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.

Modern aspects of vaginal candidiasis

Dr. Hooman-Khorasani
Posted in Uncategorized

Inflammatory diseases of the genital organs negatively affect a woman’s reproductive function and often cause infection of the fetus and newborn. Irrational use of drugs suppresses local immunity, which reduces the resistance of the vaginal biotope and contributes to the growth and progression of the number of colonies of pathogenic microorganisms.

The problem of vaginal candidiasis (VC) has acquired particular relevance. Its frequency in recent years has more than doubled, making up in different regions of Ukraine from 20 to 50% in the structure of infectious pathology of the lower genital organs.
There is evidence that with recurrent VC, the gastrointestinal tract serves as a reservoir of fungi and a source of vaginal reinfection. According to another point of view, the activation of endogenous fungal infection due to a violation of the protective role of the normal microflora of the vagina plays a leading role in the development of VC. VK often manifests itself with local or systemic antibiotic use. Apparently, a decrease in the titer of lactobacilli with the loss of the characteristic acidic environment of the vaginal biotope forms favorable conditions either for the primary penetration of fungi into the vagina, or for their intensive reproduction. VC develops against the background and exacerbates local suppression of cellular and humoral immunity under the influence of a high level of prostaglandins E2 and a decrease in interleukin-2 production. In addition, due to the presence of estrogen-binding proteins in Candida albicans, there are disturbances in the effects of estrogen at the level of vaginal cells. This damages the protective barrier on the part of the vaginal epithelium due to a decrease in the colpotrophic effect of estriol. A decrease in the content of interleukin-2 also has a systemic effect in chronic candidiasis, which leads to a violation of the synthesis of neurosteroids and neurotransmitters in the central nervous system.

Candidal infection impairs the proliferation and maturation of oligodendroglial elements as the main source of synthesis of biologically active substances in the brain, and most patients with chronic candidiasis have polyendocrine disorders, including premenstrual syndrome. The presence of VC aggravates the course of the underlying disease in women with menstrual irregularities, hyperplastic endometrial processes, climacteric syndrome.

The most common in the clinic are candidal vulvovaginitis, cervicitis and urethritis.

It is customary to isolate the acute form of VC, when the duration of the disease does not exceed 2 months, and the chronic, lasting more than 2 months. Currently, chronic vaginal candidiasis accounts for about 50-60% of all cases of the disease, and the recurrence rate reaches 25%.
Chronization of VC can be facilitated by a combination of candidiasis and trichomoniasis, since Trichomonas have the ability to keep undigested pathogenic microorganisms, including Candida, for a long time, forming a kind of “reserve” for reinfection.

Endocrine pathology, primarily disorders of carbohydrate metabolism (diabetes mellitus, metabolic syndrome X), as well as hyperandrogenism often accompanying these diseases, obesity, taking combined oral contraceptives and menopause contribute to the accumulation of glycogen in the vaginal epithelium. This allows the yeast fungi to persist on the cells of the deep layers of the vaginal epithelium, complicating therapy and facilitating chronicity. At the same time, Candida albicans is more often found in patients with type I diabetes, and Candida glabrata in women with type II diabetes.

Clinically, VC (usually acute) is manifested by itching and burning in the vagina, profuse cheesy leucorrhoea, and dyspareunia. On examination, there is swelling and hyperemia of the vaginal mucosa with whitish deposits of pseudomycelium filaments and desquamated epithelial cells, long-term non-healing abrasions and ulceration. However, it should be borne in mind that in about half of the cases, chronic candidiasis has an erased oligosymptomatic course.

The diagnosis is based on complaints, history data, objective research and laboratory methods, primarily bacterioscopy of vaginal discharge. Laboratory confirmation is extremely important, since the opinion formed by the majority of gynecologists “candidiasis is abundant cheesy leucorrhoea” is only partially correct. Only in half of the cases, this clinical sign is due to vaginal candidiasis [6].
The presence of mycelium and spores in wet smears treated with 10% KOH solution confirms the diagnosis. It is possible to use a bacteriological culture method, the material for research in which are whitish films and tiny plaque from the mucous membrane of the vagina, cervix and external genital organs. The use of bacteriological express diagnostic kits is very promising, it does not require a lot of time, it is not difficult to carry out such analyzes, but it is associated with certain material costs. They are based on a qualitative reaction of the nutrient medium, leading to its staining brown in the presence of Candida growth.

Depending on the state of the vaginal microcenosis, three forms of Candida infection of the vagina are distinguished:
Asymptomatic candida infection, in which there are no clinical manifestations of the disease, yeast-like fungi are detected in a low titer (less than 104 CFU / ml), and lactobacilli are absolutely dominant in the composition of microbial associates of vaginal microcenosis. quantity;
True candidiasis, in which fungi act as a mono-pathogen, causing a clinically pronounced picture of vaginal candidiasis. At the same time, in the vaginal microcenosis, Candida fungi are present in a high titer (more than 104 CFU / ml) along with a high titer of lactobacilli (more than 106 CFU / ml) and in the absence of diagnostically significant titers of any other opportunistic microorganisms;
Combination of VC and bacterial vaginosis, in which yeast-like fungi are involved in polymicrobial associations as causative agents of the disease. In these cases, yeast-like fungi (more often in a high titer) are detected against the background of a massive amount (more than 109 CFU / ml) of obligate anaerobic bacteria and gardnerella with a sharp decrease in the concentration or absence of lactobacilli.
Treatment of VC is carried out in several directions at once:
elimination or weakening of the influence of risk and pathogenetically significant factors;
etiotropic therapy with antimycotic drugs;
restoration of normal microflora of the vaginal biotope.
In this case, both specific and non-specific methods of treatment are used.
Nonspecific methods of therapy include well-known drugs: sodium tetraborate in glycerin, Castellani liquid, gentian violet, etc. The action of the above drugs is based on the maximum removal of mycelial forms of the fungus from the crypts of the vagina, as well as on violation of the process of attachment of the fungus to the vaginal wall and inhibition of reproduction. It should be emphasized that all these drugs are not etiotropic due to the fact that they do not possess fungicidal and fungistatic effects. In addition, the disadvantage of these methods is the need for medical procedures by medical personnel, multiple treatments, which in turn can lead to the fact that there is a risk of delay in the crypts of the vagina of fungal cells, and hence more frequent recurrence of the process.

Specific antifungal agents are available in dosage forms for internal and external use. They are represented by preparations of polyene (nystatin, levorin, amphotericin B, natamycin), imidazole (ketoconazole, clotrimazole, bifonazole) and triazole (fluconazole, intraconazole) series, as well as drugs from other groups (griseofulvin, nitroflungintozin), …

The action of fluconazole is aimed at inhibiting the sterol biosynthesis of the fungal membrane. The drug binds a group of heme dependent on cytochrome P-450 of the enzyme lanosterol-14-demethylase of the fungal cell, disrupts the synthesis of ergosterol, as a result of which the growth of fungi is inhibited. In this case, fluconazole selectively acts on the fungal cell, does not affect the metabolism of sex steroids. Concomitant use of fluconazole with oral contraceptives does not affect the effectiveness of the latter.

