Data and Picture Interpretation Stations: Cases 1–45
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar in ENT OSCEs, 2023
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.
Acute Infections of the Larynx
John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford in Head & Neck Surgery Plastic Surgery, 2018
Systemic antifungal therapy is necessary for immunocompromised patients. Antifungal agents suppress fungal growth, making recurrent infection likely unless the underlying predisposing factors are addressed and corrected. Recurrence will also occur if the agent is used for too short a period or in an inadequate dose. Suitable agents include fluconazole, ketaconazole, itraconazole and amphotericin B. Each agent has its own characteristics: fluconazole for 3–4 weeks is the preferred agent for candida infection; itraconazole is particularly effective for aspergillus infections at a dose of 100–400 mg daily, monitored by regular blood levels; ketaconazole is the agent of choice for histoplasmosis and blastomycosis. Amphotericin B needs to be administered intravenously and also has significant adverse effects on the kidney, heart and liver.
Vulvar therapies
Miranda A. Farage, Howard I. Maibach in The Vulva, 2017
Multiple double-blind, randomized studies have proven the efficacy of both oral and topical antifungals for the treatment of candidiasis. Administration route is largely dependent on patient preference. Topical antifungals include butoconazole, clotrimazole, miconazole, nystatin, terconazole, and tioconazole. Table 31.1 (57–75) summarizes topical treatments tested in RCTs. Cure rates are over 80%, with symptomatic resolution in 48–72 hours and mycological cure within 4–7 days (76). Oral azoles (fluconazole, itraconazole, and ketoconazole) also achieve high cure rates; however, fluconazole is currently the only FDA-approved agent (77). Itraconazole has been found to be as effective as fluconazole. Oral agents may be preferable because of convenience and the avoidance of skin sensitization that has been associated with topical antifungals. Side effects of fluconazole are mild and infrequent, but include gastrointestinal intolerance, headache, and rash (76). There is increased hepatotoxicity with concomitant use of fluconazole with other hepatotoxic drugs, most notably statins. Oral azoles should not be used during pregnancy. One RCT has shown boric acid to be as effective in treatment as nystatin; however, this agent can cause skin irritation, is toxic if ingested, and should not be a first-line therapy (78).
Case report: nanopore targeted sequencing in the diagnosis of invasive pulmonary Aspergillus infection in a patient with acute promyelocytic leukemia
Published in Hematology, 2023
Qiuxia Huang, Yaohui Wu, Xuan Lu, Linghui Xia
Invasive pulmonary aspergillosis (IPA) is an infectious disease caused by the growth of Aspergillus hyphae, invading the lung parenchyma. Prolonged profound neutropenia, hematological malignancies, hematopoietic stem cell or solid organ transplantation, and long-term use of high-dose glucocorticoid or immunosuppressive agents, and inherited or acquired immunodeficiency status are risk factors for IPA infection [1–3]. Early diagnosis and timely treatment are key to good patient outcomes. However, due to the lack of typical clinical manifestations of the disease and various deficiencies in the current main laboratory testing methods, there is an urgent need for a rapid and accurate detection technology to assist in the diagnosis of IPA. This paper describes a case of acute myeloid leukemia with pulmonary infection and large pleural effusion, in which the pathogen Aspergillus flavus was detected by nanopore targeted sequencing (NTS). Based on the NTS results, we performed an effective antifungal therapy and achieved good results.
Optimal diagnosis and management of common nail disorders
Published in Annals of Medicine, 2022
Treatment options include oral antifungals, topical agents and devices. Systemic therapies (terbinafine and itraconazole) are often prescribed due to their accessibility, affordability and high efficacy [36]. Fluconazole may also be prescribed, but as off-label treatment for onychomycosis. While most patients do not experience side effects, headaches and gastrointestinal distress can occur in some patients [20]. However, elevated transaminases, hypertriglyceridaemia, neutropenia and drug–drug interactions are much less common, but serious adverse events associated with these agents. Before and during treatment, laboratory values should be monitored closely and medications carefully reviewed in patients that are at increased risk. Older adults, who may be more likely to have underlying conditions, including peripheral vascular disease and diabetes, as well as, polypharmacy can make treatment difficult. These conditions can impair wound healing and predispose patients to secondary infections [38]. Terbinafine is the treatment of choice in the elderly population, if there are no contraindications, as there are less associated side effects and drug interactions compared to itraconazole [39].
Candida auris biofilm: a review on model to mechanism conservation
Published in Expert Review of Anti-infective Therapy, 2023
Arsha Khari, Biswambhar Biswas, Garima Gangwar, Anil Thakur, Rekha Puria
Earlier, C. auris was shown to have a filamentous morphology in cultures on YEPD medium from mouse liver, kidney, brain, lung, and spleen specimens that had invasive candidiasis [41]. When other fungi are subjected to triggers i.e. environmental factors, such as temperature, nutrient limitation, and pH changes, they form filaments but C. auris fails to do it on exposure to triggers. Interestingly, it was observed that under the genotoxic effect, its DNA gets damaged and it starts forming filaments. This may occur due to the interaction of this fungus with the host immune response or upon antifungal treatment. According to the literature, some genes such as FLO11, EED1, HWP1, HWP2 or ECE1 which cause filamentation in S. cerevisiae and C. albicans are missing from the C. auris genome. Though we did not find HWP2 on orthologs analysis but HWP1exists in C. auris’ genome. In C. albicans, tup1∆ cells trigger the formation of constitutive filamentation but not in C. auris.
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