Candida Homeopathic Remedies

Yeast Infection No More

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Candida and Other Fungi

Candida spp, principally Candida albicans, are the most prevalent esophageal pathogens. When Candida is found in the normal host, a search for and correction of any predisposing factors plays an important role in both resolving the disease and preventing recurrence. Such factors include antibiotic use, inhaled or ingested corticosteroids, diabetes mellitus, malnutrition, and esophageal motility disturbances. Therapy is highly effective for Candida esophagitis with either oral or intravenous medications. Although species other than Candida albicans cause esophagitis (eg, Candida tropicalis), speciation is not required as treatment is generally the same, regardless of species. The choice of therapy primarily depends upon the cause, severity, and expected duration of immune dysfunction. If disease is found incidentally at the time of endoscopy and the cause for candidal infection can be easily reversed (see above), no therapy may be necessary. Although nonabsorbable locally acting...

Fungal infections oral candidosis

Oral candidosis is the most common oral infection in palliative care. The predisposing factors include dry mouth, dentures, and immunosuppression. Candida albicans is responsible for most oral fungal infections, but other species such as C glabrata, C dubliniensis, and C tropicalis are also important. Oral candidosis may present in several different clinical forms, including pseudomembranous, erythematous, denture stomatitis, and angular cheilitis. Oral candidosis may spread locally to cause oesophageal candidosis or more widely to cause systemic candidosis. The management of oral candidosis involves treatment of any predisposing factors (such as disinfection of dentures), together with treatment of the infection with topical or systemic antifungal drugs. Topical treatments for oral candidosis include nystatin, amphotericin B, and miconazole. Topical treatments can be effective, although this depends on correct use. Many palliative care patients find it difficult to comply with the...

Vulvovaginal Candidiasis

The most common cause of vulvo-vaginal candidiasis is Candida albicans. Other non-albicans species, such as C. glabrata, account for less then 10 per cent of cases but it is this group that may be more resistant to treatment (Kinghorn and Priestly, 1998). Around 75 per cent of women will experience candidiasis at some time. It is usually related to pregnancy or follows antibiotic therapy. However, while sexual acquisition plays a small role in the aetiology of vulvo-vaginal candidi-asis, the infection may be passed on by male partners, who can then act as asymptomatic reservoirs of re-infection. Male partners can also develop symptomatic balanitis (Kinghorn and Priestly, 1998). Ten to twenty per cent of women of reproductive age may harbour Candida species and remain asymptomatic, and, for these women, treatment is not required. Candida albicans and the non-albicans species share common symptoms. Table 10 Clinical features (Candida albicans and non-albicans species share common Table...

Yeast infections

Candida infection may occur in the flexures of infants and elderly or immobilised patients, especially below the breasts and folds of abdominal skin. It needs to be differentiated from (a) psoriasis, which does not itch (b) seborrhoeic dermatitis, a common cause of a flexural rash in infants and (c) contact dermatitis and discoid eczema, which do not have the scaling margin. Candida intertrigo is symmetrical and satellite pustules or papules outside the outer rim of the rash are typical. Yeasts, including Candida albicans, may be found in the mouth and vagina of healthy individuals. Clinical lesions in the mouth white buccal plaques or erythema may develop. Predisposing factors include general debility, impaired immunity (including AIDS), diabetes mellitus, endocrine disorders, such as Cushing's syndrome, and corticosteroid treatment. Vaginal candidosis or thrush is a common infection of healthy young women an underlying predisposition is rarely found. The infection presents with...

Acquired immunodeficiency syndrome

(AIDS) A disease of humans caused by Human immunodeficiency viruses (HIV) 1 and 2. Globally, more than 36 million people were infected by the year 2000. The incubation time from infection to development of AIDS appears to range from 6 to 13 years (median 10 years). AIDS is primarily a disease of the immune system so the infection usually results in a wide range of adverse immunological and clinical conditions. The extent of the disease is generally measured by the CD4+ lymphocyte count, and as the count declines to below 200 per microliter there is serious risk of AIDS-related complex (ARC), a syndrome involving opportunistic infections, such as recurrent bacterial infections, candidiasis, pulmonary tuberculosis, Pneumocystis carinii pneumonia, EBV-associated lymphoma, and Kaposi's sarcoma. The opportunistic infections (i.e. those caused by microorganisms that seldom cause disease in persons with normal defense mechanisms) and cancers resulting from immune deficiency are

Inflammatory Bowel Disease

The medical and dental literature abounds with articles describing extra-abdominal, oral signs of inflammatory bowel diseases (IBDs), which include aphthous-like ulceration, gingivitis, candidiasis, pyostomatitis vegetans, cobblestone appearance of the oral mucosa, oral epithelial tags and folds, persistent lip swelling, lichenoid mucosal reactions, granulomatous inflammation of minor salivary gland ducts, and angular cheilitis. Current dental literature focuses on the oral status of IBD patients with regard to the potential use of thalidomide against antitumor necrosis factor-a for the treatment of recalcitrant oral granulomatous lesions, caries rate, salivary antimicrobial proteins, and infections of bacterial and fungal origins. Interestingly, oral manifestations of IBD may precede the onset of intestinal radiographic lesions by as long as a year or more. IBD is of interest to both physicians and dentists because of their complicating oral sequelae and their diagnosis and...

Empiric Antifungal Therapy

Given the prevalence of Candida esophagitis in AIDS, empiric antifungal therapy is widely prescribed for symptomatic patients. A prospective randomized trial comparing endoscopy with empiric fluconazole in HIV-infected patients with esophageal symptoms demonstrated a high response rate and substantial cost savings with flucona-zole, and no patient failing empiric therapy developed complications before definitive endoscopic examination (Wilcox et al, 1996). Although not critically studied, an empirical approach is commonly employed in other immunocompromised patients. If patients do not improve rapidly following empiric therapy, I do not recommend additional empiric trials, such as with antiviral therapy. Similarly, immunosuppressed transplant patients who develop esophageal symptoms while already receiving prophylactic antimicrobial therapy, warrant endoscopic examination rather than additional empiric trials or radiological studies. This is particularly true if the patient is...