The leading triad of pathogens (C. albicans, C. parapsilosis, C. tropicalis) is the cause of more than 95% of candidiasis of all localizations and among the fungi of the genus Candida it is most sensitive to fluconazole.

It should be emphasized that the pharmacokinetic characteristics of drugs containing fluconazole, when taken orally and intravenously, are similar, which distinguishes them from other antimycotic drugs. The bioavailability of fluconazole is high and reaches 94%. Fluconazole is well absorbed in the gastrointestinal tract, penetrates the histohematogenous barriers. Its level in blood plasma after oral administration reaches 90% of that with intravenous administration.
It is important to note that the absorption of the drug from the intestine is independent of food intake.

Considering the long half-life of fluconazole from plasma (about 30 hours), this drug can be administered once, which determines its advantage over other antimycotic agents (already 2 hours after taking the drug, the therapeutic concentration in plasma is reached, and after 8 hours – in the vaginal contents) … The activity persists for at least 72 hours.
Recently, there has been a decrease in the effectiveness of all antimycotics and triazoles in the treatment of Candida non-albicans, which sometimes forces a change in the traditional scheme of prescribing fluconazole in the direction of increasing the “loading” dose to 200 mg.

While taking antimycotic drugs, patients with chronic vaginal candidiasis need a protein-vitamin diet with limited carbohydrate intake. The appointment of multivitamins and topical probiotics, for example, dried microbial mass of lactobacilli, is also shown. The use of a vaccine made from inactivated minus variants of lactobacilli has become widespread. Their use in 90% of cases provides a confirmed bacteriologically clinical recovery.

In the “first aid kit” of every obstetrician-gynecologist there is an arsenal of favorite means and treatment regimens for VC. At the same time, the leading role in their assessment is assigned to compliance in patients. Fluconazole is one of the few drugs that is not only effective in treating candidiasis, but also safe. This gives reason to consider it the # 1 drug in monotherapy. Fluconazole is preferable from the standpoint of pharmacoeconomics, it is safe in the treatment of VC, including in patients with a chronic recurrent form of this disease.

Modern approaches to the treatment of vulvovaginal candidiasis

Dr. Hooman-Khorasani
Posted in Uncategorized

Vulvovaginal candidiasis (VVC) is one of the most common diseases, affecting up to 75% of women of childbearing age. Many questions of its etiology and pathogenesis, including the development and formation of chronic and complicated forms, remain controversial and not fully resolved. 

The widespread use of EBC is associated with the effect of various environmental factors on the woman’s body, a change in the ecological situation, the widespread use of antibiotics and their interaction, which leads to a decrease in the body’s immunological defense. Other predisposing factors are also important, such as radiation therapy, long-term use of oral contraceptives, corticosteroids and cytostatics, metabolic and endocrine system disorders, chronic diseases of the gastrointestinal tract, hypo- and avitaminosis, immunodeficiencies that developed against the background of an infectious or hematological disease , oncological process, intoxication, etc.
KVV – payment for civilization. Its development is facilitated by wearing underwear made of synthetic fabrics that tightly fit the body, when a microclimate with high humidity and temperature is created, leading to maceration of the stratum corneum and creating favorable conditions for the development of local microflora, including intestinal microflora. In this microflora among the fungi of the genus Candida, the most common causative agent of CVC C. albicans is over 95%.

Fungi of the genus Candida are conditionally pathogenic microorganisms and can be isolated from the vagina of a practically healthy woman. But when exposed to aggravating factors, they acquire pathogenic properties and become the cause of CVI. Usually, VVC occurs endogenously as a consequence of dysmetabolic disorders and dysfunction of the immune system, but infection is also possible through sexual contact, although this point of view is still controversial and the sexual route of transmission is currently not considered significant.

There are uncomplicated and complicated forms of CVI. Antifungal susceptible C. albicans is the main cause of nearly 90% of uncomplicated mild to moderate EBC cases. In complicated forms of CVI, the disease acquires a severe course with frequent recurrence (more than 4 times a year) and is observed, as a rule, in women with extragenital pathology. The main causative agent of complicated CVI is Candida spp., Not belonging to the C. albicans species.

The ubiquitous number of patients with VVC dictates the need for timely diagnosis and rational etiotropic therapy.
The drugs used in the treatment of VKK are intended for both local and / or systemic use.

Systemic antifungal therapy is prescribed in the case of a pronounced clinical picture of IHC, chronic course of the disease, resistance to local therapy, and immunodeficiency (HIV infection). The most effective drugs of systemic action are azole compounds: fluconazole and itraconazole.

In the case of an uncomplicated course of IHC, drugs of local action are used for 6-7 days or drugs of systemic action (fluconazole 150 mg once, itraconazole 200 mg 2 times a day for 3 days).

In cases of a complicated course of VVC, the course of therapy should be doubled, while the duration of the use of local drugs should be 14 days. Systemic antimycotics (fluconazole, itraconazole) in all cases of chronic recurrent VVC are recommended as the main course of therapy.

In recent years, there has been a decrease in the sensitivity of opportunistic microorganisms to antibiotics. In this regard, new, pathogenetically grounded methods of treatment of VKK and mixed bacterial-fungal infections of the vagina are being developed, including with the local use of antiseptics. Gynecologists and their patients have at their disposal a large number of antifungal drugs and antiseptics, suitable or specially designed for the treatment of VVC (both as prescribed by a doctor and without a prescription). While self-medication with systemic antimycotics is becoming more and more popular, local therapy remains the most demanded and safest method of treatment. Specially conducted studies have shown that specialized intravaginal forms of antimycotics are currently most in demand, occupying more than half of the methods used for self-treatment and more than a quarter in treatment according to the doctor’s prescriptions in monotherapy.

Currently available topical antifungal agents include vaginal suppositories / balls or tablets, and special vaginal creams. The choice of a drug in each specific case should depend on the severity of the clinical course of VKK, the presence of mixed infection, concomitant pathology, and predisposing factors. The active ingredients generally include imidazole or polyene antimycotics. The latter include various preparations of nystatin and natamycin. Among the imidazoles, clotrimazole preparations are most commonly used. In addition, there are vaginal forms of miconazole, econazole, isoconazole, omokonazole and other imidazole derivatives.

Despite the variety of existing methods of treatment of vulvar and vaginal candidiasis, their frequency does not tend to decrease. This circumstance encourages practitioners to constantly search for and test new medications
offered by the pharmaceutical market for the treatment of this pathology.

Since the highly active antifungal imidazoles were introduced for the treatment of vulvovaginal candidiasis about 20 years ago, two important developments have occurred: one has expanded our knowledge of the pathogenesis of the disease, and the other has changed our view of the required duration of effective treatment.

