Candidiasis. Symptoms and Treatment

Dr. Hooman-Khorasani
Posted in Uncategorized

A fungal viral disease that affects the mucous membrane of the mouth or genitals is called thrush or candidiasis. Usually the symptom and sign of the disease is a visible white cheesy coating on the surface of the mucous membrane. This disease is a viral infection.

The causative agents of the disease – Candida fungi – themselves are not dangerous to health. Their appearance indicates a weakening of immunity and a violation of hormonal levels. Fungi are a harbinger of serious diseases such as diabetes or gastritis and duodenitis. Most often, this disease occurs in women. In newborn babies, candidiasis is often transmitted from the mother through breastfeeding. They suffer from the oral form of the disease. In men, thrush is much less common.

Thrush can appear after treating viral diseases with antibiotics and after using birth control pills. Candidiasis can develop from wearing uncomfortable synthetic underwear or from improper diet. Sweet and spicy foods, dietary supplements contribute to the appearance of fungus. Candidiasis indicates the presence of an acute viral infection in the body.

Often, thrush in men and women causes unpleasant discomfort, pain during intimacy, itching, and irritation. It is also transmitted in everyday life.

At the first symptoms of the disease, you should immediately consult a doctor in order to conduct the necessary studies of the secretions in the laboratory and prescribe the correct treatment.

You can get rid of thrush today quickly and easily. There are special pharmaceutical preparations for this. Their choice is huge. At the same time, one should not forget about the side effects of such treatment. All antifungal medications are not safe. There are vaginal and oral gels. Even gentle drugs have side effects. Their use kills thrush and at the same time violates the microflora. The body loses its defenses. After treatment with medications, serious digestive problems often appear, and dysbiosis develops. Sparing home treatments that do not have severe side effects will help get rid of these problems.

Alternative home treatment

In the treatment of thrush in young children, ordinary soda helps well. This is the easiest and most affordable way. It is recommended to treat the affected areas of the oral mucosa with this solution several times a day. For this, a tablespoon of soda is diluted in a glass of water. At the same time, to strengthen the immune system, you need to take orally a tablespoon of chamomile or mint decoction. It is good to use thyme and calendula for these purposes. A teaspoon of raw materials is poured with a glass of boiling water, after which it is imperative to insist in the heat for several hours. Take a tablespoon of broth before meals. Alcohol tinctures and alcohol, even in small dosages, are contraindicated in the treatment of this disease. They can harm a small child.

To eliminate the vaginal form of candidiasis in women, douching is done with soda solution and herbal decoctions twice a day. The course of such treatment is 10 days. In this case, you should not use soap, gels and other products that contain alcohol and alkali.

A very good effect and a positive result is given by an ointment made of honey and water in equal proportions. Apply it to the affected areas three times a day.

In men, thrush can lead to impotence. The most effective for them are special medications.

Symptoms and treatment of fungus in the ears in humans

Dr. Hooman-Khorasani
Posted in Uncategorized

The ear, like other ENT organs, can be affected by otomycosis , an infectious disease caused by various types of fungi. This is a rather dangerous and frequent disease that does not respond very well to treatment. But with the correct identification of the pathogen, the treatment gives an excellent result.

How to identify a fungal infection of the ear

A certain amount of fungi is always present on human skin. With a weakening of immunity, the disease begins to progress, fungi begin to multiply at an unprecedented rate. They primarily affect the eardrum and the auditory canal. Rarely observed otomycosis directly in both ears, usually affects only one.

Symptoms of the lesion depend on the stage of the disease itself.

  • In the first stage, symptoms are mild or do not appear at all. Usually, patients experience itching and a slight congestion in the ear, mistaking this for discomfort caused by the accumulation of sulfur. Then the itching becomes permanent, pain and burning appear.
  • A characteristic symptom of the acute stage is the presence of discharge from the ear canal. Highlights can be white, green, yellow. They clog the ear canal, which is why the patient has ear congestion and hearing loss. Puffiness appears.
  • The chronic stage is characterized by the presence of sulfur plugs with a hard crust. In the chronic course of the disease, the fungus can penetrate deeply into the human body, affecting the temporal bone, which can provoke osteitis of the base of the skull.

Diagnosis and treatment of ear fungus

To detect the disease, an external examination is carried out, the discharge from the ears is examined. Ear culture is the main method for detecting fungal spores.

For effective treatment of otomycosis, it is necessary to eliminate the root cause of the disease. This could be:

  • Taking medicines
  • The use of hormonal drugs.
  • Decreased immunity against the background of other diseases.

Otomycosis is difficult to treat, as the fungus has the ability to “get used” to the drug. During treatment, it is necessary to carefully monitor the hygiene of the auditory canal, clean the outer ear with 3% boric acid or hydrogen peroxide. It is very important to do this in order to clear the ear of mycotic masses, otherwise the treatment will be ineffective.

In accordance with the type of pathogen, funds are selected. Found fungus in the ears is treated with the following types of drugs:  

  • Drops . Usually doctors prescribe “Dexamethasone” and ” Clotrimazole “
  • Ointments and creams . This agent lubricates the outer area of ​​the auditory canal after washing with peroxide or boric acid. Ointment ” Clotrimazole ” and ” Econazole ” are often prescribed .
  • Pills . Most often these are broad-spectrum antifungal drugs.

The course of treatment must be comprehensive. The therapy lasts about two weeks, after which antifungal drugs should be taken for some time.

You should not treat a fungal infection of the ear on your own. Since without identifying the type of pathogen, treatment can only suppress the multiplication of the infection, but not eliminate it completely.

