Dr Maher M.

Ahmed
Professor of Pediatrics
By the end of this presentation, students
should know:

1) Clinical presentations of mycotic infections

according to types.
2) Diagnosis.
3) Lines of treatment of these infections.
 CANDIDA
A newborn infant is noted to have white plaques on his
buccal mucosa that are difficult to scrape off with a tongue
depressor. When removed, a small amount of bleeding is
noted by the nurse. The infant just received a course of
empiric antibiotics for suspected Group B β-hemolytic
Streptococcus infection.
Most human infections with C. albicans; part of normal gastrointestinal
tract and vaginal flora of adults

Types of Candida albicans infections

❖ Oral infection = thrush; white plaques; seen with recurrent or
continuing antibiotic treatment and immunodeficiency and normally
in breast-fed infants
o Diagnosis: punctate bleeding with scraping
o Treatment: oral nystatin; if recalcitrant (resistant) or recurrent, single-
dose fluconazole

❖ Diaper dermatitis: intertriginous areas of perineum; confluent,

papular erythema with satellite lesions
o Diagnosis: skin scrapings; see yeast with KOH (potassium hydroxide)
prep, but not usually necessary in the presence of clinical findings
o Treatment: topical nystatin; if significant inflammation, add 1%
hydrocortisone for 1–2 days
Oral thrush

Diaper Rash Secondary to Candida Albicans Infection

Candida dermatitis Contact dermatitis
Satellite lesions No satellite lesions
Rash within skin folds Skin folds spared
Wet, shiny appearance Dry appearance
More red, beefy More pink

Differential diagnosis of diaper dermatitis (diaper rash)

❖ Catheter-related fungemia can affect any organ; may look like bacterial
sepsis
o Diagnosis: buffy coat, catheter tips, urine shows yeast, culture
o Treatment: remove all catheters; amphotericin B is drug of choice

Umbilical catheter

Central line catheter

❖ Chronic mucocutaneous candidiasis: recurrent or persistent superficial

infections of the skin, mucous membranes, and nails primary defect of T
lymphocytes in response to Candida; often when endocrine (diabetes
mellitus) and autoimmune disease present.
 CRYPTOCOCCUS NEOFORMANS
o Soil contaminated with bird droppings, or in fruits and vegetables
o Predominant fungal infection in HIV patients; rare in children and
immunocompetent
o Inhalation of spores; in immunocompromised (mostly in HIV patients)
disseminated to brain, meninges, skin, eyes, and skeletal system; forms
granulomas

▪ Pneumonia most common presentation; asymptomatic in many;

otherwise, progressive pulmonary disease

▪ Diagnosis: Latex agglutination: cryptococcal antigen in serum; most useful

for CSF infections

▪ Treatment:
o Oral fluconazole for 3–6 months if immunocompetent and only mild disease
o Amphotericin B + flucytosine if otherwise
o In HIV: lifelong prophylaxis with fluconazole
 COCCIDIOIDOMYCOSIS (SAN JOAQUIN FEVER;
VALLEY FEVER)
A 14-year-old who lives in Arizona, USA presents to the physician with
a 10-day history of fever, headache, malaise, chest pain, and dry cough.
Physical examination reveals a maculopapular rash and tibial erythema
nodosum.

Coccidioidomycosis triad
Transmission: Inhaled arthroconidia from dust; no person-to-
person spread

Types
❑Primary (self-limiting)
❑Residual pulmonary lesions (transient cavity in chest x-ray)
❑Disseminating: can be fatal; more common in males,
Filipino/Asians, blood group B

Clinical presentation
There is Influenza-like symptoms +/- Chest pain
o Dry, nonproductive cough
o Maculopapular rash
Tibial erythema nodosum
o Tibial erythema nodosum
(Erythema nodosum: bilateral, raised, erythematous,
painful subcutaneous nodules on the anterior tibial surface)
Diagnosis
o Sputum should be obtained via bronchoalveolar lavage or gastric
aspirates.
o Diagnosis is confirmed by culture, PCR

Treatment
o Most conservative
o In general, coccidioidomycosis is a self-limited illness in most of
children. Antifungal therapy is indicated for children at high risk to
develop severe infection (immune compromised, and those with
diabetes) to prevent and treat dissemination
A 10-day preterm neonate admitted to neonatal care unit and he is
currently on IV antibiotic treatment for neonatal infection. Today, the
nurse noticed white plaques over the tongue and inner lips as well as
palate. When you tried to scrap them with tongue depressor, you find
punctate bleeding. Which of the following is the most appropriate
initial treatment?
a) Single dose fluconazole
b) IV Amphotricin B
c) Topical antibiotic
d) Oral nystatin*
e) IV acyclovir
A 2-week-old neonate presented with redness in the diaper area,
involving the skin folds. It looks beefy red and you noticed presence
of satellite lesions. No ulcerative lesions or vesicles. Which of the
following is the most probable diagnosis?
a) Irritant contact dermatitis
b) Impetigo
c) Herpes simplex infection
d) Cellulitis
e) Candida dermatitis*
Which of the following is the correct statement regarding
cryptococcus neoformans infection?
a) It is a respiratory droplet transmission
b) Meningitis is the most common presentation
c) Treatment with amphotricin B if immunocopetent patient
d) It is a predominant fungal infection in HIV patients*
e) Life long prophylaxis is not needed