Imidazoles remain the first-line treatment for vulvovaginal candidiasis. However, it is recognized that up to 50% of patients stop treatment after experiencing relief of symptoms. To improve adherence, physicians developed a trend to shorten drug use times, and as a result, treatments with miconazole nitrate and clotrimazole were shortened from the initial 14 days to 7 and 3. Ultimately, a single dose regimen was developed. , thanks to the creation of a new bioadhesive matrix in the form of a prolonged-release cream for intravaginal use with 2% butoconazole nitrate (butoconazole 1-BSR). Butoconazole nitrate was selected for its very acceptable safety profile and proven clinical efficacy. Meticulous analyzes have shown its broad spectrum of antifungal activity: it has consistently shown high activity against the most important eight non-albicans Candida species. Butoconazole 1-BSR outperformed the currently used imidazoles (miconazole, clotrimazole, ketoconazole, and terconazole) in inhibiting the growth of C. albicans and for pathogenic Candida species other than albicans.

Effective therapies using a single dose of potent fungicidal imidazoles seem to be nearly ideal for the clinical suppression of vaginal mycoses.
For the doctor, they actually guarantee the patient’s full compliance with the treatment regimen. Single dose therapy minimizes the inconvenience of long-term therapy plans. Repeated doses of the drug are especially unpleasant for the physically active or frequent traveler. Additional inconveniences are drug leakage and possible restriction of sexual activity during repeated doses of the drug.

In this regard, a vaginal cream with butoconazole 1-BSR (in 2% concentration) is of particular interest, which has the ability to adhere to the surface of the vaginal mucosa for a long period of time with a continuous release of the active substance, which ensures constant contact of the active active substance with the pathogenic agent and as a result, its high antifungal activity. The cream does not leak out of the vagina or cause irritation. Clinical studies and experience confirm that this cream lasts twice as long in the vagina as a conventional vaginal cream, and its systemic absorption is three times lower. A single intravaginal dose of butoconazole (2%) in a prolonged-release cream provides a speed of healing comparable to the speed of the known seven-day regimen of therapy with daily doses of miconazole nitrate (2%) in a regular vaginal cream. An additional advantage of butoconazole 1-BSR is the significantly faster relief of severe symptoms of vulvovaginal candidiasis, which is already detected on the first day after administration of the drug.

Butoconazole is an antifungal imidazole proven to be effective in the treatment of VKK. The guaranteed patient compliance with the single application of the drug, its efficacy and very favorable safety profile support its use in the treatment of VKK in clinical practice.

Candidiasis

Dr. Hooman-Khorasani
Posted in Uncategorized

Candidiasis is an infectious disease affecting the skin, mucous membranes and / or internal organs, caused by yeast-like fungi of the genus Candida. In the structure of nosocomial infections in debilitated patients, candidiasis is up to 12% and in the structure of infectious infectious mortality – up to 40%. The real clinical significance of this pathology is much higher: undiagnosed cases, an increase in hospital stay by 30 bed-days, significant economic losses for the treatment of visceral forms. The rapid growth (almost 11 times) in recent decades in the frequency of candidiasis in inpatients with various immunity disorders gave the specialists from the Center for Disease Control in Atlanta (USA) to call the current situation a nosocomial epidemic .

Microbiology
The main pathogen is Candida albicans, which is associated with more than 80% of candidiasis. But the infection can be caused by other species: C. tropicalis, C. parapsilosis, C. krusei, C. lusitaniae. Yeast-like fungi do not form true mycelium. The length of the pseudomycelium reaches 12-16 microns. Cells multiply by germination and multipolar budding. They can grow on agar culture media and are aerobic. Favorable conditions for growth 21-370C, pH 6.0-6.5. At 400C, growth is inhibited, at 500C, cells die, complete death with a few minutes of boiling.

Often, fungi are detected as saprophytes in the microflora on the skin and mucous membranes of the respiratory and gastrointestinal tract, and the vagina. Widely distributed in nature (fruits, vegetables, dairy products, etc.). 

Pathogenesis Yeast-like fungi of the genus Candida in small quantities can be part of the natural microflora of the mucous membranes, and therefore an important role in the development of candidiasis is played by violations of the competitive interaction of fungi with bacteria of the normal microflora of the host, the integrity of the skin and mucous membranes, phagocytosis, immunological reactions, hormonal balance, distress. Generalization of fungal infection is associated with a change in the relationship between the virulence of the fungus and the patient’s immunity.
Almost all parts of the immune system are involved in protection against fungal infections. Neutrophils, macrophages and eosinophils phagocytose candida blastospores, neutrophils and monocytes – their pseudohyphae. Disseminated candidiasis develops in patients with quantitative and functional defects of neutrophils, suppression of the T-cell link of immunity. A deep defect in the T-cell system explains the predisposition to the development of candidiasis in patients with AIDS. Specific conditions include drug neutropenia during treatment with cytostatics and immunosuppressants.
The disease usually occurs as a result of an endogenous infection. The penetration of the fungus into the tissue occurs when the skin and mucous membranes are damaged, for example, with perforations of the gastrointestinal tract, trauma, surgery, the introduction of catheters into the vessels, with peritoneal dialysis, intravenous drug administration, etc. intestinal dysbiosis.
The causative agent has allergenic and antigenic properties, but antibody titers are high only in visceral candidiasis.

Clinic
Depending on the degree of lesion, candidiasis can be superficial and deep. Superficial includes cutaneous, oropharyngeal, urogenital and is characterized by lesions of the corresponding mucous membranes. The most dangerous are disseminated candidiasis and deep visceral forms.
In the cutaneous form, the disease manifests itself in the form of small vesicles, in the place of which erosions quickly form with a shiny, moist, dark red surface, clear irregular boundaries, with a border of exfoliating macerated epidermis. Characterized by “dropouts” on healthy skin in the form of the smallest erosions with a fringe along the edges and erythematous, scaly spots in the center. The third and fourth interdigital folds of the hands and feet, the inguinal and axillary regions, and the anus may be affected. Paronychia develops. Candidiasis of the oral mucosa (pseudomembranous mucositis or “thrush”) manifests itself in the form of white plaques on the mucous membrane of the cheeks, back of the throat, and tongue. The affected area is usually painless. When plaque hardens and cracks form, slight soreness may appear.
The defeat of the esophagus by candidal infection is characterized by the appearance of dysphagia and single phagia. When the intestines are involved in the process, abdominal pain, bloating, diarrhea are noted. There may be pain and itching in the anus. Stool often contains blood. With agranulocytosis, infiltration and necrosis of the intestinal wall lead to the development of intestinal obstruction, peritonitis, gastrointestinal bleeding, and conditions characterized by high mortality.
Urogenital candidiasis has three clinical forms: candidiasis, acute and chronic (recurrent) urogenital candidiasis. Candidacy is characterized by the absence of complaints. But with microbiological research, fungi are found in small quantities. The acute form is characterized by a pronounced inflammatory picture: redness, swelling, rashes on the skin and mucous membranes of the urogenital organs. The duration of the disease with an acute form of candidiasis does not exceed 2 months. The chronic form is characterized by a disease duration of more than 2 months. Clinically, urogenital candidiasis is manifested by profuse or moderate cheesy discharge, itching, burning, irritation in the external genital area, increased itching during sleep or after water procedures and intercourse, an
unpleasant odor that intensifies after sexual intercourse. When the urethra is damaged, discharge from the urethra of a pale yellow color appears, often scanty. Candidal urethritis in men can be complicated by candidal prostatitis, epididymitis, cystitis.