Idiopathic Esophageal Ulcer

Weekly fluconazole may be helpful to prevent esophageal candidiasis, which may complicate steroid therapy. Prednisone is inexpensive and very well tolerated. We use thalidomide for patients intolerant or refractory to prednisone. Because of its known sedative effect, we start with 200 mg d given at bedtime. The most common side effects are rash and neuropathy. Caution must be exercised and patients must be educated if thalidomide is used, given its horrific teratogenic effects.

Supplemental Reading

Arathoon E, Gotuzzo E, Noriega LM, et al. Randomized, doubleblind, multicenter study of caspofungin versus amphotericin B for treatment of oropharyngeal and esophageal candidiases. Antimicrob Agents Chemother 2002 46 451-7. Barbari G, Barbarini G, Calderon W, et al. Fluconazole versus itraconazole for Candida esophagitis in acquired immunodeficiency syndrome. Gastroenterol 1996 111 1169-77. Blanshard C, Benhamou Y, Dohin E, et al. Treatment of AIDS-associated gastrointestinal cytomegalovirus infection with fos-carnet and ganciclovir a randomized comparison. J Infect Dis 1995 172 622-8. Shafran SD, Singer J, Zarowny DP, et al. A comparision of two regimens for the treatment of Mycobacterium avium complex bacteremia in AIDS rifabutin, ethambutol, and clarithroym-cin versus rifampin, ethambutol, clofazimine, and ciprofloxacin. N Engl J Med 1996 335 377-83. Wilcox CM, Alexander LN, Clark WS, Thompson SE. Fluconazole compared with endoscopy for human immunodeficiency virus-infected...

Characteristics of staff authorised to take responsibility for the supply or administration of medicines under Patient

Clinical condition, inclusion and exclusion criteria for the treatment of genital candidiasis Clinical condition - The PGD is applicable to any patient (male or female) who has been diagnosed with genital candidiasis. Genital candidiasis is a fungal infection and is commonly caused by the species Candida albicans. In women the sites of infection may include the vulva, vagina and the urethra, and in men the most common sites include the glans, prepuce and urethra. Signs and symptoms are variable. Women may complain of a thick white vaginal discharge, pruritus, soreness, erythema, dysuria and dyspareunia. Fissuring may be apparent on the vulva. Men may present with a visible rash on the glans and they may also complain of pruritus and dysuria. Diagnosis is confirmed either clinically, microscopically (by wet and dry slide) or by culture media. Inclusion criteria - symptomatic patients who have had Candida diagnosed clinically and or microscopically, and symptomatic patients who have had...

Submandibular and Sublingual Spaces

A variety of microorganisms has been isolated from cases of Ludwig's angina. In recent years, anaerobic bacteria have predominated, including Fusobacterium spp., AGNB, and Peptostreptococcus spp. Often, one or more of the following also have been found staphylococci, streptococci, pneumococci, E. coli, Vincent's spirochetes, Haemophilus influenzae, and Candida albicans (4). Management includes high doses of parenteral antibiotics, airway monitoring, early intubation or tracheostomy, soft tissue decompression, and surgical drainage (55).

Microbiology and Pathogenesis

The bacteriology of paronychia is polymicrobial aerobic and anaerobic in three-fourth of the cases. The predominant aerobic organisms are S. aureus, Streptococcus spp., Eikenella corrodens, GABHS, Klebsiella pneumoniae, Proteus spp., Pseudomonas aeruginosa, and Candida albicans. The predominant anaerobes are gram-negative bacilli of oral origin (Prevotella and Porphyromonas), Fusobacterium, and Peptostreptococcus spp. BLPB are present in about half of the patients (8).

Why should I take drugs that have side effects

Inflammation of the bladder associated with symptoms of urinary frequency and urgency. Pyelonephritis an acute infection of the kidney associated with fever, contrasting with cystitis (a bladder infection) where fever does not occur. Thrush throat infection by the yeast Candida albicans. It commonly complicates treatment with antibiotics and steroids. Yeast vaginitis a common infection due to the yeast Candida albicans. Systemic infections Although yeast infestation of throat (thrush) and yeast vaginitis are relatively common problems with steroid treatment, they are usually generally easy to manage. Systemic infections are rare, but these can occasionally be very serious. Fungal infections are unusual except accompanying chronic steroid use.

Pathogenesis and Microbiology

Microbiologically, patients suffering from adenoiditis harbor an abnormal NP and oropharyngeal microflora. Typically, this flora is characterized by the persistent presence of two to five bacterial species that are frequently associated with clinical infections of the head and neck GABHS, S. aureus, H. influenzae, Streptococcus pneumoniae, Candida albicans, enteric gramnegative aerobes and AGNB. The viruses often present are adenoviruses and Epstein-Barr virus (85,86). Candida albicans

Pathological Infective Skin Rashes That May Be Seen In Gum Clinics

FUNGAL INFECTIONS Candida infections Candida infections can cause marked skin irritation and oedema. Erythema is commonly present in women and fissuring may occur at the introitus. Though infection is less common in men, mild erythema and balanitis or balanoposthitis may occur, with fissuring of the prepuce.

