Fungal Infections

Mycoses

Mycoses: A general term referring to any fungal infection

Systemic Mycoses

Opportunistic

  • Occurs in immunocompromised hosts.

  • Examples include:

    • Candidiasis

    • Aspergillosis

    • Cryptococcosis

    • Mucormycosis

Non-opportunistic

  • Occurs in any host

  • Examples include:

    • Sporotrichosis

    • Blastomycosis

    • Histoplasmosis

    • Coccidioidomycosis

Superficial Mycoses

Candida species:

  • Commonly infects mucous membranes and moist skin.

  • Chronic infections may involve scalp, skin, and nails.

  • Oral candidiasis (thrush)

  • Vulvovaginal candidiasis

    • 75% of women experience at least once

    • Risk factors

      • Pregnancy

      • Diabetes

      • Debilitation

      • HIV

      • Oral contraceptives

      • Systemic glucocorticoids

      • Anticancer agents

      • Systemic antibiotics

Dermatophytes:

  • Typically confined to skin, hair, and nails.

  • Tinea pedis: Ringworm of the foot (commonly known as “athlete’s foot”).

  • Tinea corporis: Ringworm of the body.

  • Tinea cruris: Ringworm of the groin (commonly known as “jock itch”).

  • Tinea capitis: Ringworm of the scalp.

  • Onychomycosis: Fungal infection of nails (can be caused by candida or dermatophyte)

Candidiasis

  • Candidiasis: A fungal infection caused primarily by yeast species from the Candida genus.

  • Candidiasis is primarily caused by Candida albicans.

  • It is considered a normal commensal organism, frequently present on human skin and mucous membranes.

  • Opportunistic pathogen: Thrives in warm, moist environments which facilitate heightened growth.

Risk Factors

  • Immunosuppression: Conditions such as HIV/AIDS, cancer treatment, and transplants can predispose individuals to candidiasis.

  • Antibiotic use: Disruption of normal flora may lead to overgrowth of Candida.

  • Diabetes mellitus

  • Pregnancy

  • Infancy and old age

  • Warm environment

  • Poor hygiene

Types

  • Mucosal: Involves oral and vaginal areas.

  • Cutaneous: Affects skin folds such as:

    • Axilla

    • Groin

    • Gluteal folds

    • Under breasts

    • Genitals

    • Between fingers and toes

    • Nail folds

  • Invasive/Disseminated: Encompasses candidiasis affecting the bloodstream and internal organs.

Manifestations

  • Oral thrush: Characterized by white patches on the mucosa.

  • Vaginal candidiasis: Presents with vaginal discharge, itching, and dysuria.

  • Skin manifestations: Skin rashes or intertrigo can occur in affected skin folds.

Diagnosis

  • Clinical examination: Initial assessment by a healthcare provider.

  • Microscopy: Techniques such as KOH preparation and Gram stain are utilized.

  • Fungal culture: Laboratory culture assesses for Candida species.

  • Serology and molecular tests: Employed for the diagnosis of invasive diseases.

Treatment

  • Vulvovaginal candidiasis:

    • Topical therapy for 1 to 3 days.

    • A single dose of fluconazole may be effective.

    • For invasive disease, intravenous (IV) antifungals such as amphotericin B or IV fluconazole are indicated.

  • Oral candidiasis:

    • Topical treatments: Nystatin, clotrimazole, and miconazole.

    • For immunocompromised patients: May require oral therapy with fluconazole or ketoconazole.

    • Oral therapy alternatives: Lamisil and itraconazole (Sporanox).

    • Topical treatment: Ciclopirox (Penlac Nail Lacquer).

  • Clotrimazole: Drug of choice for dermatophytic infections and candidiasis affecting skin, mouth, and vagina.

  • Ketoconazole: Used for both oral and topical therapy of superficial mycoses.

  • Miconazole: Preferred topical drug for oral thrush.

  • Nystatin:

    • A polyene antibiotic used solely for candidiasis.

    • The drug of choice for intestinal candidiasis and can treat candidal infections in skin, mouth, esophagus, and vagina.

    • Routes of administration: Oral suspension, topical powder, ointment, and vaginal tablets or suppositories.

Prevention and Nursing Care

  • Practice good hygiene and maintain cleanliness and dryness of body areas.

  • For women:

    • Avoid tight clothing and use breathable cotton underwear.

  • Maintain controlled blood sugar levels if diabetic.

  • Follow antibiotic prescriptions carefully to avoid overuse.

  • Enhance immune system function through a healthy diet and lifestyle.

  • Denture care:

    • Clean dentures thoroughly and allow to dry adequately.

  • Implement preventative antifungal medications if at high risk (e.g., during chemotherapy).

  • Treat underlying conditions to lower the risk of Candida overgrowth.

  • Maintaining a balanced microbiome and healthy immune system are critical to preventing candidiasis.