Candidal endocarditis is similar in flow with bacterial, manifested by prolonged fever and the formation of vegetations on the heart valves. Against the background of immunity disorders, fungal microabscesses in the myocardium can develop, leading to arrhythmias. Sometimes fungal thromboembolism of the coronary arteries develops with the development of ischemia and heart failure.
Lung involvement usually results from hematogenous spread of infection. In such patients, sputum is almost not separated, and the symptoms of pneumonia are similar to bacterial, although they are less constant. There is a discrepancy between severe respiratory failure and scant auscultatory and radiological signs.
Candidal meningitis is typical for newborns and premature babies, and also as a secondary complication of neurosurgical interventions. It is most difficult in patients with impaired immunity. It manifests with severe cerebral and meningeal symptoms, in the case of intracerebral abscesses – focal symptoms with neutrophilic or lymphocytic pleocytosis (depending on the degree of neutropenia). Skin lesions in acute disseminated candidiasis occur in 5-10% of cases. It manifests itself in the form of dense, rising above the surface of the nodes 0.5-1 cm in diameter, pink-red in color, which do not disappear with pressure, papular or maculopapular rash, similar to drug.
For chronic disseminated candidiasis (“hepatolienal”), the most characteristic is the defeat of the liver and spleen with their increase and the development of multiple microabscesses. The disease is accompanied by prolonged fever, sometimes with the development of jaundice and pain in the right hypochondrium. In half of the patients, high leukocytosis and severe hyperbilirubinemia (mainly due to the direct fraction) are noted in the blood. The level of transaminases increases inconsistently and no more than 3 times. Often such liver damage looks like cholestatic hepatitis and is mistaken for toxic liver damage by cytostatics, especially in the absence of characteristic changes according to ultrasound data.
Hematogenously disseminated forms of candidiasis (candidal sepsis) are characterized by a severe course, high fever and severe symptoms of general intoxication. Fever of an irregular type, with repeated chills alternating with profuse perspiration. The disease is accompanied by damage to various organs (lungs, gastrointestinal tract, brain, kidneys, etc.), and the presence of several foci is characteristic. Often, the retina is involved in the process and spread to the vitreous body. Patients are worried about pain in the eyes and visual disturbances. When the lungs are damaged, a strong cough appears,
at first dry, then with a small amount of viscous mucopurulent sputum, sometimes streaked with blood. X-ray examination reveals infiltrates, more often in the lower lobes, prone to fusion. Disintegration with the formation of cavities is often observed. The pleura may be involved. The hilar lymph nodes are enlarged and indurated. Occasionally, hematogenous, deep, localized infections of Candida such as osteomyelitis, arthritis, endophthalmitis, and liver abscess occur. Blood cultures remain negative, and if they become positive, it is often only late. If granulocytopenia persists and the neutrophil count does not increase, the likelihood of death is very high, even with antifungal treatment.

Diagnosis
Diagnosis of cutaneous lesions of Candida spp. is put on the basis of clinical manifestations.
Candidiasis of the digestive tract is determined by the characteristic thrush in combination with symptoms of damage to other organs. It is possible to reveal the involvement of the esophagus, stomach, and large intestine in the process by endoscopic examination (with taking material from the affected areas for laboratory research).
In genitourinary candidiasis, colposcopy after staining with Lugol’s solution reveals colpitis in the form of small-point inclusions (“semolina”), often with a pronounced vascular pattern. Microscopy of a vaginal smear stained with methylene blue is performed. Scanty sputum discharge in pneumonia still allows the pathogen to be isolated in it.
The clinical manifestations of candidal meningitis are nonspecific, and morphological examination of the cerebrospinal fluid of the drusen of fungi or pseudomycelium cannot be detected. The nature of the disease is often established posthumously.
A reliable diagnosis is considered with the laboratory isolation of yeast-like fungi (from ulcerative lesions of the mucous membranes, pus, bile, and in case of candidal sepsis – from blood and punctuate of closed cavities). It is important to detect fungi in histological preparations obtained with targeted biopsy, re-isolation of the same type of fungi from an open affected surface, and their antigens in the blood serum. High titers (1: 160-1: 1600) or an increase in antibody titers during the course of the disease are considered positive.
Of the immunological methods in the diagnosis of candidiasis, enzyme immunoassay, agglutination reactions, complement binding, direct hemagglutination, and immuno-electrophoresis are used. The main ones are enzyme-linked immunosorbent assay, polycepid reaction, crops. In HIV-infected patients, serological tests remain negative.
At present, in addition to classical microbiological methods, the determination of D-arabinitol and mannose markers of candidiasis by gas chromatography is used, which allows not only to establish a diagnosis, but also to evaluate the effectiveness of treatment.

Treatment
Treatment is carried out in a hospital and is aimed at eliminating the factors contributing to the occurrence of candidiasis. In case of skin lesions, local treatment is carried out in an open way using antifungal ointments.

For lesions of the mucous membranes, an antifungal suspension is used. With lesions of the gastrointestinal mucosa, antifungal drugs can be administered orally, intravenously, and in the form of rectal suppositories.
For urogenital candidiasis, antifungal drugs are administered in the form of tablet forms, vaginal balls, tablets and ointments. For visceral and disseminated forms of candidiasis, antifungal drugs are prescribed intravenously in the form of drip infusions. Fluconazole occupies a special status among antifungal drugs. It is distinguished by high bioavailability and efficiency at any localization of the process – from common skin lesions to meningitis, penetration into all biological fluids and body tissues, a good effect of oral forms, the possibility of intravenous use in a serious condition of the patient and the introduction of a shock (double) dose on the first day of treatment , lack of toxicity and low frequency of adverse reactions. The drug can be used in premature babies. In all cases, fluconazole is prescribed once a day.
When fluconazole therapy is ineffective, one should think about candidiasis caused by naturally resistant Candida species, such as C. krusei. In these cases, antifungal therapy is recommended with an effective, but potentially toxic, amphotericin B. Treatment is carried out only in a hospital under close laboratory supervision. Doses of amphotericin B due to the danger of nephrotoxic reactions should not exceed 0.5-1 mg / kg per day intravenously once a day or every other day. For microabscesses in the liver, brain and other organs, the liposomal form of amphotericin B is most effective.
In stubborn cases, along with antibiotic therapy, a multivalent vaccine from Candida cultures, antihistamines, solutions of sodium or potassium iodide inside, B vitamins, ascorbic acid are used.