Specific Infections Vulvovaginitis

In both specific and nonspecific VV, changes occur in the normal vulvovaginal flora that may induce inflammation. The specific organisms that cause infection in the prepubertal female are often respiratory, enteric, or sexually transmitted pathogens. The respiratory pathogens include Group A streptococcus, Streptococcus pneumoniae, Neisseria meningitidis, S. aureus, and Haemophilus influenzae. Other rare pathogens are Shigella (8), Yersinia (9), and Candida (6). The three most common types of VV include nonspecific VV, or VV caused by candida, or trichomonas. Sexually acquired infections include Neisseria gonorrhoeae, G. vaginalis, Trichomonas vaginalis, Chlamydia trachomatis, herpes simplex virus, and Condyloma accuminata.

Oral and oesophageal disease

Oral cavity pain or discomfort are caused by candidiasis, herpetic or aphthous ulceration, periodontal disease, and tumours. Often the diagnosis can be made by simple inspection and appropriate treatment initiated without further investigation. Systemic oral therapy of herpes simplex ulceration and candidiasis is preferred for reasons of efficacy and ease of use. Recurrence is common and if frequent, maintenance therapy may be required rather than the short treatment of each occurrence. Maintenance therapy may be more likely to induce resistance. About one third of patients develop oesophageal disease. The likelihood of candidiasis is so high that a therapeutic trial with a systemic antifungal agent is indicated before considering further investigation. If symptoms fail to respond, or recur despite adequate maintenance therapy, endoscopy is performed to exclude herpes simplex, cytomegalovirus and other causes of oesophageal ulceration including malignant lesions.

Family Medical History

'In your family - that is, your parents, brothers and sisters - are there any health problems that seem to run through the family ' You may prompt with suggestion such as diabetes, hypertension, and skin problems. This gives you information about predisposition, especially with diabetes and skin problems, and helps with differential diagnosis and may be a contributing factor in the reason for the visit, as for example with impotence or recurrent vaginal candidiasis.

Emerging Antigungal Agents 31 Amino acids

B-Amino acids, 2-aminocyclohexenecarboxylic acid and cis-2-amino-cyclohexanecarboxylic acid (cispentacin) were recently identified as novel antifungal agents targeting protein biosynthesis through inhibition of isoleucyl tRNA synthetase. SAR studies of these lead compounds led to the discovery of acid, (PLD-118, icofungipen, 19). Icofungipen showed high antifungal activity against C. albicans in in vitro studies (IC50 0.13 mg ml). A successful outcome from a phase IIb study (started in November 2003) would indicate potential for salvage therapy in the oral treatment of azole-resistant oropharyngeal and esophageal candidiasis. Icofungipen was administrated for 10 days starting 24 h after intravenous inoculation of C. albicans blastoconidia in rabbits. Treatment with icofungipen at 25mg kg day in two divided dosages gave significant tissue clearance of C. albicans 72 .

Diagnosis and Treatment

The etiologic diagnosis of disorders of food intake can be approached using a diagnostic algorithm (Figure 46-1). One should not conclude that anorexia is due to a medication until other possibilities are ruled out, or the patient responds positively to a supervised trial of medication withdrawal. In an AIDS patient with suspected esophageal candidiasis, it is advisable to treat empirically and only examine patients with persisting symptoms (Rabeneck and Laine, 1994). In contrast, all esophageal ulcerations should be investigated by direct examination and biopsy. Oral candidiasis responds to a variety of antifungal therapies including the topical therapies, nystatin and clotrima-zole, and the systemically active azole drugs. Esophageal candidiasis is best treated using systemically active compounds, because the organism is invasive. The infection may

Genital Ulcer Diseases

Herpes simplex virus typically presents as multiple painful vesicles or pustules, which break down to form erosive ulcers. These are generally painful and may coalesce to form larger areas of painful ulceration. True primary episodes are generally more severe than subsequent episodes, and are often associated with systemic symptoms. Many people, however, are unaware they are infected, as they do not experience symptoms. Asymptomatic shedding of Herpes simplex virus has been shown to occur and is probably an important means of trans-mission.An understanding of asymptomatic shedding can facilitate acceptance of what may become a chronic recurring condition. Differential diagnoses include primary syphilis, candidiasis, contact dermatitis and fixed drug reaction.

Onychomycosis and its treatment

Dermatophytoma

Candida onychomycosis Further reading fungi (Table 8.1) include dermatophytes (most frequently Trichophyton rubrum), moulds (Scytalidium spp., Scopulariopsis spp., Fusarium spp., Acremonium spp., Onychocola canadensis) and yeasts (Candida spp.). The skin of the palms and soles is frequently involved, especially in dermatophytic infections with plantar scaling (Figure 8.2). Tinea cruris is common in patients with onychomycosis due to T. rubrum and Epidermophyton floccosum (see Figure 8.7). scraped off (white superficial onychomycosis, WSO). Tinea pedis interdigitalis is frequently associated. Children presenting with WSO may have Candida infection. Total dystrophic onychomycosis (TDO) may rarely occur as a primary condition or, most commonly, represent the secondary evolution of untreated DLSO or PSO. Primary TDO is usually due to Candida and typically affects immunocompromised people, such as patients with chronic mucocutaneous candidiasis or HIV infection. The nail is diffusely...

Surgical Treatment of Infected Aortic Aneurysms

Ruptured Mycotic Aneurysm

The bacteriology of mycotic aortic aneurysms has changed over the years. Although initially the predominant organisms were nonhemolytic Streptococci, Pneu-mococci and Staphylococci, recent reviews since 1965 has suggested that Staphylococcus aureus, Streptococcus and Salmonella are the predominant organisms.3,5 In 1984 Brown3 reported that Staphylococcus aureus and various streptococcal species were found in 37 of infected aneurysms when all types were considered. Gram negative organisms have been reported with increasing frequency. Of particular importance is Salmonella which appears to have a predilection for the arterial wall, particularly when atherosclerotic, and accounts for most cases of microbacterial arteritis. Patients with positive cultures for Salmonella from an infected aneurysm should also have their gallbladder examined as many of them are carriers and thus cholecystectomy should be considered part of the management. Other gram-negative organisms have been reported in...