Diagnostics, treatment and prevention of microsporia

Dr. Hooman-Khorasani
Posted in Uncategorized

Microsporia (aka ringworm) is a dangerous disease of the skin of all parts of the body. This disease can be present in both humans and animals. It is dangerous in that it affects the skin and nails, and when it reaches the head it can cause hair loss.

Methods of transmission of the disease and its causes

Usually microsporia is transmitted to humans from pets, but methods of infection from a person suffering from this disease are also not excluded.
Also, the causes of the disease can be:

  • Childhood
  • Lowered immunity, lack of vitamins, malfunctioning of some glands
  • Violation of the skin, micro injuries of the skin
  • Neurovascular disorders

Symptoms and Diagnosis

Signs of microsporia in humans are:

  • Round spots of different diameters on different areas of the skin (the more there are, the more tissue damage is)
  • The lesions are covered with small scales, the crust is formed mainly in the center of the spot
  • Over time, the edge of the stain rises slightly, forming a ridge consisting of crust and bubbles
  • A new focus may form inside the spot
  • Moderate itching
  • When a hair is infected, a well-visible white “muff” forms around it, the hair falls out, the remnants of their roots are easily pulled out.

The main types of diagnostics of microsporia are:

• Research for the presence of microsporia (scraping) – the crust and scales taken from the foci of the infected are examined in a chemical laboratory, after which the patient is given a test result, and a specific type of fungus is established. 

• Luminescent method – this method determines the presence of the causative agent of the disease, the area of ​​skin lesions and the effectiveness of the drugs used for treatment. 

• Blood and urine analysis – checking blood and urine for the presence of non-standard elements. 

Treatment and prevention

To treat skin microsporia, antifungal drugs and pills prescribed by a doctor are used. In the morning, the spots are smeared with 5% iodine, by the end of the day they are smeared with an ointment against the fungus (sulfuric, sulfur-salicylic, sulfur-tar ointments are used). In addition, the patient uses other modern ointments twice a day to help cope with the fungus. In the presence of an infection, the patient, in addition to the above drugs, also uses Triderm ointment. With exacerbated forms of microsporia, the patient uses Dimexide-containing ointments (applied twice a day).

In case of damage to the scalp, it is necessary to carry out systemic antifungal therapy directed against microsporia, the patient is prescribed Griseofulvin. Patients take this drug three to four times a day with food, washed down with a teaspoon of vegetable oil (used to increase the level of drug solubility in the body). After the first negative test result for the presence of a fungus, its dose is gradually reduced, but they continue to be taken for some time for prevention.

A measure of disease prevention is its timely detection. The patient’s belongings must be disinfected; it is worth observing enhanced control of the cleanliness and sterility of the room in which the patient is located. People who come into contact with the sick must be tested. Animals suspected of having ringworm should be taken to a veterinarian.

Eczema on hands

Dr. Hooman-Khorasani
Posted in Uncategorized

Eczema of the hands is an inflammatory lesion of the skin, accompanied by rashes, abscesses, peeling and weeping erosive formations. The patient feels itching and burning in the affected area. This disease is not life-threatening, not contagious, but it brings a person moral and physical discomfort. Urgent treatment required. In advanced cases, treatment is long-term and not always effective.
The exact reasons are not fully determined, but doctors suggest some of their types:

  • Contact with dyes, flavors
  • Wearing rings, watches, bracelets that are made of alloys
  • Taking analgin, paracetamol and aspirin
  • Vaccination
  • Fungal, bacterial infections, helminths
  • Insect bites
  • Abuse of artificial products
  • Allergen products
  • Stress and neuroses
  • Diseases of the kidneys, liver, stomach and intestines
  • Hormonal disorders
  • Diabetes.

The skin of the hands is subject to various eczema: true, microbial and professional. It also happens to be wet and dry. The top layer of the hands, fingers, spaces between the fingers becomes red and swollen. Vesicles, abscesses, erosions with discharge, merging of separate erosions into one, severe itching and burning appear.

Weeping eczema is characterized by classic symptoms, while dry eczema is manifested by the formation of cracks. The disease is complicated by stratified infections that lead to suppuration. This always reflects badly on a person’s well-being – the temperature rises.

Treatment should be done only under the supervision of a doctor using complex methods. External use of lotions, ointments and creams will not give a positive result. First of all, it is necessary to normalize the daily routine, rest more, follow a diet excluding allergenic foods.

The patient should take antihistamines, use external use – glucocorticosteroid ointments to relieve inflammation. In addition, preparations should be used to relieve irritation and soften the skin. For secondary infection, antibiotics are used.
Eczema is considered a chronic disease prone to recurrence. The prognosis of treatment is favorable. Doctors recommend following preventive measures:

  • Normalize rest and work
  • Avoid stress, overvoltage
  • Eliminate alcohol
  • Treat skin diseases in time.

Ointments and creams can be prescribed in chronic and acute periods. The composition includes a mixture of medicinal additives and fatty substances. Evaporation of the skin and heat transfer are slowed down. The blood vessels dilate and the skin gets warm. Medicated ointment softens and loosens the skin, which promotes deep penetration of the substance.

The most effective ointments: “Elokom”; “Celestoderm”, salicylic ointment and others.

Self-medication is strictly prohibited, so you need to contact a dermatologist so as not to aggravate the condition. The best and most effective drug for eczema can only be selected by a doctor. This will help to cure the disease completely or prevent the risk of relapse.