Prognosis
With superficial forms, the prognosis is favorable, with generalized and visceral forms, it is more serious.
Prevention
Long-term antibiotic therapy requires the appointment of antifungal drugs.

Vaginal candidiasis

Dr. Hooman-Khorasani
Posted in Uncategorized

Vaginal candidiasis – this diagnosis was made at least once in the life of almost every woman. It is a collection of fungal diseases of an infectious nature, proceeding in the form of vulvovaginitis or, less often, fungal dermatitis of the vulva. They are so common that candida infection can be detected in 45% of women who have a discharge.

Source of infection: about the pathogen

The causative agent of vaginal candidiasis are specific yeast-like fungi belonging to the known genus Candida. The peculiarity of these microorganisms is that they are part of the natural vaginal flora, and do not enter the body immediately before the onset of the manifestations of the disease. Representatives of our flora are in a kind of competitive relationship. The beneficial microflora has a numerical advantage. For example, on the mucous membrane of the female vagina, the number of lactobacilli exceeds 95%. They prevent fungal agents from multiplying. The nature of candida is symbiotic: they are able to peacefully coexist with other representatives of microflora, while not harming the human body.

In order to maintain the ability to multiply and not die, fungi hide behind a protective shell. When the balance of microorganisms in the female vagina is disturbed, candida expose their cells and begin to multiply in a spore manner. New individuals create chains that turn into colonies. The causative agent of thrush begins to infect the cells – it immediately acts on the epithelium, and then penetrates deeper. Its pathogenic effect is expressed through the poisoning of cells with toxins after the fungus “takes away” all the useful substances that interest it.

Features of female microflora

At different periods of life, the composition of the microflora of the female vagina is very different. So, in newborn girls, the vaginal mucous membranes are sterile. During the first three weeks, he is still affected by maternal estrogens, and after the mother’s hormones are completely eliminated from the body, microorganisms settle in the vagina, which will make up the microflora. In adolescence, the flora of a girl becomes identical to an adult, fully consistent with her composition. In addition to a large number of lactobacilli (their number can reach 95-98%). They are lactobacilli or lactic acid bacteria of nine different species. Conditionally pathogenic microorganisms coexist with them:

  • Staphylococci
  • Staphylococci
  • Streptococci
  • Anaerobic bacteria
  • Gardnerella
  • Mycoplasma
  • Candida.

Of course, the percentage of representatives of opportunistic flora is individual for each woman. Moreover, the total number of conditional threats is too small to cause harm. The superficial layer of the vagina contains glycogen, the amount of which is regulated by estrogen. Lactobacilli are involved in the breakdown of glycogen to lactic acids, which maintain the acidity level on the mucous membranes. Lactoflora also unites in colonies, and then becomes attached to the mucous membranes of the vagina. As a result, epithelial cells are surrounded by the vital products of lactobacilli in the form of a special biofilm – a protective glycocalyx. Lactic acid does not allow opportunistic microorganisms to multiply, protecting the body from inflammation and infections. Lactic acid also helps regulate the candida population. Penetration into the mucosa is prevented by glycocalyx. But as soon as the number of lactobacilli decreases , the number of conditionally pathogenic flora increases, and the protective abilities of the vaginal mucosa are significantly reduced.

Manifestations of vaginal candidiasis at different periods

The self-regulating dynamic system, which is the flora of our vagina, can malfunction. Fluctuations in her parameters accompany a woman constantly, they can be associated with different life stages and simply cyclical changes. 75% of women claim that they have encountered such a phenomenon as thrush at least once. However, not all deviations from the norm can affect the development of the disease. One of the most common causes of vaginal candidiasis is called pregnancy. During this period, the frequency of cases increases almost 3 times. Most often, the disease manifests itself in the first and last trimesters. At the beginning of pregnancy, there is literally a crazy hormonal surge, so the composition of the microflora can change significantly. In recent months, the load on the woman’s body has been increasing as much as possible, the body can weaken under the influence of a variety of external and internal factors. Against this background, genital candidiasis willingly develops . The same diagnosis can be made not only for adult women, but also for children. Girls at three, seven years old, and then during puberty are often victims of infection. If a teenager has an inflammatory disease on the genitals, then in 25% of cases it is the development of the fungus that becomes its cause. Vaginal candidiasis does not spare older women. During the period when hormonal functions fade away, a decrease in lactobacilli in the vagina is considered quite natural. Candida use this state with pleasure. In the period before menstruation, the number of estrogen changes, which entails changes in the composition of the flora and acidity. Therefore, chronic thrush usually manifests itself a week before the onset of menstruation. After they are over, the acidity returns to normal, so candidiasis itself fades away. Usually, the disease has a rather bright clinic, a persistent course and a recurrent nature. Moreover, if a woman has a good immune system, then the symptoms may be mild, and then disappear on their own. 

Why is thrush worried: reasons

The cause of the development of the disease is the excessive reproduction of the fungal flora in the vagina. It occurs against the background of a general decrease in immunity. There are also a number of predisposing factors that contribute to the fact that thrush manifests itself as a disease: 

  • Antibiotics (if they are used very often or uncontrollably) that reduce local immunity, as well as adversely affect the growth of beneficial microflora.
  • Injuries that are on the vaginal mucosa: for a number of reasons, it is possible to violate the integrity of the vaginal epithelium with simultaneous damage to the protective layer of lactobacilli. As a result, these areas are defenseless when exposed to infection.
  • Diabetes mellitus is accompanied by impaired glucose metabolism, therefore, the sugar content in the epithelial cells of the vagina increases, which leads to a decrease in the number of beneficial bacteria. Also, diabetes in itself greatly affects the immune system, reducing its protective abilities.
  • Pregnancy, as already mentioned, is a very favorable period for fungal agents. Hormonal changes at this time are combined with immune disorders, which gives rise to the reproduction of harmful microorganisms.
  • The climacteric period is characterized by atrophy (thinning) of the natural mucous layer. As a result, such mucosa contains less glycogen, and the number of lactobacilli decreases.
  • Hormonal drugs (especially if they are oral contraceptives) artificially regulate the level of female estrogen. If natural cyclic changes occur under the pressure of drugs, then this again affects the concentration of glycogen.
  • Inflammatory processes of the reproductive system lead to the fact that the mucous membrane becomes vulnerable, losing its natural protective properties.
  • Bacterial vaginosis can be a backdrop for yeast infection in the vagina.
  • Intestinal dysbiosis, as well as other chronic ailments associated with the work of the gastrointestinal tract, can provoke the growth of candida.
  • Drugs that suppress the immune system – corticosteroids, cytostatics, immunosuppressants – can lead to the fact that protective mechanisms cannot work with sufficient force.
  • Allergies and immunodeficiencies also seriously reduce immunity.
  • Children’s age from two to seven years is characterized by increased allergization, in addition, the structure of the vaginal mucosa during this period is somewhat “inferior” due to insufficient maturation, therefore girls often develop vulvovaginitis of a fungal nature.
  • During adolescence, the risk of developing vaginal candidiasis increases greatly. This is due to physiological hormonal surges.
  • Failure to comply with personal hygiene standards can provoke the growth of candida. This fungus is able to survive not only in the human body, but also in the environment. Together with contact with unwashed hands and insufficiently clean tissues close to the genitals, a large number of pathogens can penetrate into the vagina.
  • The fact that candidiasis is contagious remains unresolved. This is due to the fact that the presence of a disease in a sexual partner is not a guarantee that it will develop in a woman. However, sexual contact with an infected man against the background of a weakened female immunity can provoke the development of the disease. If one of the partners is sick, then it is more advisable to conduct treatment in pairs. At the same time, it is better to abandon sexual intercourse for the duration of therapy, and after it ends, use barrier contraception for some time in order to protect against re-infection in case of recurrent thrush.

