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Candidiasis
- May affect the skin and/or the mucous membranes of the mouth, intestines, or the vagina
- Risk Factors
- Poor hygiene
- Hot and humid environment
- Antibiotic therapy
- Immunosuppression
Clinical Presentation
- Oropharyngeal candidiasis – (thrush)
- Sore and painful mouth
- Burning mouth or tongue
- Dysphagia
- Thick, whitish patches on the oral mucosa
- Diffuse erythema and white patches that appear on the surfaces of the buccal mucosa, throat, tongue, and gums.
- Esophageal candidiasis
- Often normal oral mucosa
- Dysphagia
- Odynophagia
- Retrosternal pain
- Epigastric pain
- Nausea and vomiting
- Genitourinary tract candidiasis
- Vulvovaginal candidiasis
- Erythematous vagina and labia
- Burning
- Dyspareunia
- Thick, curd-like discharge, cottage cheese discharge
- Dermatitis –
- Most commonly found where skin touches skin
- Axilla
- Beneath the breast
- Beneath the pannus
- Groin
- Diaper Rash
- Pustules, vesicles and papules with satellite lesions
- Most commonly found where skin touches skin
Labs & Studies
- For a wet mount, scrapings or smears examined under the microscope
- Potassium hydroxide (KOH) prep – pseudohyphae and budding yeast cells
- Gram stain
- Gastrointestinal candidiasis
- Endoscopy with or without biopsy
Treatment
- Good hygiene
- Breathable clothing
- Topical agents
- Itraconazole
- Ketoconazole
- Miconazole
- Fluconazole
- Nystatin
- Oral medications
- Itraconazole
- Ketoconazole
- Miconazole
- Fluconazole
- Nystatin
- IV
- Amphotericin B
Cryptococcosis
- Cryptococcus neoformans – encapsulated yeast
- Found in soil or dust contaminated with bird droppings
- Usually affects immunocompromised patients
- Classification
- Wound or cutaneous cryptococcosis
- Pulmonary cryptococcosis
- Cryptococcal meningitis
Clinical Presentation
- Pulmonary infection
- Cough
- Cough with the production of a little mucoid sputum
- Pleuritic chest pain
- Low-grade fever, dyspnea, weight loss, and malaise (less common)
- Meningitis and meningoencephalitis – causes cerebral edema
- Headache
- Confusion
- Lethargy
- Obtundation
- Nausea and vomiting
- Fever and stiff neck – with an aggressive inflammatory response
- Blurred vision, photophobia, and diplopia
- Seizures
- Ataxia
- Aphasia
- Coma
Labs & Studies
- Cutaneous lesions
- Biopsy with fungal stains and cultures
- Blood:
- Fungal culture
- Cryptococcal antigen testing
- Cerebrospinal fluid
- India ink smear – ink doesn’t enter the capsule
- Fungal culture
- Cryptococcal antigen testing
- CT
- Large focal brain lesions
- CXR
- Lung consolidation
Treatment
- Antifungal Therapy
- Amphotericin B –
- Flucytosine
- Fluconazole –
- Pneumonia
- Fluconazole
- Meningitis
- Amphotericin B
Histoplasmosis
- Inhaled spores often found soil contaminated with bird and bat droppings
- Histoplasma capsulatum
- Typically patients have little or no symptoms if not immunocompromised
Clinical Presentation
- Chest pain
- Chills
- Cough
- Fever
- Joint pain and stiffness
- Muscle aches and stiffness
- Extreme weakness
Labs & Studies
- Medical and travel history
- Laboratory tests
- Blood and urine antigen detection – to diagnose systemic disease
- CBC – may present mild anemia, pancytopenia
- Alkaline phosphatase and lactate dehydrogenase – elevated
- Sputum culture
- Bronchial lavage
- Complement-fixing antibodies
- Immunoprecipitating antibodies
- Chest x ray – miliary infiltrates
- CT Scan of the lungs
Treatment
- Symptoms typically resolve on their own
- Treating severe histoplasmosis in the lungs, chronic histoplasmosis, and disseminated histoplasmosis
- Antifungal Medications
- Itraconazole for several months is first line
- Amphotericin B
- Treating acute respiratory distress symptoms
- Corticosteroids
- Antifungal Medications
Pneumocystis
- Pneumocystis jirovecii pneumonia (PJP)
- Previously known as Pneumocystis carinii pneumonia (PCP)
- The most common opportunistic infection in HIV/AIDS
Clinical Presentation
- Fever
- Mild and dry cough or wheezing
- Shortness of breath, especially with activity
- Rapid breathing
- Fatigue
- Major weight loss
- Chest pain with respiration
Labs & Studies
- Chest X-ray – diffuse interstitial infiltrates
- Hypoxia
- Sputum induction
- Bronchoalveolar lavage
- Bronchoscopy – to extract fluid sample if sputum induction is unsuccessful
- Biopsy – to confirm diagnosis
- Thickened alveolar septa with fluffy eosinophilic exudate in the alveoli
Treatment
- Bactrim (TMP-SMX) is given as empiric treatment to all immunocompromised patients who present with a cough.
- Pentamidine
- Steroids
