YEAST INFECTIONS

recep — Mon, 20 Apr 2009 09:46:45 +0000

YEAST INFECTIONS
Candidiasis
An infection caused by the yeast Candida albicans, which thrives in warm, moist areas such as the groin, the axilla, and the submammary region. Diabetic and immunosuppressed patients, as well as those receiving systemic antibiotic therapy, are at increased risk. The organism may be carried asymptomatically in the bowel, mouth, and vagina, causing treated sites to become reinfected.
Candidal vulvovaginitis is manifested by pruritus vulvae, vulvar erythema and edema, and a creamy vaginal discharge. Patients with these signs should be tested for glycosuria because diabetes strongly predisposes patients to candidal infections.
Oral candidiasis (thrush) is characterized by creamy white plaques on the tongue or buccal mucosa, which can be easily scraped off.
Perleche (angular cheilitis) is a mixed bacterial and candidal infection of the corners of the mouth. The skin appears moist, cracked, and fissured. Predisposing factors include deep folds at the corners of the mouth, poorly fitting dentures, and retention of saliva and food particles in the affected areas.
Treatment: For vulvitis, miconazole 2% or clotrimazole 1% cream can be applied tid. For vulvovaginitis, a 100-mg clotrimazole vaginal insert can be applied once a day for 7 days. Nystatin vaginal suppositories can also be used (2 tablets of 100,000 u. each inserted high into the vagina every night for 14 nights). Nystatin cream should then be applied to the labia, perineum, and perineal area, after which the hands should be washed thoroughly.
For oral candidiasis or perleche, either nystatin or amphotericin B, available as mouthwashes and lozenges, can be used qid. Dentures should be soaked in nystatin suspension because they are invariably contaminated with C. albicans. Miconazole 2% or nystatin cream tid for 1 wk usually produces rapid improvement.
Intertrigo
A dermatitis, usually caused by maceration and exposure to irritants, occurring between two folds of skin—eg, between the buttocks, the thighs, or the scrotum and the thigh. Intertrigo often appears as moist, red, and sometimes scaly and pruritic areas in the flexures. Intense itching or soreness may develop from the groin to the perineum, in the inner thighs, and in the intergluteal cleft. Contributing factors include obesity, poor personal hygiene, and clothing made of synthetic fabrics that do not breathe.
Intertrigo may mimic or coexist with a candidal superinfection. Candida often produces so-called satellite lesions—small vesicles at the periphery of the lesion. Examination of a scraping prepared with KOH solution may reveal the characteristic budding yeasts and pseudohyphae.
Treatment: Affected areas should be kept as dry as possible. Topical antifungal creams (eg, clotrimazole 1% or miconazole 2%) should be applied tid if Candida is suspected. Nystatin cream, another anti-candidal agent, is not effective against dermatophytes and therefore should be used only when there is no suspicion of tinea infection. If inflammation is severe, a low-potency, topical corticosteroid cream (eg, hydrocortisone 1%) can be applied tid. Some available commercial preparations combine an antifungal agent and a topical corticosteroid cream, such as clotrimazole and betamethasone diproprionate cream.

health articles » YEAST INFECTIONS

YEAST INFECTIONS