Infection options

The disease usually affects the surface layer of the vaginal epithelium. Until the fungal agents are deepened, they can interact quite closely with the rest of the microorganisms. As a result, the further development of the disease is closely related to the state of the vaginal environment and its composition at the microbiological level. Along with the decline in the number of lactobacilli, a chance for reproduction appears not only in fungi, but also in other microorganisms. They can create peculiar associations and even supplant fungal agents or, conversely, help her take a leading position. In approximately 20% of patients, trichomoniasis or gardnerellosis is also detected simultaneously with vaginal candidiasis. If the vaginal dysbiosis is moderate, then the number of lactobacilli can still inhibit the growth of candida, preventing it from penetrating deeper into the mucosa, however, their strength is not enough to completely eliminate the fungal infection. As a result, the body is in a state of some balance that occurs between the fungus and the beneficial flora. As a result, the disease can go in the following ways: 

  • Candidiasis, which is not a pathology, since it has no negative consequences.
  • If the body has sufficient internal strength, then at the expense of its own reserves, it simply restores the normal ratio of microorganisms. In this case, the fungi die and recovery occurs. Such a course is characterized by acute thrush in those women who have strong immunity. 
  • When the internal resources for the complete extermination of the infection are not enough, but enough to prevent the infection from multiplying for some time, this results in the remission of chronic candidiasis.
  • The internal resources of the body are often severely depleted, which aggravates the infectious process and constantly provokes an exacerbation of the disease. Chronic vaginal candidiasis, which is constantly accompanied by relapses, is usually characteristic of women who have not only weakened immunity, but also have an unfavorable gynecological history and extragenital pathology.

Most patients can clearly describe the situation that provoked the development of infection in their case.

Symptoms: how to recognize vaginal candidiasis

As a rule, the disease has characteristic symptoms that can be quite easily recognized. It: 

  • Itching

It manifests itself both on the external genitalia and inside the vagina, accompanied by burning and usually intensifies in the afternoon, after the mucous membranes come in contact with water and at night. The severity of the symptom is also facilitated by walking and sexual intercourse. Doctors have a test for thrush: a woman sits in the “foot to foot” position, at this time the itching with candidiasis intensifies. The manifestation of this symptom is also affected by cyclicality: before menstruation, it is more pronounced. It happens that other symptoms of the disease do not appear, but itching itself requires research for the presence of fungal flora.

  • Allocations

Of course, women constantly have vaginal discharge, but during the development of a fungal infection, they differ from the norm. At first, there are more of them, and then, with the development of the disease, the discharge also changes its structure. They become like cottage cheese due to the presence of white lumps and flakes in them.

  • Pain sensations, urination disorders

Due to the strong inflammatory process that provokes a fungal infection, the mucous membranes of the vulva and urethra also suffer, so pain accompanies urination. Also, due to contact with urine, a burning sensation occurs.

  • Puffiness, hyperemia

Inflammation leads to the fact that the external genital organs and the vagina swell and swell, and the places of direct introduction into the epithelium of the fungus turn red.

  • Discomfort during intercourse

Due to swelling of the mucous membranes, painful sensations are more pronounced, pain and burning accompany sexual intercourse, and in most cases there is no orgasm.

Establishing diagnosis

Despite the fact that the symptoms of vaginal candidiasis are quite characteristic, it is impossible to engage in self-diagnosis. The fact is that the disease can occur against the background of more severe infections, and the combined infection is fraught with a lot of threats. In addition, for successful treatment, it is necessary to establish the reason why candidiasis began to develop. Only after its elimination will the disease leave the woman. In nature, there are about 20 species of candida that can provoke symptoms of thrush in the human body. For successful treatment, you need to determine which species caused the disease in order to be able to choose the right drugs. The doctor makes a diagnosis by analyzing data from such sources:

  • Anamnesis
  • Clinical picture
  • Analysis data.

The history contains information about the patient’s complaints, as well as her assumptions about the cause of the disease and a history of recent illnesses. The clinical picture gives the doctor a high probability to assume that it was the manifestation of vaginal candidiasis that led the woman to the doctor. During the examination, the doctor sees characteristic discharge, a white coating on the mucous membranes. Due to itching, mechanical damage is observed in the form of ulcers, scratching, and wounds. In a smear taken from the vagina, a large number of candida is found (a moderate amount is considered normal). Inoculation is also carried out on a nutrient medium to determine the type of yeast. Additionally, you will need to pass general blood and urine tests, a blood glucose test. If the disease is started, the specialist will recommend visiting an ultrasound room to see how seriously the infection is spread inside, and check the organs for complications.

How is fungal infection treated?

Treatment of vaginal candidiasis should be prescribed only by a specialist. Contrary to the information that we hear on television, this disease is not so easy to get rid of. The treatment has a lot of nuances that only a good gynecologist can know. An important point is the elimination of provoking factors. For this, the patient needs to follow a few simple rules:

  • Give up all bad habits
  • The patient is shown sexual rest
  • Do not take unnecessarily antibacterial and hormonal agents
  • Follow the rules of personal hygiene.

It is important to follow a diet during the treatment of vaginal candidiasis. To do this, you need to focus on cereal dishes, as well as eat more vegetables and fruits. It is useful during this period to drink yoghurts, kefirs, starter cultures based on beneficial bacteria to restore microflora. However, it is better to temporarily exclude some products:

  • Chocolate
  • Sweets
  • Bread
  • Bakery products
  • Smoked meats
  • Pickles
  • Spicy and highly seasoned dishes
  • Milk products.

If you follow this simple diet, then recovery comes much faster. Hygiene procedures must be performed with great care. It is better if the woman will wash herself twice a day. Douching is contraindicated. Do not use aggressive hygiene products for washing. You can use a solution of soda to reduce acidity, a slightly pink manganese solution in order to dry mucous membranes, as well as decoctions and infusions of chamomile, barberry, calendula, and cloves. By the way, chamomile is also good for ingestion (like a herbal tea). After water procedures, you need to blot the external genitals with a clean, specially designed towel or pharmacy napkins. Linen should be worn only clean, made from natural fabrics, it should not be tight, like the clothes themselves.