Ingrown toenail: causes, stages of the disease and treatment methods

Dr. Hooman-Khorasani
Posted in Uncategorized

An ingrown toenail is an unpleasant disease that causes discomfort and unbearable pain to a person, and, in case of refusal of treatment or with self-medication, can lead to serious complications, up to amputation. In most cases, an ingrown toenail is found on the outside or inside of the thumbs, but it can also occur on any other toe. Both men and women are susceptible to this disease. It happens that children also suffer from this. 

The causes of the disease

There are several reasons for this ailment.

1. Heredity. Quite a common reason. Hereditary predisposition is expressed in the fact that in humans, by nature, the leg has the shape of the so-called “bear paw”. Large, voluminous fingers, wide, very strong nail plate. This is often passed down from generation to generation. Thus, several family members are exposed to the disease. Excess weight can also aggravate the situation. 

2. Incorrectly performed pedicure. Avoid trimming the corners of the nails to avoid further ingrowing them into soft tissue. This can also include a cut, deformation of the nail. 

3. Incorrectly fitted shoes. Too tight, tight, and the shoe squeezes toes. When wearing such shoes for a long time, especially when it comes to high heels, nails begin to grow into the soft tissues of the fingers. 

4. You can also highlight such a reason as some diseases , orthopedic and fungal, which can provoke this ailment. 

Disease stages

There are three stages of the disease:

1. Onset of the disease. There is a slight swelling and mild soreness. Usually, discomfort occurs when walking and when pressing on the pad of the finger. At this stage, coping with the disease is quite easy. You can insert a cotton swab (flagellum) between the nail plate and the soft tissue of your finger to lift the sharp tip of the nail. It should not be cut. This can hurt even more. Better to just use a nail file. However, this must be done with great care so as not to infect the infection. It is best to seek help from a specialist at the clinic at this stage. Then you can definitely avoid further development of the disease. 

2. The occurrence of a purulent-inflammatory process. The swelling increases, the pain becomes excruciating, and suppuration appears. This is due to the fact that the nail plate grows and more strongly rests against the soft tissues. At this stage, you must immediately consult a doctor. To relieve pain at least a little, you can hold your foot in warm water with salt or soda. This will help reduce inflammation a little. Pain relievers can be taken if the pain is severe. After this procedure, you must make a bandage with antibacterial ointment. There are many ways to treat folk remedies. However, as practice shows, self-medication, one way or another, leads to a surgeon. 

3. Transition of the disease into a chronic form. Suppuration intensifies, which can provoke the attachment of a fungal infection, the transition of inflammation to the bone and even amputation. At this stage, a person is not able to move freely. You need to immediately seek help from a doctor. Baths are powerless at this stage, hot water can only do much harm. 

Treatment methods

Previously, there was only one method of treatment – surgery. The nail plate was removed completely or partially, depending on the stage of the disease. There is also such a method of nail removal as laser. This is definitely a more gentle way. However, at this stage, when medicine does not stand still, such a specialist has appeared as a doctor for a long time. Podiatrists cope with this problem without surgery, at almost any stage of the disease. Just do not forget about the above causes of the disease in the future. It is necessary to do a pedicure correctly, wear comfortable shoes. Disease is better prevented than cured.

Fungal infections: causes, symptoms, therapy

Dr. Hooman-Khorasani
Posted in Uncategorized

They hide where it is warm and humid: in saunas and swimming pools, changing rooms, and bathrooms of hotel rooms. Fungi love this climate. And they are usually transmitted by skin cells, i.e. in places where many people go barefoot. They don’t care if their feet are clean or dirty. Mycosis has nothing to do with poor hygiene. Skin fungus is one of the most common infections, with studies showing that one in three adults will contract a foot fungus at some point in their lives, and one in eight with a toenail fungus. Fungal infections of the feet tend to arise from filamentous fungi called dermatophytes – and rarely from yeasts or molds. In general, the fungus primarily affects the foot between the toes and the soles of the feet. From there, it can migrate to the nails.

Fungi love old skin

Not everyone who comes into contact with fungal spores is necessarily infected. Children and young people rarely become infected with foot and nail fungus. But the older a person is, the more vulnerable he is. This is due to the fact that the skin becomes thinner over the years and blood circulation is poorer. Then the body’s defenses decrease. Especially susceptible to the fungus, except for the elderly, diabetics and people with circulatory problems or immunodeficiency. In men, infections are more common than in women. If the skin swells under the influence of heat and moisture, it is especially easy for fungus to penetrate into it. After a sauna, after a bath, or when your feet are sweating in sealed shoes, a favorable environment is created for fungus. It has enzymes that soften the stratum corneum so that it can slide through the skin.

Fungi can ally with bacteria

Fungi on fingers and nails form stains: nails can grow and become inflamed. These viruses can also spread and infect other areas of the skin. However, they cannot reach bones or organs. In the worst case, fungi and other microorganisms such as bacteria make their way through the body. This is how the so-called erysipelas with skin inflammation, high fever and chills appear. Thus, one should always be alert to fungi. It is also possible to infect others, so you should always carry slippers with you.

Symptoms

The fungus makes itself felt in different ways, depending on where it is located. The most common is the so-called interdigital type. The upper layers of the skin swell and appear whitish. The skin turns red, gets wet, sometimes there are blisters. If you wear shoes that are sealed, your skin can itch a lot. From the space between the fingers, the fungus spreads to the sides of the fingers and the instep. It can appear on the soles and edges of the foot. In this case, the skin becomes easily inflamed from the very beginning. It becomes dry and scaly. Cracks may appear later. There is also a third form of mycosis. With it, large groups of bubbles appear on the sole. Since the skin is very thick there, the bubbles do not burst, but dry out. The leg in this place is very itchy and inflamed.