Kadipiro virus Java7075 KDVJa7075 A

Kaisodi virus (KSOV) An unassigned virus in the family Bunyaviridae, related to Lanjan virus and Silverwater virus. A member of the Kaisodi serogroup. Isolated from ticks and a ground thrush in the Shimoga district of Mysore, India. Not reported to cause disease in humans.

Doripenem Antibiotic [2225

Eberconazole is a new member of the azole class of antifungal agents, and it is indicated for the topical treatment of cutaneous fungal infections, including tinea corporis (ringworm of the body), tinea cruris (ringworm of the groin) and tinea pedis (athlete's foot) infections. Its mode of action is similar to that of other azole antifungals, namely inhibition of fungal lanosterol 14a-demethylase. Eberconazole exhibits good in vitro activity against a wide range of Candida species, including Candida. tropicalis, dermatophytes and Malassezia spp. yeasts. It shows good activity against Candida. Parapsilosis (MIC90 0.125 mg mL), which is a relevant species in skin and nail disorders. In addition, eberconazole is effective against some of the highly triazole-resistant yeasts such as Candida. glabrata and Candida. krusei, as well as fluconazole-resistant Candida. albicans. However, eberconazole is less active than clotrimazole and ketoconazole against Candida. neoformans and a number of...

Biological Properties

Mehrotra et al. (1993) reported the marked antifungal activity of A. dracunculus volatile oil against Candida albicans and Sporotrichum schenkii, while Margina and Zheljazkov (1996) have highlighted the susceptibility of A. dracunculus to the pathogenic rust fungus Puccinia dracunculina.

Fungal Infection With Multimicrobial Colonization

Gross Diabetes Mellitus

Superficial ulcers of 10 days' duration on the facing sides of the left first and second toe of a 70-year-old type 2 diabetic lady with diabetic neuropathy, before debridement are shown in Figures 8.8 and 8.9. Note soaking of the skin. An X-ray excluded osteomyelitis. Staphylococcus coagulase-negative, Pseudomonas aerugi-nosa and enterobacteriaceae were recovered after swab cultures in addition to Candida albicans. She was treated successfully with itraconazole for 5 weeks. The patient used a clear gauze in order to keep her toes apart, together with local hygiene procedures twice daily. Weekly debridement was carried out and no antimicrobial agent was needed.

GI Manifestations in Other Primary Immunodeficiency Diseases

Giardiasis has been reported as a cause of chronic diarrhea, but GI complaints are rare in XLA patients. Patients with SCID often have intractable diarrhea resistant to medical treatment, leading to failure to thrive. Children with SCID also present with oral candidiasis and viral infections, including rotavirus and adenovirus. Intestinal biopsies in SCID patients show villous atrophy and are devoid of lymphocytes. Following bone marrow transplant, SCID patients may develop graft-versus-host disease in the gut leading to diarrhea and wasting (Cunningham-Rundles et al, 1984).

Antimicrobial properties

It is generally recognized that alkaloids have strong antimicrobial, antibacterial and antifungal biological Moreover, some studies have evidenced anti-parasitic activity in this group of compounds392 393. Caron et al.329 have investigated 34 quasi-dimeric indole alkaloids for antimicrobial activity using 8 different test micro-organisms. It was found that all of the studied alkaloids showed activity against Staphylococcus aureus and Bacillus subtilis, which are Gram-positive bacteria. Caron et al.329 found that 31 alkaloids showed biological activity against micro-organisms. The micro-organisms tested by Caron et al.329 were B. subtilis, S. aureus, Mycobacterium smegmatits, Escherichia coli, Pseudomonas aeruginosa, Candida albicans, Aspergilus niger. This study concluded that antimicrobial activity of alkaloids is connected with the stereochemistry of the carbon ring, its aromatic substitution and oxidation329.

Oral and Esophageal Disease

Candidiasis decreases taste sensation and affects swallowing, in addition to causing oral or substernal discomfort. Most cases are due to Candida albicans. Candidiasis in the esophagus and may occur in the presence or absence of thrush. Hairy leukoplakia, a hyperkeratotic lesion found along the sides of the tongue and adjacent gingiva, may be mistaken for Candida, but is asymptomatic. Severe gingivitis or peri-odontitis, infectious or idiopathic ulcers, or mass lesions, such as Kaposi's sarcoma (KS) or lymphoma, occur in the oral cavity and can cause pain or interfere with chewing and swallowing. The esophagus is affected by many of the same lesions as the oral cavity. Overall, studies have demonstrated a decline in the incidence of both oral and esophageal disease in subjects on HAART, with the possible exception of human papilloma virus (HPV)-induced lesions.

Fertility and Disease Activity

Active CD does impair fertility (Khosla et al, 1984). Ileal inflammation can involve the ovaries and fallopian tubes resulting in scarring and obstruction. In addition, recto-vaginal and perianal fistulizing disease may contribute to fear of intimacy, and dyspareunia, and vaginal candidiasis may follow medical therapy. In general, patients with UC and CD should have a quiescent disease interval of at least 3 months prior to conception. The course of IBD during pregnancy usually correlates with disease activity at time of conception. Patients with active disease may continue with symptoms one-third of the time and may actually have worsening of disease. Women with disease quiescence typically remain in remission during the pregnancy. Additionally, the gastroenterologist should be vigilant for possible disease recurrence in the puerperium.