Topical treatment of vaginal candidiasis

If thrush bothers a woman for the first time, then the infection reacts to local therapy. They produce drugs for external use in the following forms: 

  • Vaginal suppositories
  • Candles
  • Vaginal tablets
  • Creams
  • Ointments
  • Gels
  • Solutions
  • Sprays.

Local treatment has many advantages, since the effect on the fungus is carried out directly in the place where the infection has settled, then they do not have a negative effect on the body. The therapeutic effect of this interaction is quite strong, therefore, local drugs quickly relieve the patient of the manifestations of candidiasis. It is convenient and easy to apply. Most popular now:

  • Clotrimazole
  • Pimafucin
  • Ketoconazole
  • Miconazole
  • Nystatin.

The course of treatment ranges from a week to a month, depending on the drug and the severity of the disease. But drugs for external use are in most cases single-component, and this leads to the fact that they cannot cope with an infection that has managed to take root.

Systemic treatment of thrush

Where local therapy is not effective enough, reinforcement in the form of systemic drugs is required. They are available in the form of tablets or capsules. Oral antifungal agents attack the fungus from the inside, but at the same time they have a large number of contraindications, so their intake should be carried out under the supervision of a specialist. Most of the pills for thrush are developed on the basis of Fluconazole. A single dose of 150 mg of the drug is enough to help the body cope with the infection, but there are times when the drug is extended to 3-4 weeks (the dose is the same, taken once every seven days). Intraconazole is considered an alternative to Fluconazole. Its dosage is slightly higher, and the doctor determines the intensity of the course individually. Also in the treatment of fungal infections for oral administration, Nystatin and Levorin (these are antibiotics) are suitable. Acute thrush, subject to timely treatment, takes place after a week, but the treatment of the chronic form of the disease is more difficult, after getting rid of the symptoms for three months, control is performed to avoid new outbreaks. It is impossible to stop treatment when the symptoms disappear, you need to bring the course to the end – this will avoid complications. If you are worried about vaginal candidiasis, and you do not know how to cope with the problem, or have doubts, write to our specialist and get a detailed qualified answer as soon as possible.

Photodermatitis is not a sentence

Dr. Hooman-Khorasani
Posted in Uncategorized

Photodermatitis is a type of dermatitis in which there is an acute skin reaction to sunlight, or, more specifically, to ultraviolet rays. It can be sudden or chronic acute. Photodermatitis occurs when the immune system reacts to ultraviolet rays as hostile to the body.

A person with photodermatitis can develop a rash, blisters, or flaky spots after exposure to the skin of the sun. The degree of exposure and reactions differ for each person. Photodermatitis can also appear as a side effect from certain medications: antibiotics, antifungal drugs, nonsteroidal anti-inflammatory drugs, diuretics, antidepressants, chemotherapy agents.

People who are most prone to photodermatitis usually have fair skin, lupus erythematosus, or those who actively take sunbaths from 11 a.m. to 3 p.m.

For the prevention and treatment of photodermatitis, according to the recommendation of the medical site “ altherapy.ru ”, you should completely exclude exposure to the sun from 11 to 15 hours, constantly use sunscreens with a degree of protection from 30 to 50 spf, limit the intake of drugs that provoke manifestations of photodermatitis. If a disease occurs, an urgent appeal to a dermatologist is necessary to prescribe means of suppressing the immune system and antihistamines. Also, homeopathy is successfully fighting the manifestations of photodermatitis. 

Most reactions of photodermatitis, according to the site & quot; altherapy.ru & quot , will disappear sooner or later, without causing any permanent harm, if the patient promptly contacts a dermatologist and the underlying cause of the disease is diagnosed and eliminated. In rare severe cases, the treatment of photodermatitis can take several years, and also have serious complications in the form of a chronic form of the disease, as well as photosensitivity, hyperpigmentation, premature aging of the skin, melanoma (skin cancer). 

Patients suffering from photodermatitis should be closely monitored by a doctor, who must always monitor the frequency and duration of attacks. This information may help determine the most appropriate treatment.

Attention, feet!

Dr. Hooman-Khorasani
Posted in Uncategorized

We are often extremely inattentive to our own legs. But summer roads and swelling make you care for them regularly. Let’s start with simple gymnastics: legs up! Legs are great “workaholics.” They “work” every day, from morning to night, and at the same time carry the entire weight of the body. In return, they require basic attention: daily care and good shoes.

The measure of attention to the legs is directly proportional to overall well-being: all internal organs are projected onto the foot. Cardiovascular disease or kidney disease can cause regular leg swelling. Failure to pay attention to flat feet can lead to deformity of the fingers or to more serious complications. So make it a rule to follow Beauty Tips every night.

GENTLE MASSAGE

It is advisable to rub foot cream with simultaneous massage. Foot massage is a combination of stroking, rubbing and kneading movements. Start with your foot. Feet and lower legs massage, gradually rising up to the knee joint (3-4 times). Then massage each finger from the tip to the base, then stretch the entire foot. Finish the massage with stroking (3-4 times).

NO FATIGUE, NO SWEAT

With excessive sweating of the legs, it is recommended to use talcum powder daily or do foot baths with the addition of boric acid or borax (1 teaspoon per basin). After such a procedure, it is very good to wipe the gaps between the fingers and sprinkle them with a powder consisting of a mixture of 6 teaspoons of borax, 6 teaspoons of talcum powder and 1 teaspoon of boric acid. Put on your socks at night. Do not wash your feet in the morning.
Oak bark bath (for sweating). Brew 1 tbsp. a spoonful of bark with a glass of boiling water, leave for 2-3 hours; add the infusion to the water prepared for the bath.

DRY AGAINST FUNGI

Strangely enough, fungal diseases occur in very clean people. Try to keep your feet dry at all times to avoid problems.
In the evenings, rinse your feet and wipe dry all the interdigital spaces.

If there are cracks, itching, redness, lubricate the skin between the fingers with green paint or Novikov liquid (glue), or just iodine (it is better to dilute the iodine solution in half with vodka). In more serious cases, use antifungal ointments – mycoseptin or Teymurov paste.

GYMNASTICS FOR LEGS

Gymnastics for the legs is very useful: walk on tiptoes, on the lateral surfaces of the feet, on a rubber mat or in massage slippers. On vacation, try to paddle your barefoot more on water and on pebbles.

Foot care prevents varicose veins. As a preventive measure, the exercise “bicycle” and walking with feet on the wall are effective.

SAFE PEDICURE

A pedicure is not only a sure sign of true love for yourself, but also a pleasant excuse to bring your legs to life.
A professional procedure can be provided only by a beauty salon and pedicurist with experience. Look for your master in a salon with a good reputation, with disposable tools and sterile underwear. Any infection threatens with months of painful treatment. If you yourself have mastered the pedicure technique, do not forget:

pre-take a warm soapy foot bath;
sanitize tools;
cutting off nails, do not round their edges;
try not to hurt the delicate cuticles on the toes, the wounds are painful and take a long time to heal.