The fungus infects the nail plate

The color of the nail changes initially. White, yellow, or brown spots are a sign that this is an infection and is spreading under the nail plate. If you do not take any action against the fungal infection, the nail plate loses its elasticity, becomes fragile, thickened and deformed. Sometimes the infection also covers the nail bed. Over time, the fungus can completely destroy the nail. Then there is pain and discomfort when walking. More often than not, the fungus affects only one nail, but it can spread to other nails. Toenail fungus occurs up to four times more often than toenail fungus. Nail fungus is not always easy to identify. Other conditions can also change the nails. This can be, for example, nail psoriasis. Also bacteria, viruses, or medications can damage your nails. If in doubt, consult a dermatologist.

Therapy

Fungal infections rarely go away on their own. The sooner you start treating them, the faster you can get rid of the trouble. The doctor will prescribe a so-called safe antifungal agent. This is a drug that either inhibits the growth of fungi or completely destroys them. Basically, it is enough for treatment to lubricate the affected areas with cream, spray with spray or varnish. Only in difficult cases is it necessary to take pills. But this rarely happens. Many antifungals are available over the counter at a pharmacy. In addition to medication, it is important to keep the spaces between your toes dry. You should dry your feet well after swimming and wear breathable shoes and socks. Disinfect shoes, ventilate them, wear comfortable shoes that do not lead to minor injuries. Wash your socks in at least 60 degrees hot water to avoid new infections. Swimming pools, saunas and gyms are ideal breeding grounds for fungus. On the one hand, there are a lot of people, on the other hand, the spread of microbes in warm and humid air is faster. Therefore, do not go barefoot in such places. This also applies to the dressing room. Do not walk barefoot in a hotel room: fungus can survive for a long time on carpeted floors.

Excessive sweating of the feet

Dr. Hooman-Khorasani
Posted in Uncategorized

Excessive sweating of the feet is not uncommon. Someone tries in every possible way to eliminate it, and someone simply resigns itself, despite the fact that sweaty feet have an unpleasant odor.

What are the causes of excessive sweating?

1. Failure to comply with basic hygiene rules.
2. In winter, sweating appears when the legs freeze over.
3. Constant stress.
4. Fungal diseases of the feet.
5. Disorders of the endocrine system.
6. Low-quality and unsuitable footwear. Namely, from synthetic materials.
7. Wearing synthetic socks.

How to deal with sweating feet?

You should consult a dermatologist in order to determine the presence or absence of a medical problem. If there are no such problems, then sweating can be treated at home or in.

It is recommended to do foot baths at home. They will help reduce sweating until complete recovery.
• Bath with oak bark.

You will need no more than 100 grams of the bark itself and a liter of water. The bark should be boiled for half an hour. This bath must be repeated every day.
• Tray with bay leaves.

Take 25 bay leaves and pour two liters of boiling water for half an hour. Do the bath for 15 minutes.
It is also recommended to repeat it every day.
• Bath with nettles.

Pour a tablespoon of sage, nettle and mint into one liter of boiling water. It should be insisted for about 40 minutes. Also keep your feet in a broth at room temperature for 20 minutes.

Such baths should be done before bedtime.
In addition to trays, you can do various lotions, rubbing and rinsing. They are recommended to be carried out once a day.
• Lotion with a solution of apple cider vinegar and lemon juice. Vinegar and lemon juice should be diluted 1: 1 with water. The acid neutralizes unpleasant odors.
• Rinsing with salt solution. For 200 ml of water, a tablespoon of salt. You can use both regular cooking and seafood.
• Rubbing feet with boric acid.
• Rinse your feet with a mild potassium permanganate solution.

What to do to avoid this problem?

1. Choose your shoes carefully. Pay attention to the material of manufacture, it is best of all genuine leather. Shoes should not be small or large, but should be exactly in size.

2. Take good care of your shoes. Wash periodically using antibacterial agents. Dry your insoles daily.

3. Practice good foot hygiene. Wash with soap 2 times a day and wipe with a clean towel.

4. One pair of socks – one day. Synthetic socks are not suitable, only natural cotton socks.

5. Avoid hypothermia of the legs.

Well-groomed feet add confidence. Don’t forget about them.

Acute esophagitis

Dr. Hooman-Khorasani
Posted in Uncategorized

Acute esophagitis is an acute inflammatory lesion of the esophageal mucosa, which is caused by a strong, but short-term effect of any damaging factor. Such an inflammatory process can last from several days to 3 months.

Development reasons, pathogenesis

The causes of acute esophagitis can be divided into 4 subgroups:

– exposure to an infectious agent (these include scarlet fever, fungal infections, tuberculosis, cytomegalovirus, influenza, diphtheria, syphilis, herpes);

– exposure to various physical factors (such as high or low temperature, traumatism during instrumental methods of examining the esophagus or other parts of the gastrointestinal tract, as well as when foreign bodies enter the esophagus);

– exposure to chemical factors (acid, alcohol, alkaline burns), as well as exposure to various other chemicals;

– various manifestations of food allergies.

The development of esophagitis occurs either against the background of severe damage due to chemical or physical exposure, or with a decrease in immunological reactivity, when favorable conditions are created for the introduction of an infectious agent into the esophageal mucosa. In other cases, the development of esophagitis is unlikely, since the esophageal mucosa is resistant
to damaging factors. This is due to the fact that it is represented by stratified squamous epithelium (there may be up to 29 layers), which in turn is covered with thick mucus.