Crohns Disease

Various medications have been reported to cause oral lichenoid (lichen planus-like) drug reactions, including anti-inflammatory and sulfa-containing preparations, which are commonly used to manage IBD patients. Superinfection with Candida albicans may represent a reaction to the bacteriostatic effect of sulfasalazine, a primary manifestation of the disorder, or an impaired ability of neu-trophils to kill this granuloma provoking fungus (Curran et al, 1991). This underscores the sometimes subtle intraoral clinical signs and symptoms of CD that may render a dentist invaluable to the physician working up a patient with previously undiagnosed CD. useful when the lesions are localized and direct topical application is possible. In cases when lesions are disseminated or oropharyngeal in distribution, dexamethasone elixir 0.5 mg 5 mL can be used as a rinse or gargle for 1 minute, 4 times daily and expectorated. The patient must be advised that prolonged use of topical steroids will result in...

Local causes

Toenails Onychomadesis

Are onychogryphosis and, in children, congenital malalignment of the hallux nails. In fungal onycholysis, primary Candida infection is almost exclusively confined to the finger nails. In distal subungual onychomycosis of the toe nails, the horny thickening raises the free edge with secondary disruption of the attachment of the nail plate to the nail bed. The nail bed epithelium is irreversibly transformed into epidermis, thus prohibiting reattachment of the nail. Primary candidal onycholysis is almost exclusively confined to the finger nails. In distal subungual onychomycosis of the toe nails, the horny thickening raises the free edge of the nail with disruption of the normal nail plate-nail bed attachment this gives rise to secondary onycholysis. Some authors have questioned whether great toe nail onychomycosis is ever truly primary. Its presence should always lead to a search for abnormalities of the foot such as hyperkeratosis of the metatarsal heads, thickening of the ball of the...

Genital ulcers

Genital blisters or painful ulcers are most likely to typify Herpes simplex virus. With agreement from the patient, these can be sampled with a cotton-tipped swab and sent in medium to the laboratory for testing and possible typing. A painless solitary ulcer is most likely to typify a syphilitic chancre. Again in agreement with the patient, this should be scraped, and the serum collected on to a plain slide. A cover slip should be placed over the sample and it should be read for spirochetes on a dark-field microscope. Three samples should be taken at the first visit, and the sampling repeated over the next two days. Sero-logical testing for syphilis should also be carried out at the first visit, although dark-field microscopy remains the test that will yield the earliest diagnosis. The tropical sexually transmitted infections, such as chancroid, lymphogranuloma venereum (LGV) and donovanosis are relatively uncommon in the UK, however, are important causes of genital ulcers in some...

Fungal infections

The common fungal infections of the skin are dermatophytosis or ringworm, superficial candidiasis, and Malassezia infections. There are two growth forms of fungi, moulds, and yeasts. Mould fungi produce thread-like hyphae that comprise chains of cells. In dermatophyte fungal infection of the skin, hair, and nails these hyphae invade keratin and are seen on microscopic examination of skin, hair, or nails from infected tissues. Vegetative spores (conidia) develop in culture, and their distinctive shape helps to identify the different species. Skin scrapings or clippings from infected nails can be easily taken and should always be sent to the laboratory for mycological examination and culture in any patient suspected of having a fungal infection. In yeast infections such as those due to candida, the fungal cells are individual and separate after cell division by a process called budding. In systemic, or deep, fungal infections subcutaneous on deep visceral structures are attacked....

Vaginal Examination

NON-SEXUALLY ACQUIRED CONDITIONS Candida albicans Candida albicans can have a watery or lumpy 'cottage cheese' type appearance and a 'yeasty' smell.There is usually intense itching soreness, exacerbated by the itch scratch cycle. In severe cases, this can impact on the activities of living and interfere with sleep. Candida is not a sexually transmitted infection (there is little no benefit to treating asymptomatic partners), but is caused by an overgrowth of yeast organisms found commensally in the vagina. Diabetic and pregnant women are particularly susceptible however, most women will experience at least one episode during their lifetimes.

Chronic Paronychia

Chronic paronychia represents an inflammatory reaction of the proximal nail fold to irritants or allergens. It affects hands that are continually exposed to a wet environment and to multiple microtrauma, favouring cuticle damage. Secondary colonization with Candida albicans and or bacteria occurs in most cases. Patients with chronic paronychia should avoid a wet environment, chronic microtrauma and contact with irritants or allergens. Application of high-potency topical steroids (clobetasol propionate 0.05 ) once a day at bedtime is an effective first-line therapy. If Candida is present a topical imidazole derivative should be applied in the morning. Topical antifungal agents alone and systemic antifungal therapy are not useful. In severe cases, intralesional or even systemic steroids (prednisone 20 mg day) can be used for a few days to obtain a prompt reduction of inflammation and pain. Acute exacerbations of chronic paronychia do not necessitate antibiotic treatment since they...

Gehidyegysvlp

Sequence comparison of galactokinases from different species. (a) The galactokinase reaction. (b) Comparison of a region of human galactokinase (amino acids 35-54 of the 392 amino acid protein). Key Hs - Homo sapiens, Sc - Saccharomyces cerevisiae, Ec - Escherichia coli, Bs - Bacillus subtilis, Ca - Candida albicans, Hi - Haemophilus influenzae, St - Salmonella typhimurium, Kl - Kluyveromyces lactis, At - Arabidopsis thaliana. Amino acids have been coloured according to their properties. Blue indicates positively charged amino acids (H, K, R), red indicates negatively charged residues (D, E), green indicates polar neutral residues (S, T, N, Q), grey indicates non-polar aliphatics (A, V, L, I, M) and purple indicates non-polar aromatic residues (F, Y, W). Brown is used to indicate proline and glycine, while yellow indicates cysteine

Liver Abscess

Amebic liver abscess is most often due to Entamoeba histolytica. Fungal abscesses primarily are due to Candida albicans and occur in individuals with prolonged exposure to antimicrobials, hematologic malignancies, solid-organ transplants, and congenital and acquired immunodeficiency. Abscesses due to Aspergillus spp. have been reported.