BEAUTY TIPS
If you have been walking intensively all day or have stood a lot, do not go to bed until you have relieved fatigue from your legs with a cream, bath or massage.
Avoid uncomfortable tight shoes with high erratic heels. Do not spare money for expensive, comfortable shoes.
If you have problems with the foot – flat feet,
deformation of the fingers – buy shoes with arch support or insert them into new shoes.
Use a special foot cream regularly. Try to get one that contains extracts of horse chestnut, caffeine, horsetail, or other ingredients that improve blood and lymph circulation.
In the evening, lie on the floor for at least half an hour and lift your legs up or lean them against the wall.
Take a foot bath after exercise. If time permits, alternate hot and cold baths, normalizing (the temperature of hot water should be 40-50 °, cold – 20 °). While sitting on a chair, lower your legs first in a bowl of hot water, then with cold water and so on 8-10 times (legs should be three times longer in hot water than in cold). Finish the procedure in cold water. In a bowl of hot water, you can add an infusion of chamomile, linden blossom or nettle. After the bath, dry your feet well, then rub in the cream.

By the age of 12, 90% of Russians are already infected with the facial herpes virus

Dr. Hooman-Khorasani
Posted in Uncategorized

According to the World Health Organization, herpes, one of the most common viral diseases, “sits” in almost every person.

By the age of 12, 90% of Russians are already infected with the herpes simplex virus type 1 (facial herpes). The infection sticks to the rest later, already in adulthood.

Microtraumas of the skin, mucous membranes, and conjunctiva of the eyes have been and remain the entry gates for infection. Having penetrated the nerve endings into the sympathetic ganglia (the oldest formations of the human nervous system), the virus settles there for life.

Lurking in nerve nodules, he patiently waits for his time and as soon as this hour strikes (hypothermia, stress, weakened immunity), extremely painful vesicles and sores appear on the skin.

But some people carry the virus in themselves for years and do not get sick, while others are regularly subjected to the strongest 2-3-week herpes attacks, when the temperature rises to almost 40 degrees, the lymph nodes increase and hurt.

Herpes can occur under the guise of a variety of diseases, such as cystitis or thrush. Traditional antibiotics and antifungal medications that are effective for these diseases are completely useless in the case of herpes. In combination with certain types of papillomoviruses, genital herpes becomes one of the factors in the occurrence of cervical cancer in women and prostate cancer in men.

Herpes simplex virus type 1 causes a “fever” on the lips. It can also affect the eyes, larynx and pharynx (herpetic sore throat). The main target of the herpes simplex virus type 2 is the genitals. More recently, facial herpes and genital herpes affecting the genitourinary system lived on their own, but today, when the concept of oral sex is known to every schoolchild, the spheres of influence of viruses have mixed.

Cytomegaly disease, which weakens the immune system and leads to severe pathology of pregnancy and newborns, is also one of the forms of herpes. Zoster caught herpes can get one of two “pleasures”: children – chicken pox,
adults – herpes zoster.

The latter, in addition to the strongest skin rashes, gives a complication in the form of inflammation of the nerve node, in which the virus “slept” from the moment it entered the body in childhood. True, the skin will heal (if it is well treated – in two weeks, bad – in two months), but the pain can remain for many years.

Herpes, like HIV, suppresses cellular immunity, multiplying in white blood cells, white blood cells and lymphocytes. As soon as they stop working, the body’s defenses are weakened, the virus multiplies even more.

It is almost impossible to avoid infection with the herpes virus. After all, the owner of herpes can be infectious not only at those moments when the virus finds itself with rashes on the skin and mucous membranes. Sometimes the infection does not manifest itself at all, but the virus is nevertheless excreted with saliva, sperm, and cervical secretions.

If a woman with a “fever” on her lips cleans her face, then the virus from the lips can get into every pore
cleaned by the beautician. And herpes of the whole face will begin. It can cause severe pain along the branches of the trigeminal nerve – in the ear canal, in the jaw, pain syndrome like cervical radiculitis and angina pectoris.

Genital herpes can sometimes provoke terrible pain in the pelvic plexus in women and in the perineum in men. And when such manifestations are seen by doctors who do not know the characteristics of the virus, then they begin to treat not for it, and the story can be very delayed.

Modern methods of DNA diagnostics are able to detect virus particles and tell with high accuracy whether there is this “beast” in your body. But information about how active he is will not be given. For this, a special culture for the virus is done. Pregnant women or just planning to become mothers are recommended to do just such tests.

The scenario depends on how strong a person’s immune system is. If herpes worsens again and again,
it means that a serious breach has appeared in the body’s defense line.

So, the best, cheapest and most affordable way to strengthen the body is a healthy lifestyle. If the defenses are completely weakened, the doctor may recommend drugs that stimulate the production of their own interferon.

And most importantly, it is necessary to eliminate the cause that brought down the immune system. Exit, finally, from stress, relax, eat right. In short, take care of yourself.

Who needs to see a doctor
Those who have a fever on the lips or genitals regularly, more often 3-4 times a year;
parents with herpes, who have a small child in their family;
those who have had eye herpes at least once;
children with frequent fever on the lips, under the nose, in the nose;
genital herpes should be treated in any case, especially for women preparing for pregnancy.

Nail plate fungus

Dr. Hooman-Khorasani
Posted in Uncategorized

Doctors say that in recent decades 20-25% of the inhabitants of our planet are diagnosed with nail diseases. About 90% of cases of these diseases are due to fungal lesions of the nail plates on the legs or arms. Many patients are mistaken and believe that this is a cosmetic defect, but this is a dangerous delusion. Fungal lesions contribute to the penetration of a wide range of infections into the nail and skin of the foot. As a result, you can completely lose nails, as well as get damage to nearby skin.

Where and how can you get infected?

There are certain risk factors that can contribute to the spread of nail plate infection. Let’s indicate the main limits of risk where infection with onychomycosis occurs.

So, where and under what circumstances does this infection penetrate easier on the nails?

  • When you visit pools, baths or a water park without proper shoes;
  • when visiting cinemas and supermarkets, where a person comes into contact with public facilities that may contain fungal microorganisms (binoculars, baskets, carts, money and tickets);
  • contact with non-sanitized manicure accessories;
  • when you wear shoes that meet the latest fashion trends, but do not quite meet the requirements of comfort and safety (narrow, uncomfortable, impermeable). Such shoes contribute to the appearance of scratches and cracks in the nails, and it is much easier to get a fungus into an injured nail;
  • when you live with a person who suffers from fungal diseases of the nails (using common household items, bedding and bedding).

When to be treated?

If you find a fungus on your toenails, immediately contact a specialist podologist: 

  • when there is itching and burning of the skin of the foot, against the background of which peeling or redness appears;
  • discoloration of the nail, the appearance of spots;
  • changes in the structure of the nail, the appearance of cavities or tubercles;
  • bad smell.

Please note that in the initial stage of the development of the disease, the nails may become white or gray, with yellowish spots. More advanced forms can be characterized by the appearance of spots and green stripes, and the nail can become completely black or brown.