Classification

According to various sources and authors, there are a number of classifications of esophagitis, in this regard, there is no single classification. The following classification is possible:

1. By etiological factor: exposure to an infectious agent, various physical factors, chemical factors, food allergies.

2. According to the stages of development: edema and redness of the mucous membrane, the appearance of single erosive lesions in the area of ​​edema, a significant increase in edema and hyperemia of the mucosa, which has foci of bleeding and erosion in places. “Weeping” mucous membrane – there are multiple diffusely located foci of erosion, and the mucous membrane is prone to bleeding even with the slightest mechanical damage.

3. By morphology: erosive, catarrhal, pseudomembranous, membranous, hemorrhagic, phlegmonous, necrotic.

Some aspects of certain forms of acute esophagitis

Catarrhal esophagitis. The most common form associated with acute esophagitis. This form of acute esophagitis develops against the background of inaccuracies in nutrition (such as eating cold or hot foods, spicy foods); alcohol burns, minor mechanical injuries. In the clinic, such patients have chest pain and severe burning. Because of these manifestations of the disease, patients cannot eat for several days. With instrumental methods of examination, a specific picture is found in such patients. X-ray examination reveals esophageal hyperkinesia, and endoscopic examination reveals stage 1–2 esophagitis. 

Erosive esophagitis. The emergence of this type of esophagitis occurs against the background of an infectious disease and the introduction of an infectious agent in scarlet fever, fungal infections, tuberculosis, cytomegalovirus infection, influenza, diphtheria, syphilis, herpes, allergies. Also, erosive esophagitis in some cases is possible with traumatic injury to the esophagus and chemical burns. We can say that erosive esophagitis in its own way is the next phase of catarrhal esophagitis. The clinical picture is primarily dominated by the symptoms of the underlying disease, against which the development of erosive esophagitis occurred. In the clinic of developed esophagitis, significant chest pains are noted that appear during or after eating. Belching, heartburn, increased secretion of the salivary glands, and bad breath are observed. Endoscopic examination will reveal areas of edema, redness, hemorrhage, erosion, which will correspond to the 2-3rd stages of esophagitis. Radiographically, there will be a significant amount of mucus, hyperkinesia of the esophageal walls, as well as a change in relief, as a result of which flat “pockets” will form. 

Hemorrhagic esophagitis. It is a rather rare type of erosive esophagitis. The onset of hemorrhagic esophagitis is possible against the background of an infectious disease and, accordingly, the introduction of an infectious agent in scarlet fever, fungal infections, tuberculosis, cytomegalovirus infection, influenza, diphtheria, syphilis, herpes, allergies. Also, hemorrhagic esophagitis is observed in some cases with traumatic injury to the esophagus and with chemical burns. In the clinical picture, such patients are characterized by the appearance of intense chest pains, as well as bloody vomiting. With endoscopic examination of the esophagus, a picture of the 3-4th stages of esophagitis will be observed. Bleeding will occur. Exfoliation of the mucous membrane of the esophagus is possible in the form of “narrow ribbons”. 

Pseudomembranous esophagitis. The development of this form of acute esophagitis is possible due to a number of diseases, which include diphtheria, radiation sickness, scarlet fever, fungal diseases, blood diseases. The clinical picture is marked by the presence of intense pain, dysphagia, vomiting, nausea. An increase in clinical manifestations after eating is possible. In the vomit, fibrin films may appear, as well as blood impurities. During endoscopic examination of the esophagus in the affected area, there are fibrinous plaques that have a gray or yellow-gray color. Fibrinous deposits are formed due to detrin and fibrin, which normally cover the lining of the esophagus. 

When fibrinous deposits are rejected, ulcers or erosions form, which later slowly heal. In some cases, it is possible that membranous stenoses may remain in the esophagus. To eliminate them, use the bougie method.

Membranous esophagitis. By etiology, development is possible against the background of an infectious process (such as herpes, sepsis, smallpox, shingles); chemical damage (burns of various nature). In the clinic, such patients have very diverse manifestations. It is possible to develop both mild forms of membranous esophagitis, when a minimal clinical picture is observed, and severe, when intoxication, bleeding, dysphagia, esophageal perforation, pain syndrome, mediastinitis can be observed. Severe forms of membranous esophagitis often lead to the death of the patient. In endoscopic examination, attention is drawn to the defeat of all layers of the esophagus. In this case, epithelial rejection will be noted. After the inflammation in the esophagus subsides, the formation of rough cicatricial stenosis is possible. 

Necrotizing esophagitis. Refers to acute forms of inflammation of the esophagus. It is quite rare. As a result of a number of serious diseases, which include candida mycosis, sepsis, typhoid fever, there is a decrease in immunity in the body. Due to this, the development of necrotic esophagitis occurs. The clinical picture is characterized by the presence of painful dysphagia, weakness, profuse vomiting. Sometimes bleeding occurs, the development of diseases such as pneumonia, pleurisy, mediastinitis is possible. The disease cannot be cured without consequences. After a full course of treatment, strictures may form in the esophagus. Such strictures can be attributed to the initial precancerous changes. 

Septic esophagitis. A rare disease of streptococcal nature. Inflammation of the walls of the esophagus in this disease can be both diffuse and local. The occurrence of a disease is possible in violation of the integrity of the esophageal mucosa due to damage by a foreign body. In rare cases, it is possible to develop acute phlegmonous esophagitis, which is a complication of various forms of acute esophagitis, which in turn is a consequence of purulent fusion of the walls of the esophagus. As a result of purulent damage to the walls of the esophagus, pus penetrates into the tissue of the mediastinum, and as a result, a number of complications are possible, which include purulent bronchitis, mediastinitis, pneumonia, pleurisy, spondylitis, aortic rupture. If an anaerobic infection is attached, the patient may develop mediastinal emphysema, as well as the formation of spontaneous pneumothorax. In such patients, the clinical picture will be characterized by the existing intoxication, vomiting, chest pain, pain in the cervical region, high fever. 