Figure 741

Other renal findings in patients with AIDS include infections and tumors. Almost all opportunistic infections seen in patients with AIDS may localize in the kidneys as manifestations of systemic disease. However, rarely are these infections expressed clinically, and often they are found at autopsy. Cytomegalovirus infection is the most common 209 . Referrals to a urologist are reported for renal and perirenal abscesses with uncommon organisms (Candida, Mucor mycosis, Aspergillus, and Nocardia). Nephrocalcinosis can occur in association with pulmonary granulomatosis, Mycobacterium avium-intracellulare infection, or as a manifestation of extrapul-monary pneumocystis infection. Renal tuberculosis is a manifestation of miliary disease. Non-Hodgkin's lymphoma and Kaposi's sarcoma are the most frequently found renal neoplasms in patients with AIDS, usually as a manifestation of disseminated involvement.

Infections

Hepatitis B and C may result from blood transfusions particularly if they were administered prior to 1991, from an infected sexual partner, or, more rarely, from an infected donor. Importantly, previously infected SCT candidates are at higher risk for GVHD and VOD (Strasser and McDonald, 1999). Overt hepatitis may not manifest itself until after engraftment has occurred and immunosup-pressive agents are tapered. Immunosuppression leads to increases in viral load, and sometimes a significant hepatitis occurs when the immunosuppressive agents are withdrawn. On occasion, a fulminant hepatitis may result. Pre-SCT treatment of hepatitis C is often not feasible because effective therapy with pegylated interferon and rib-avirin usually requires 12 months of therapy. Furthermore, a complication of interferon therapy is bone marrow suppression. Strasser and McDonald (1999) suggested that therapy be attempted once patients are off immunosup-pressive medications for at least 6 months. Infections...

Microbiology

Yeast and fungi predominate in immunocompromised patients and those with cancer. These include Aspergillus spp., Candida spp., Cryptococcus neoformans, Coccidioides immitis, and the mucormycosis agents (10-13). Protozoa and helminths may also cause brain abscess. These include Entamoeba histolytica, Cysticerosis, Schistosoma japonicum, and Parogonimus spp. (14) Patients with T-lymphocyte defects and those with acquired immune deficiency syndrome (AIDS) are susceptible to Toxoplasma gondii, Nocardia asteroides, Mycobacterium spp., Listeria monocytogenes, Enterobacteriaceae, and Pseudomonas aeruginosa (15).

Allylamines

Allylamines are antifungal agents targeted to squalene epoxidase, an enzyme necessary for ergosterol biosynthesis. Naftifine (12) was the first allylamine agent introduced in therapy in the early 1980s as 1 cream or gel for topical use. It has fungicidal activity against dermatophytes and fungistatic activity against Candida species. Its sensitizing capacity seems to be greater than in the commonly used azoles 58 . Terbinafine (13) was approved in 1990s in the UK and USA for the treatment of onychomycosis. It is the most frequently prescribed oral antifungal agent in North America, for onychomycosis. Eighteen randomized controlled trials have shown terbinafine to be highly effective with mycological cure of 76 . 13 has an established safety profile and very low occurrence of drug interactions 59 . An improved antifungal composition for topical application to the skin and nails has been developed for allylamines (naftifine or terbinafine) 60 . A formulation to provide a product having...

Miscellaneous

The novel benzothiazole derivative FTR1335 (22) was reported as potent antifungal agent against C. albicans isolates including fluconazole-resistant strains, and C. tropicalis. MICs were from 0.39 to 3.13 mM. Data reported in tests against C. albicans ATCC suggested that the antifungal activity of FTR1335 against this strain was fungicidal 76,77 . FTR1335 and related derivatives were proven to inhibit the C. albicans N-myristoyltransferase that catalyzes the transfer of the fatty acid myristate from myristoyl-CoA to the amino (N)-terminal glycine residue of a number of eukaryotic cellular proteins. Interesting antifungal activity was reported for some pyrrolo 1,2-a 1,4 benzodiazepine derivatives. Among them, compound 23 showed high antifungal activity in vitro against A. fumigatus and C. parapsilosis, but not against other Candida spp. After treatment with a 300 nM solution of 23 a strong accumulation of squalene was revealed, suggesting that squalene epoxidase is the biochemical...

Human Bites

Talan et al. (2) conducted a multicenter prospective study of 50 patients with infected human bites. Fifty-six percent of injuries were clenched-fist injuries and 44 were occlusional bites. The median number of isolates per wound culture was 4 (3 aerobes and 1 anaerobe) aerobes and anaerobes were isolated from 54 of wounds, aerobes alone were isolated from 44 , and anaerobes alone were isolated from 2 . Isolates included Streptococcus anginosus (52 ), S. aureus (30 ), E. corrodens (30 ), F. nucleatum (32 ), and Prevotella melaninogenica (22 ). Candida spp. were found in 8 . Fusobacterium, Peptostreptococcus, and Candida spp. were

Infection

Infections with both bacteria and fungi are frequent with FHF, occurring in as many as 80 of patients in some studies. Defects in immunological defenses, including complement deficiency and leukocyte dysfunction, and the presence of venous, arterial, and bladder catheters, as well as an ICP monitor, probably all contribute to the high incidence of infection. Bacterial infections, typically of the lungs, urinary tract, or blood, usually occur with in the first 3 days of admission and are most often due to Staphylococcus aureus, Staphylococcus epidermidis, or enteric gram-negative rods (eg, Escherichia coli). Diagnosis requires frequent surveillance cultures because the usual signs of infection, such as fever and leukocy-tosis, may be absent. Controversy surrounds the issue of empiric antibiotics. At UCSF we typically begin enteric antibacterial and antifungal prophylaxis, perform surveillance cultures of blood, urine and sputum on a daily basis, and initiate parenteral antibiotics for...

