Fungal Infections

The dermatophytes most often encountered in tinea cruris are E. floccosum and T. rubrum. Maceration and occlusion of the skin in the groin give rise to warm moist conditions that favour the development of the infection. Tinea cruris is a common form of dermatophytosis.

Tinea corporis is caused by E. floccosum and many species of Trichophyton and Microsporum. Infection with anthropophilic species, such as E. floccosum or T. rubrum often follows autoinoculation from another infected body site, such as the feet. Tinea corporis caused by T. tonsurans is sometimes seen in children with tinea capitis and their close contacts. Tinea corporis commonly occurs following contact with infected household pets or farm animals, but occasional cases result from contact with wild mammals or contaminated soil.

The condition is worldwide in distribution, but is most prevalent in Africa, Asia and southern and eastern Europe, where it is the most common form of dermatophytosis. Improved standards of hygiene and prompt eradication of sporadic infection have led to a marked decline in the incidence of tinea capitis in North America and western Europe.

Pulmonary fungal infection endemic to the Southwest USA. Can become progressive and involve extrapulmonary sites, including bone, CNS, and skin. Known as the “great imitator.” Incubation period is 1 to 4 weeks after exposure.

A mucocutaneous disorder caused by infection with various species of Candida. Candida is normally present, in very small amounts, in the oral cavity, gastrointestinal tract, and female genital tract. Genetics: Chronic mucocutaneous candidiasis is a heterogeneous clinical syndrome that usually presents in childhood and can have an autosomal recessive, dominant or sporadic mode of inheritance. Sera from HIV-infected patients with thrush have been screened for C. albicans genomic expression.

Candida albicans and related species cause a variety of infections. Cutaneous candidiasis syndromes include erosio interdigitalis blastomycetica, folliculitis, balanitis, intertrigo paronychia, onychomycosis, diaper rash, perianal candidiasis, and the syndromes of chronic mucocutaneous candidiasis. Mucous membrane infections include oral candidiasis (thrush), esophagitis, and vaginitis.

Systemic mycoses, such as histoplasmosis, coccidioidomycosis, cryptococcosis, blastomycosis, paracoccidioidomycosis, and sporotrichosis, are caused by primary or “pathogenic” fungi that can cause disease in both healthy and immunocompromised individuals. In contrast, mycoses caused by opportunistic fungi such as Candida albicans, Aspergillus spp., Trichosporon, Torulopsis (Candida) glabrata, Fusarium, Alternaria, and Mucor are generally found only in the immunocompromised host.

bItraconazole plasma concentrations should be measured during the second week of therapy to ensure that detectable concentrations have been achieved. If the concentration is below 1 mcg/mL, the dose may be insufficient or drug interactions may be impairing absorption or accelerating metabolism, requiring a change in dosage. If plasma concentrations are greater than 10 mcg/mL, the dosage may be reduced.