When examining patients with a diagnosis of septic esophagitis, attention is drawn to the forced position of the head with an inclination to one side, swelling in the neck area, impaired mobility in the cervical spine. Often after septic esophagitis, the formation of purulent mediastinitis occurs. From laboratory data, a general blood test is important, where there is an increase in the erythrocyte sedimentation rate, the number of leukocytes significantly increases. In order to confirm the streptococcal nature of the disease, blood is cultured on nutrient media. X-ray and endoscopic examination in the acute period of the disease is not indicated. During the scarring period, due to the danger of the formation of gross defects that can lead to the development of esophageal stenosis, X-ray examination is mandatory. Treatment of acute esophagitis
is based on principles that include symptomatic, etiotropic and pathogenetic treatment. Etiotropic treatment consists in treating the underlying disease. However, against the background of the addition of acute esophagitis, therapy undergoes certain changes and adjustments. In cases where, against the background of any infectious diseases, acute esophagitis occurs, it is necessary to prescribe parenteral antibiotics. With the existing necrotic, hemorrhagic changes along the esophagus, it is advisable to refuse food intake within 2-3 weeks. For this period, parenteral nutrition is prescribed. Intravenous administration of vitamins, amino acids, protein hydrolysates is carried out. Des-intoxication therapy is prescribed. It is recommended to start regular nutrition after the inflammatory process subsides. It is recommended to start with both chemically and thermally benign foods. It can be vegetable soups, milk, cereals, cream. Reduction of local inflammatory symptoms is achieved through the use of collargol, tannin, novocaine. Astringents are prescribed. In this case, the patient must comply with bed rest, the head must be at the level of the body or below. If no visible changes occur after the application of astringent drugs, then parenteral non-narcotic analgesics are recommended. If there are symptoms of esophageal dyskinesia, then drugs such as raglan, cerucal, cisapride are used before meals. With existing erosions of the esophagus, bismuth preparations are prescribed. In cases of existing bleeding or with hemorrhagic esophagitis, drugs such as dicinone, aminocaproic acid, vicasol are recommended. If there is severe bleeding, then a plasma and blood transfusion is prescribed. With the existing purulent process, the patient is prescribed antibiotic therapy, including several antibiotics, parenteral nutrition; the abscess is being sanitized. In order to prevent stenosis of the esophagus due to the formed strictures, bougienage is performed. A favorable prognosis is possible only in cases of erosive and catarrhal esophagitis. In all other cases, the prognosis is poor. Prevention of the disease must be timely, otherwise there may be complications in the form of acute esophagitis.

Dermatomycosis

Dr. Hooman-Khorasani
Posted in Uncategorized

Dermatomycosis – fungal diseases of the skin, nails, hair, caused by a group of related filamentous fungi, which include tricho- and epidermophytos, microsporum. Accordingly, the first group of fungi affects the skin, nails and hair, the second group – only the skin and the third – mainly hair.

Sources of infection with different types of trichophyton and microsporum can be both humans and animals, while epidermophytos are transmitted only between people.

It is characteristic that an infected person acquires a certain resistance to re-infection.

Dermatomycosis of the face, trunk, arms and legs

The reasons for the development. These fungal infections in children are mainly caused by Mlsgoyarogitis satz. Infected pets are usually the source of infection.

Clinic. When infected, dry, slightly erythematous raised papules or plaques with a scaly surface appear on the skin. The disease is characterized by the spread of skin changes along the periphery of the primary lesions with simultaneous cleansing in the center, as a result of which it is called lichen ring. Less commonly, the disease manifests itself in the form of grouped pustules, while the center of the focus is cleared, but not always. 

Treatment for this disease is external. Antifungal agents are prescribed twice a day for 2-4 weeks until complete recovery. In case of persistent and complicated course, treatment with griseoful-vin-microcrystallin is recommended for several weeks. 

Dermatomycosis of the groin area

The reasons for the development. The source of infection is usually a person infected with fungi, in more rare cases – an animal. More often, the disease occurs in male adolescents.

Clinic. First, there are raised, scaly erythematous rashes of a small size on the inner thigh. Then these formations grow along the periphery, often forming multiple small bubbles. As they grow, these elements merge with each other into bilateral, irregularly shaped, clearly delimited plaques with a brightly colored scaly center. Skin changes are accompanied by itching, which subsides as the inflammatory response decreases. 

In severe cases, the fungal infection can spread beyond the affected thigh.

Treatment. The infection resolves spontaneously. The use of absorbent powder (zinc undecylenate) and the wearing of cotton underwear are recommended. 

Local treatment is carried out only in cases of severe fungal infection.

Athlete’s leg

The reasons for the development. This form of fungal infection affects the skin on the pads of the fingers and plantar surfaces. Usually the infection is localized in the III and IV fingers.

Mostly young children get sick, but an infectious lesion can also occur in boys during the prepubertal and pubertal periods.

Airtight footwear and warm, damp weather predispose to fungal infections. Infection is possible when visiting

shower and swimming pools.

Clinic

With this fungal infection, the skin of the interdigital and base of the fingers becomes cracked and macerated, which is accompanied by painful itching and an unpleasant odor.

In young children, the lesions are presented in the form of bubbles, are usually rounded and affect the dorsum of the foot.

In rare cases, there is a chronic form of the disease in the form of increased keratinization of the plantar surfaces, accompanied by slight erythema.

Treatment. Despite its severity, the disease resolves spontaneously. Thorough wiping of the interdigital spaces after bathing, the use of absorbent antifungal powders, and the wearing of breathable shoes are recommended. 

