Updated: 10/4/2016

Fungal Infections

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Introduction
Classification
  • Infections divided into three categories
    • cutaneous
      • includes nail bed infections (onychomycosis)
    • subcutaneous
      • includes sporothrix schenckii from rose thorn prick
    • deep
      • orthopaedic manifestation
        • tenosynovial
        • septic arthritis
        • osteomyelitis
      • organisms include
        • endemic
          • coccidiomycosis
          • histoplasmosis
          • blastomycosis
        • opportunistic include
          • candidiasis
          • mucormycosis
          • cryptococcocis
          • asperfillosisi
      • requires surgical debridement
Onychomycosis
  • Introduction
    • defined as fungal infection in vicinity of nail bed (cutaneous)
    • most common organisms are
      • trichophyton rubrum
        • a destructive nail plate infection
      • candida
        • chronic infection of nail fold
  • Treatment
    • topic antifungal treatment & nail plate removal
      • indications
        •  first line of treatment
    • systemic griseofulvin or ketoconazole
      • indications
        •  recalcitrant cases
Sporothrix schenckii
  • Introduction
    • Sporothrix schenckii a common soil organism
    • a subcutaneous infection
    • rose thorn in classic mechanism of subcutaneous transmission
  • Presentation 
    • physical exam
      • will show local ulceration (papule) at site of penetration  
      • with time additional lesions form in region on lymphatic vessels 
      • may show proximal lymph node involvement
  • Evaluation
    • S schenckii isolated at room temperature on Sabouraud dextrose agar
  • Treatment
    • oral itraconazole for 3 to 6 months
      • indications
        • mainstay of treatment
      • has replaced potassium iodide due to side effects which included
        • thyroid dysfunction
        • rash
        • GI symptoms
Coccidiomycosis
  • Introduction
    • found in southwest arid regions (e.g., new mexico)
    • often a deep infection
  • Presentation
    • manifestations include
      • subclinical pulmonary involvement
      • orthopaedic manifestations
        • synovitis
        • arthritis
        • periarticular osteomyelitis
  • Treatment
    • amphotericin B & surgical debridement
Histoplasmosis
  • Introduction
    • histoplasma capsulatum infection
    • found in Mississippi River Valleys and Ohio
  • Presentation
    • usually subclinical
    • often found incidentally on CXR
    • may present with tenosynovial infection
  • Evaluation
    • diagnosed by skin testing
  • Treatment
    • amphotericin B & surgical debridement / tenosynovectomy
 

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