Female circumcision

Once the speculum is in place, careful observation should be made of the vagina and cervix. A sample may be taken from the lateral vaginal walls for Candida and bacterial vaginosis using either a cotton-tipped or a loop swab. To ensure a good sample, a scraping action to the actual walls of the vagina is used (as opposed to just collecting vaginal discharge). The sample is then applied thinly to a plain slide, in preparation for Gram stain and microscopy. The same sample may also be used to culture for Candida, for example, using the Saboraud medium. A gentle sweeping action should be used to ensure that the agar remains intact. Using the same type of swab a sample is taken from the posterior fornix (at the top of the vagina, underneath the cervix) for Trichomonas vaginalis. A sweeping motion from side to side is used. Once the sample has been obtained the swab is gently agitated into a few drops of normal (0.9 ) saline on a plain slide and a cover slip is then applied.This 'wet prep'...

Herpes Simplex Virus

Linear esophageal ulcers caused by herpes simplex virus (HSV) and Candida. Infection with HSV-1 and -2 leads to stomatitis and esophagitis post-transplantation without acyclovir prophylaxis. Additionally, paronychia, corneal ulcers, encephalitis, genital lesions, disseminated involvement of the gastrointestinal tract, pancreas, and liver, and interstitial nephritis has been seen. HSV-6 causes exanthem subitum in children, mononucleosis, and hepatitis. There has been some evidence that reactivation infections may be associated with rejection in transplant recipients. Both reactivation and reinfection may occur. HSV-8 is associated with Kaposi's sarcoma. Prevention of these infections has been achieved using prophylactic acyclovir following transplantation. If clinical symptoms occur from HSV, they usually are treated with acyclovir adjusted for renal function.

Prophylaxis

HIV positive patients, including those receiving HAART should receive primary prophylaxis against P. carinii pneumonia if they have a CD4 count < 200 cells l or a history of oral pharyngeal candidiasis or if they have a CD4 lymphocyte count < 14 of total lymphocyte count, or if they have other AIDS-defining diagnoses, for example Kaposi's sarcoma, regardless of CD4 count. If close monitoring of CD4 counts (at least every three months) is not feasible then prophylaxis should be considered for patients with CD4 counts between 200 and 250 cells ul. Secondary prophylaxis is given to all HIV-infected patients after an episode of P. carinii pneumonia, regardless of CD4 count.

Figure 632

Hallmark of certain forms of tubulointerstitial disease. The best-known form is that of sarcoidosis. Interstitial granulomatous reactions also have been noted in renal tuberculosis, xanthogranulomatous pyelonephritis, renal malacoplakia, Wegener's granulo-matosis, renal candidiasis, heroin abuse, hyperoxaluria after jejunoileal bypass surgery, and an idiopathic form in association with anterior uveitis.

Selenium

Selenium (Se) is required for the activity of the enzyme glutathione peroxidase, and selenium deficiency may be associated with myopathy, cardiomyopathy and immune dysfunction including oral candidiasis, impaired phagocytic function and decreased CD4 T-cell counts. When a host is malnourished, the immune system is compromised and there is an increased susceptibility to viral infections. Research published points about the importance ofhost nutrition during a viral disease, not only from the perspective of the host, but from the perspective of the viral pathogen as well. When a benign strain of coxsackievirus B3 is injected into Selenium (Se)-deficient or vitamin E-deficient mice, it evolves to become virulent. Studies have shown that in addition to immunosuppression due to micronutrient deficiency, the virus itselfbecomes altered 43 , Beck et al. have shown in a mouse model of coxsackievirus-induced myocarditis, that host deficiency in either selenium or vitamin E leads to a change in...

Drug Resistance

Resistance to fluconazole due to target modifications and or efflux has also been shown to be significant in vivo using pharmacodynamic modeling. Sorensen et al. studied several strains of C. albicans with over a 2000-fold range in MIC in a mouse model of disseminated candidiasis. The reduction in counts in kidneys at 24 h following fluconazole was found to be described by the AUC MIC ratio for all doses and strains tested 44 , suggesting that elevated fluconzole MICs due to target or efflux-based mechanisms correspond to similar levels of reduced activity in vivo.

Denture hygiene

This patient had a drug induced dry mouth, which resulted in poor oral hygiene, halitosis, and oral candidosis the oral symptoms led to low mood, while the halitosis led to limited physical contact between the patient and her family This patient had a drug induced dry mouth, which resulted in poor oral hygiene, halitosis, and oral candidosis the oral symptoms led to low mood, while the halitosis led to limited physical contact between the patient and her family

Diaper Dermatitis

Monilial Dermatitis

Typical candidal diaper dermatitis. Note the symmetric distribution of the rash with involvement of the intertriginous areas. Satellite lesions are often present. The skin is erythematous, swollen and slightly scaly. With healing, areas of depigmentation may occur. This should be differentiated from an ammoniacal diaper dermatitis where the rash is generally asymmetric, the intertriginous areas are spared, and satellite lesions are absent as it is a contact dermatitis. Figure 2.152. Typical candidal diaper dermatitis. Note the symmetric distribution of the rash with involvement of the intertriginous areas. Satellite lesions are often present. The skin is erythematous, swollen and slightly scaly. With healing, areas of depigmentation may occur. This should be differentiated from an ammoniacal diaper dermatitis where the rash is generally asymmetric, the intertriginous areas are spared, and satellite lesions are absent as it is a contact dermatitis. Figure 2.153. An infant...