Sluggish chronic fungal infections are treated with griseofulvin, but relapses are not uncommon.

Dermatomycosis of the palms

The reasons for the development. This form of fungal infection is rare and only in children and adolescents. Dermatomycosis of the palms is caused by a dimorphic fungus that gives a gray-black tint to the palmar surfaces.

Clinic. The infection is expressed by the appearance on the palmar surfaces of clearly defined hyperpigmented spots that do not cause concern to the patient. 

Treatment. For the purpose of treatment, Vitfeld’s ointment with undecylenic acid or iodine tincture is prescribed. 

Dermatomycosis of the nail plate

The reasons for the development. Most often accompanied by dermatomycosis of the pads of the fingers and plantar surfaces, however, it can begin as a primary infection.

Clinic. The mildest course of a fungal infection appears as single or multiple white plaques on the surface of the foot, not associated with paronychia. 

A more pronounced process of fungal infection begins from the lateral or distal edge of the nail, which gradually thickens, becomes brittle, acquires a yellowish tint and exfoliates from the nail bed. In severe cases, the nail may turn black and peel off.

Treatment. Treatment of dermatomycosis of the nail plate is often difficult. With a severe form of fungal infection, patients wishing to recover are prescribed griseo-fulvin and local applications of antifungal drugs. The use of griseofulvin is not always successful and may be required for a long period – more than 1 year. 

Side effects of griseofulvin are rare; these include functional disorders in the liver, gastrointestinal tract, headache, changes in the blood.

Dermatomycosis of the scalp

The reasons for the development. The source of infection with dermatomycosis of the scalp is most often infected people. You can get infected through combs, hats, etc. With close contact with a patient, dermatophytes may spread with air currents.

Clinic. The clinical picture of dermatomycosis of hair is different and depends on the pathogen. 

When infected with M. audoini, small papules first form at the base of the hair follicle. Then the foci of infection spread, merge with each other, forming erythematous round scaling plaques, the hair on which becomes brittle. These changes are accompanied by severe itching.

T. tonsurans causes lichen maculae. At the onset of the disease, multiple rounded plaques appear, in the area of ​​which the hair breaks off at the follicle and becomes like dots. A pronounced inflammatory reaction leads to the formation of kerions (elevated granulomatous masses), the surface of which is covered with sterile pustules. Scars and chronic alopecia (baldness) may subsequently develop .

Treatment. For treatment, griseo-fulvin is prescribed. Treatment with courses of 8-12 weeks may be required. 

Local use of shampoos with a 2.5% sulfidoselen solution is recommended. It is not necessary to trim the hair from the head.

Fungal infection in the pathology of the gastrointestinal tract

Dr. Hooman-Khorasani
Posted in Uncategorized

The importance of fungal infection in gastroenterology is either overestimated, or vice versa, is not properly appreciated. Clear overdiagnosis often occurs. For example, based on the presence of Candida fungi in the culture of a smear from the oral mucosa in a person without signs of stomatitis, or in the analysis of feces “for dysbiosis” of a patient with irritable bowel syndrome, a diagnosis of candidiasis or even “systemic mycosis” is established. At the same time, it is completely ignored that the fungus is a human commensal and is widespread in the environment (such as Candida, Aspergillus). Therefore, the excretion of, say, Candida from the surface of the skin, mouth, sputum, urine and feces should be interpreted with caution.

It should always be borne in mind that many fungi do not exhibit pathogenic properties if the host is not weakened. Violations of the anatomical, physiological and immunological mechanisms of the body’s defense create conditions for the development of an infectious process caused by its own under normal conditions non-pathogenic microflora or saprophytic microorganisms from the environment.

The conditions for the development of opportunistic infections include: treatment with corticosteroids, immunosuppressants, antimetabolites, antibiotics; AIDS and other immunodeficiency conditions; serious metabolic disorders (eg, diabetes mellitus, kidney failure); neoplasms and anticancer therapy. Fungal lesions, including those of the gastrointestinal tract, developing against the background of a serious illness, must be recognized in time and adequately treated, since this infection can have a negative effect on the prognosis of the underlying disease. A correctly recognized fungal infection of the gastrointestinal tract often provides an underlying diagnosis. Thus, candidiasis of the oral cavity and esophagus is one of the “calling cards” of AIDS. One of the important gastroenterological aspects of the problem under consideration is also the fact that fungal infection can be a complication of enteral and especially parenteral nutrition.

Clinical picture

Most often in patients with suppressed immunity, infection with Candida albicans is noted, less often with other representatives of the genus Sandida.

For candidal stomatitis, a white bloom is characteristic, slightly rising above the mucous membrane of the oral cavity and resembling curdled milk or cottage cheese. When plaque is removed, a hyperemic surface is exposed, which may bleed slightly (pseudomembranous form). With an atrophic form, the lesions look like erythema. Symptoms include dryness, burning, and frequent loss of taste. Candidal stomatitis is widespread among AIDS patients (one of the most frequent manifestations of the disease), as well as with the use of antibiotics, corticosteroids and anticancer agents.

Fungal esophagitis – most often candidal. They develop in immunodeficiency states, antibiotic therapy, often in patients with diabetes mellitus (a high concentration of glucose in saliva is favorable for the growth of fungi), in people of old age or with impaired trophological status. Fungal esophagitis also occurs with achalasia of the cardia, other movement disorders, for example, within the framework of scleroderma, and with esophageal stenosis. Clinically, fungal esophagitis is manifested by dysphagia and single phagia (painful swallowing). In severe cases, specific esophagitis can be complicated by bleeding, perforation, esophageal stricture, or the development of candidomycotic sepsis. Endoscopic examination reveals yellow-white relief overlays on the hyperemic mucous membrane of the esophagus. X-ray examination can reveal multiple filling defects of various sizes. The diagnosis is confirmed by microscopic examination of smears obtained with esophagoscopy.

