Fungal Infections

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Candidiasis                                             ICD10 CODE: B37Fungal infection usually confined to the mucous membranes and external layers of skin. Severe forms are usually associated with immunosuppressive conditions, such as HIV/AIDS, diabetes, pregnancy, cancer, prolonged antibiotic use, and steroids.

Causes

  • Candida albicans, transmitted by direct contact

Clinical features

It may present as:

  • Oral thrush
  • Intertrigo (between skin folds)
  • Vulvo vaginitis and abnormal vaginal discharge (vaginal candida is not a sexually transmitted disease)
  • Chronic paronychia (inflammation involving the proximal and lateral fingernail folds)
  • Gastrointestinal candidiasis may present with pain on swallowing, vomiting, diarrhoea, epigastric and retrosternal pain

Investigations

  • Diagnosis is mainly clinical
  • In case of vaginitis, sample collection –a high vaginal swab (protected by a speculum), pH, KOH , wet preparation and Gram stain, C&S
  • Smear examination with potassium hydroxide (KOH)

Management

Treatment LOC

Oral candidiasis

  • Nystatin tablets 500,000-1,000,000 IU every 6 hours for 10 days (chewed then swallowed)
    • Child < 5 years: Nystatin oral suspension 100,000 IU every 6 hours for 10 days
    • Child 5-12 years: Nystatin oral suspension 200,000 IU per dose every 6 hours for 10 days

HC3

HC2

Oropharyngeal candidiasis

  • Fluconazole  150-200mg daily for 14 days
    • Child: loading dose 6 mg/kg, then 3 mg/kg daily 
 HC3

Vaginal

  • Insert clotrimazole pessary 100 mg high into the vagina with an applicator each night for 6 days or twice a day for 3 days
  • Or insert one nystatin pessary 100,000 IU each night for 10 days
  • For recurrent vaginal candidiasis, give fluconazole 150-200 mg once daily for 5 days

Note: Fluconazole is associated with spontaneous abortions and congenital anomalies and should be avoided in pregnancy

 HC2

Chronic paronychia

  • Keep hand dry and wear gloves for wet work
  • Hydrocortisone cream twice daily

If not responding

  • Betametasone cream twice daily
  • Fluconazole 150-200 mg once a day for 5-7 days

HC3

HC4

Intertrigo

  • Clotrimazole cream twice a day for 2-4 weeks
  • In severe forms use fluconazole 150-200 mg once a day for 14-21 days
 HC3

Prevention

  • Early detection and treatment
  • Improve personal hygiene
  • Avoid unnecessary antibiotics