Dry mouth xerostomia

Xerostomia is associated with several other oral symptoms and problems, including oral discomfort, disturbance in taste, difficulty chewing, difficulty swallowing, difficulty speaking, difficulty in retaining dentures, dental caries, oral candidosis, and other oral infections. The various manifestations of xerostomia reflect the multiple functions of saliva. Acidic products are relatively contraindicated in dentate patients and should be used with caution in edentulous patients. A low pH predisposes to dental erosion, dental caries, and oral candidosis. It should be noted that some of the artificial salivas are acidic in nature.

Azoles

Imidazole derivatives, such as bifonazole, clotrimazole, econazole and micon-azole were the first group of azole antifungal agents used in clinical practice in the 1970s. Recently, derivatives (such as compound 1) related to bifonazole were reported, which showed potent antifungal activities both in vitro and in vivo experiments against Candida albicans and other Candida species. Interestingly, some derivatives were proven active in vitro against fluconazole resistant strains, with MIC50 ranging from 0.016 to 0.25 mg ml 15-18 . Ketoconazole (2), a phenethylimidazole characterized by a dioxolane ring, was the first agent endowed with a wide spectrum of activity against both a variety of yeasts and dimorphic fungi. Further, 2 showed good bioavail-ability after oral administration and was used against serious invasive fungal infections. The clinical use of ketoconazole has been related to some adverse effects in healthy adults, especially local reactions, such as severe irritation,...

Figure 540

Candidal paronychia, usually in association with oral candidiasis, may arise as a result of chronic maceration due to thumb sucking (Figure 5.41). Chronic paronychia is not uncommon in children. It differs from the condition seen in adults in the source of the maceration, associated diseases, the clinical appearances of the lesion, and the patient's responses to the symptoms. In children the lesions are generally prominent, with total involvement of the proximal nail fold. The skin is usually erythematous and glistening owing to the wet environment produced by continuous thumb sucking. The quality of the nail is always altered, resulting in a poor texture. The habit of sucking fingers or thumbs is the most important predisposing factor. Candida albicans is present in all cases. When an acute flare-up occurs the patient experiences pruritus and discomfort in the proximal nail fold. Children respond to this by sucking the symptoms of chronic paronychia perpetuating the habit that...

Pyrimidines

5-Fucitosine (5-FC, 18) is a synthetic antifungal agent synthesized in 1957. In vivo it is converted into 5-fluorouracil (5-FU) within susceptible fungal cells, which is transformed into 5-fluorouridine triphosphate (FUTP). FUTP is incorporated into fungal RNA in place of uridylic acid. This alters the aminoacylation of tRNA, disturbs the amino acid pool and inhibits protein biosynthesis. A second mechanism of action is involved in the antifungal activity of 5-FC. 5-FU is metabolized into 5-fluorodeoxyuridine monophosphate, which is a potent inhibitor of thymidylate synthetase, a key enzyme in the biosynthesis of DNA. 5-FC monotherapy is used in cases of chromoblastomycosis and in uncomplicated lower tract candidosis and vaginal candidosis. In all other cases for treatment of systemic mycoses, 5-FC is usually used in combination therapy with amphotericin B. Efficacy of 5-FC mono-therapy was recently reported in a neutropenic murine model of invasive aspergillosis. Survival rates of...

Esophageal Symptoms

Gastroesophageal reflux, dysphagia, and odynophagia are common complaints in the SCT patient. Severe mucositis extending down into the esophagus is common in patients receiving methotrexate for GVHD prophylaxis, and is usually treated with narcotics and TPN until it resolves. If given before initiation of the preparative regimen, sulcralfate 1 g given as an elixir 4 times a day may decrease the incidence of mucositis (Castagna et al, 2001). Dysphagia and odynophagia may result from infectious esophagitis and or acute GVHD. Upper endoscopy should be pursued to rule out infectious esophagitis caused by herpes simplex versus, CMV, or candida. The absence of oral candidiasis should not exclude an evaluation of the esophagus for candida esophagitis. Reflux symptoms are exacerbated in those patients who develop gastroparesis, and therefore gastric acid antisecretory therapy should be instituted.

Sordarins

Sordarins are a novel class of antifungal agents that act by selectively inhibiting the protein synthesis elongation step of fungi. They interact with translation elongation factor 2 of fungi and large ribosomal subunit stalk rpP0. This multiple mechanism may explain the high degree of selectivity of this class of compounds between fungal and mammalian cells 73 . Sordarins exhibit potent antifungal activities with relatively broad-spectrum activities in vitro and some compounds exhibit good efficacy in vivo. Chemical modification of the natural sordarin zofimarin, which was isolated from the fungus Zopfiella marina, led to R-135853 (20). This compound exhibited potent activities against C. albicans including fluconazole-resistant strains, C. glabrata, C. guilliermondii and C. neoformans. It was highly absorbed by oral administration in mice and exhibited good efficacy in eradicating C. albicans from the esophagi of mice when it was administrated at 50mg kg 74 . A novel sordarin...

Mouth problems

Hairy oral leukoplakia Dental abscesses caries Gingivitis Candidiasis Ulceration Bacterial Herpetic Aphthous Other common dermatoses that respond to antifungal creams (for example Clotrimazole) include tinea cruris and pedis and candidiasis. Folliculitis often responds to 1 hydrocortisone and antifungal cream, impetigo to antibiotics and shingles to aciclovir, valaciclovir or famciclovir. Recurrent perianal or genital herpes may become more troublesome, with recurrences lasting longer and occurring more frequently if this persists for more than 3 months it is considered an AIDS-defining opportunistic infection (Group IVC1). Treatment with long-term acyclovir, valaciclovir or famciclovir suppression is often required. Genital and perianal warts are common, difficult to treat and frequently recurrent, and high-grade cervical dysplasia is seen more often in HIV-infected women. Mouth problems are also common, cause considerable distress and when severe may result in difficulty with eating...

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