Complaints of dysphagia and discomfort behind the breastbone in a patient with AIDS serve as the basis for a broad differential diagnosis, since damage to the esophagus in these patients can be caused by viruses (herpes simplex, cytomegalovirus), and the development of Kaposi’s sarcoma, and other reasons. However, the diagnosis of candidal esophagitis cannot be called difficult. The presence of fungal stomatitis in an HIV-infected patient with dysphagia is likely to indicate the correct etiology of esophagitis, and endoscopy with microbiological or histological examination unambiguously establishes the diagnosis in 95.5% of cases (I. McGowan, IVD Weller, 1998).

With suppression of the immune system and a general weakening of the body, the development of fungal gastritis is possible, the most common causative agent of which are representatives of the genus Candida, Histoplasma, Mucor.

Candidiasis affecting the small and large intestine as the cause of diarrhea is not as common as it might seem at first glance. Diarrhea is one of the most common symptoms of immunodeficiency states, and not only infectious agents cause it. However, the role of fungal infections (including Candida) as a cause of diarrhea is small. So, in AIDS, the causative agents of the infectious process in the small and large intestine, accompanied by diarrhea, are, first of all, protozoa – Cryptosporidium, Microsporidium (Enterocytozoon beineusi), Isospora belli, Giardia lamblia. Of the viruses associated with AIDS with the development of diarrheal syndrome, cytomegalovirus and herpes simplex virus should be named, and from bacteria – Salmonella, Shigella, Campylobacter spp.

It is important to pay attention to a well-differentiated nosological unit – pseudomembranous colitis. It is an acute inflammatory bowel disease associated with antibiotic therapy. Its clinical presentation ranges from short-term to severe diarrhea with fever, dehydration, and complications. Cases of this disease with uremia, after cytostatic therapy are described. During colonoscopy, fibrinoid overlays are found on the mucous membrane, because of which the disease got its name. Despite the superficial resemblance to candidiasis (the onset of the disease is provoked by antibiotics, white overlays are detected on the mucous membrane), pseudomembranous colitis has nothing to do with this fungal infection. The causative agent of antibiotic-associated colitis (synonymous with pseudomembranous colitis) has been identified. This is Clostridium difficile – a gram-positive anaerobic. Antibiotic therapy, suppressing its own microflora, creates conditions for the reproduction of C. difficile and the manifestation of its pathogenic properties. The diagnosis is established on the basis of the identification of the pathogen in the feces or by the detection of C. difficile toxin. This digression on pseudomebranous colitis once again emphasizes the need for an adequate assessment of the clinical picture, instrumental examination data and laboratory tests. The diagnosis of a fungal infection, including candidiasis, should be based on as much information as possible.

Diagnostics

The most common fungal infections of the gastrointestinal tract – candidiasis of the oral cavity and esophagus – have rather characteristic signs. For a correct diagnosis, obtaining a culture of the pathogen must be confirmed by characteristic clinical symptoms, with the exception of another etiology, as well as histological signs of tissue invasion. In the case of systemic candidiasis, a culture of the fungus from blood, cerebrospinal fluid, or tissue, such as a liver biopsy, helps to clarify the clinical signs – septicemia, meningitis, or liver damage.

Cryptococcus and Histoplasma are of much lesser importance in gastroenterology. As a rule, involvement in the pathological process with these fungal infections of the gastrointestinal tract and liver occurs in patients with immunodeficiency with disseminated form of the disease. Histoplasma capsulatum with hematogenous spread from the lungs affects the liver and spleen with symptoms of hepato- and splenomegaly, and the defeat of the gastrointestinal tract is accompanied by ulceration (especially often in the oral cavity). With AIDS, Cryptococcus neoformans and Histoplasma spp. with disseminated cryptococcosis and histoplasmosis, the liver is affected by the type of granulomatous hepatitis. Clinically and biochemically, there is cholestasis syndrome. To establish an accurate diagnosis, a liver biopsy is necessary, in which fungal tissue invasion will be proven.

Treatment

Modern antifungal agents represent a very impressive arsenal.

Fluconazole (water-soluble triazole) highly selectively inhibits fungal cytochrome P450, blocks the synthesis of sterols in fungal cells. Today there is a domestic fluconazole – Flucostat. It is almost completely absorbed in the gastrointestinal tract, allowing for rapid achievement of adequate serum concentrations. It is used for candidiasis and cryptococcosis. In AIDS, for the treatment of cryptococcosis after a preliminary course of amphotericin B (without fluorocytosine or in combination with it, which is preferable), fluconazole is prescribed at 200 mg per day.

Ketoconazole (an imidazole derivative) has a broad spectrum of antifungal activity, but unlike fluconazole, it can cause a temporary blockage of testosterone and cortisol synthesis.

Fluorocytosine is incorporated into the cells of the fungus, where it is converted into 5-fluorouracil and inhibits thymidylate synthetase. Usually the drug is used to treat candidiasis, cryptococcosis, chromomycosis.

Amphotericin B acts on the sterols of the fungal membrane, disrupts its barrier functions, which leads to the lysis of fungi. The indications for its appointment are systemic mycoses – candidiasis, aspergillosis, histoplasmosis and others.

Given the severity of the disease that may lead to opportunistic infections, antifungal therapy often requires a combination of drugs, repeated courses, or supportive care.