Tags: Fluconazole

Leishmania

The genera Leishmania and Trypanosoma are members of the family Trypanosomatidae. These protozoans cause diseases with widely varied clinical presentations as well as geographic distributions, including leishmaniasis, American trypanosomiasis (Chagas’ disease), and African trypanosomiasis (sleeping sickness).

Cryptosporidium, Cyclospora, & Isospora Species & Microsporidia

Within the last decade, the AIDS epidemic has heightened awareness of several gastrointestinal spore-forming protozoan pathogens. The genera Cryptosporidium, Isospora, and Cyclospora are members of the subclass Coccidia and phylum Apicomplexa; the microsporidia are a group of organisms belonging to the phylum Microspora.

Fusarium, Penicillium, Paracoccidioides, & Agents of Chromomycosis

Fusarium spp. is an emerging fungal pathogen. Although long recognized as a cause of local infection involving nails, traumatized skin, or the cornea (eg, in contact lens wearers), deep or disseminated infection was not described until the mid 1970s. Despite its worldwide distribution and its frequent recovery from soil and vegetative material, infection is quite rare. Only ~ 100 cases involving invasive disease in immunosuppressed patients have been described in the medical literature.

Chromomycosis

Chromomycosis, also known as chromoblastomycosis, is a chronic subcutaneous infection caused by several different fungi. Although rarely seen in the United States, it is common worldwide. Chromomycosis occurs worldwide but is most frequently encountered in tropical and subtropical regions. The most common occurrence is in barefoot individuals, particularly among agricultural workers.

Cryptococcus Neoformans

Cryptococcus neoformans exists as two distinct varieties known as variety neoformans and variety gattii (Table 1). Cryptococcus neoformans variety neoformans exists throughout the world and is found frequently in pigeon droppings that have accumulated over time. The concentrations of these organisms are often quite high in old pigeon droppings found in barns, on window ledges, and around the upper floors of old buildings. Pigeons carrying the organism do not seem to be clinically affected, and wet or fresh droppings rarely contain C neoformans.

Candida Species

Candida organisms are commensal with humans and, in the absence of alterations in host defense mechanisms, usually do not cause disease. Candida exists as normal flora within the oral cavity, throughout the gastrointestinal (GI) tract, in expectorated sputum, in the vagina, and in the bladder of patients with indwelling catheters. There are >150 species within the genus Candida, although the majority are not known to cause disease in humans. C albicans, C krusei, C glabrata, C tropicalis, C pseudotropicalis, C guilliermondii, C parapsilosis, C lusitaniae, and C rugosa are known human pathogens.

Candidemia & Disseminated Candidiasis

Candidemia may present in a variety of fashions, ranging from asymptomatic to fulminant sepsis. The candidemic patient generally has risk factors for infection, such as malignancy, chemotherapy-induced neutropenia, organ transplantation, GI surgery, burns, indwelling catheters, or exposure to broad-spectrum antibiotics. Disseminated candidiasis must be assumed to be present in those with positive blood cultures, although negative cultures do not preclude the possibility of disseminated disease. Dissemination usually manifests with many microabscesses involving multiple organs, especially the liver, spleen, and eye, but almost any organ may be involved (Box 2).

Candiduria, Candida Cystitis & Urinary Tract Candidiasis

The presence of Candida spp. in the urine is common and does not necessarily represent infection. Candiduria is commonly associated with antibiotic use, indwelling urinary catheters, and diabetes mellitus and frequently resolves if predisposing factors can be corrected. Patients are generally asymptomatic, although some will have symptoms similar to bacterial cystitis, with dysuria, frequency, and urgency (Box 2).

Candida Vulvovaginitis

Risk factors for Candida infection of the vagina include pregnancy, oral contraceptive use, diabetes mellitus, HIV infection, and antimicrobial therapy, although the majority of infections occur in the absence of these risks. Typical complaints are vulvar pruritus and vaginal discharge (Box 1), although a wide range of symptoms exists.

Esophageal Candidiasis

Candida infection of the esophagus can present with a range of clinical findings (Box 1). Between 20 and 50% of patients may be asymptomatic. Others will note dysphagia, odynophagia, epigastric pain, nausea and vomiting, or hematemesis. Fever may be present.