treatment is usually effective. Nystatin oral suspension (100000 units/mL) 5 mL orally four times daily is used first line. Fluconazole and itraconazole are indicated for severe or refractory disease.
Use of Dermatologics during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Antifungals used to treat tinea corpus, cruris, pedis, and versicolor include ciclopirox, haloprogin, naftifine, and tolnaftate. No human studies of use of these drugs during pregnancy are published, but manufacturers’ information state that these antifungal agents were not teratogenic in several animal studies.
The Fungi
Published in Julius P. Kreier, Infection, Resistance, and Immunity, 2022
Although we are exposed to fungal elements daily, we are very resistant to fungal disease. Proper functioning of both the innate and the adaptive immune responses are essential for our resistance to mycotic disease since fungi possess many different virulence factors that enhance their invasiveness and survival in the host. The current increase in the incidence of fungal disease is due to the growing number of immune compromised hosts in the population. Laboratory identification of the fungal agent can be made by direct microscopic observation or by the demonstration of fungal antigens in the specimen. Serological testing is of limited use in the diagnosis of mycotic disease but is useful for epidemiological surveys. Antifungal drugs are available for therapy. Unfortunately all of these drugs produce some toxic side effects, a problem compounded by the fact that all fungal therapy is long term.
Postpartum Endogenous Endophthalmitis in a Young Immunocompetent Female by a Rare Fungus Candida ciferrii
Published in Ocular Immunology and Inflammation, 2022
Pooja Bansal, Meenakshi Thakar, Ravinesh Kumar, Poonam Loomba
This case posed multiple challenges, such as indolent course of the disease leading to delayed diagnosis of EE, prolonged treatment with steroids, neonatal safety of systemic antifungal agents and risk of developing RD due to delay in appropriate treatment as well as a complication o vitrectomy. Systemic antifungal therapy during lactation is challenging because of lack of data on efficacy and safety in neonates. Amphotericin B and fluconazole are found to be safe in pregnancy and lactation. Fluconazole has high oral bioavailability, rapid tissue penetration and a good safety profile in neonates.13,14 PPV in FEE has a diagnostic as well as therapeutic role. It is recommended in sight-threatening FEE with dense vitritis, if there is a diagnostic dilemma or not responsive to systemic therapy. Retinal detachment (RD) is a potential complication of FEE (26%) compared to endogenous bacterial infections (2%), during the course of management. Proposed mechanism is contraction of vitreous membranes in the peripheral retina or at the sclerotomy sites leading to retinal breaks. It is postulated that early vitrectomy (within a week of presentation) in FEE might reduce the incidence of RD.15,16
Inhaled antifungal therapy: benefits, challenges, and clinical applications
Published in Expert Opinion on Drug Delivery, 2022
The expected treatment duration for the eradication of fungus by antifungal agents is generally longer ranging from 6 weeks to more than 12 months, although it depends on fungus species, the severity of the illness, and the immune status of the patient. Optimal duration of therapy and length of follow up to determine the treatment benefit is not clear. Dose-Response and/or Dose-Finding should be tested in the Phase 2 drug development programmes. Several factors will affect lung deposition site and total exposure, such as the drug’s physico-chemical properties, delivery system (particle size, velocity etc) and patient matter (lung function, inflammatory condition etc) (Figure 3). To-be-marketed inhaled drug formulations and associated medical devices need to be used in Phase 2/3 clinical trials. Moreover, medical devices need to be safe and effective, and components such as spacers, holding chambers, facemasks, mouthpieces etc need to be subject to strict regulation.
Risk factors of septic shock development and thirty-day mortality with a predictive model in adult candidemia patients in intensive care units
Published in Infectious Diseases, 2021
Jin Woong Suh, Min Ja Kim, Jong Hun Kim
The guideline recommends antifungal treatment for 2 weeks after candidemia eradication in blood cultures [20]. Our study reported that the median antifungal treatment duration was 13 days. However, more than half of the patients (59.5%) received treatment for more than 2 weeks. Recent retrospective study reported that 47% of the survivors received antifungal treatment for ≥2 weeks compared to only 37% of the non-survivors. The remaining non-survivors died earlier (51%) [29]. However, our results shown that the patients treated antifungal agents for more than 2 weeks were similar between the survivors (59.3%) and non-survivors (60%), respectively, without difference. Forty percentage of the non-survivors died before antifungal therapy conclusion. These results suggest that overall short duration of antifungal treatment reported in our study might be due to occurrence of death before antifungal therapy conclusion. In addition, these results also imply that the antifungal treatment duration recommended in the guideline might be difficult to apply with limited generalizability depending on the real world clinical setting [50].