fungal genitourinary system infections

FUNGAL GENITOURINARY SYSTEM INFECTIONS

FUNGAL GENITOURINARY SYSTEM INFECTIONS

Bladder and kidneys infections

Valvovaginal infections

FUNGAL URINARY TRACT INFECTIONS

Primarily affect the bladder and kidneys

Candida species (the most common cause) Candida species is part of the micro flora of

the lower genitourinary tracts

Candida colonization differs from infection

KIDNEYS FUNGAL INFECTION All invasive fungi may infect kidneys as part of

systemic or disseminated mycotic infection:  Candida sp (yeast)

Aspergillus sp (filamentous, septate) Zygomycetes (filamentous, aseptate) Primary systemic fungi (dimorphic)

Histplasma capsulatum Blastomyces dermatitidis Coccidioides immitis

RENAL CANDIDIASIS  Acquired hematogenously Commonly originates from the GI tract Ascending infection is possible and occurs mainly in

patients with: Nephrostomy tubes Other permanent indwelling devices and stents

Immunocompromised patients at high risk: Cancer AIDS Chemotherapy

CANDIDA CYSTITIS

Mainly Candida  Urinary catheters After bacteriuria Antibiotic therapy

C. albicans prostatitis occurs infrequently in patients with diabetes, usually after instrumentation

Candida albicans in urine

VAGINITIS Vaginitis (infection of the vagina) The most common gynecologic condition Diagnosis based on the presence of symptoms of:

abnormal discharge vulvovaginal discomfort

Cervicitis may also cause a discharge and sometimes occurs with vaginitis

VAGINITIS Normal vaginal discharge maintain a normal

healthy environment.

Normal discharge is usually clear or milky with no malodour

A change in the amount, color or smell Irritation, itching or burning Could be due to an imbalance of healthy

bacteria in the vagina, leading to vaginitis

CAUSES OF VAGINITIS

The most common causes of vaginitis in

symptomatic women are: Bacterial vaginosis (40-45%)

Vaginal candidiasis (20-25%)

Trichomoniasis (15-20%)

PATHOPHYSIOLOGY

A complex balance of microorganisms is maintaining the normal vaginal flora

Important organisms include: Lactobacilli Corynebacteria Yeast

Aerobic and anaerobic bacteria can be cultured from the vagina from all age groups

PATHOPHYSIOLOGY A number of factors can change the

composition of the vaginal flora, including the following: Age Sexual activity (or abuse) Hormonal status Hygiene Immunologic status Underlying skin diseases

PATHOPHYSIOLOGY

The normal vaginal pH is 3.8-4.2

At this pH, growth of pathogenic organisms usually inhibited

Disturbance of the normal vaginal pH can alter the vaginal flora, leading to overgrowth of pathogens

PATHOPHYSIOLOGY OF VAGINITIS

The overgrowth of normally present bacteria,

infecting bacteria, or viruses can cause

symptoms of vaginitis

VULVOVAGINAL CANDIDIASIS C. albicans, C. tropicalis, and C. glabrata are

found as normal flora in 50% of women Vaginal candidiasis is the second most

common cause of vaginitis Caused by C albicans in 85-90% of cases 5-10% caused by C. glabrata or C.

parapsilosis

RISK FACTORS OF FUNGAL VAGINAL INFECTION

Oral contraceptive use

Intrauterine device use

Diabetes

HIV or other immunocompromised states

Long-term antibiotic use

Pregnancy

Condition Description pH

Candida vaginitis 

watery, white, cottage cheese-like vaginal discharges. The discharge is irritating to the vagina and the surrounding skin.

low (4.0–4.5)

Bacterial vaginitis 

discharge thin and milky with a strong fishy odour. It is associated with itching and irritation, but not pain during intercourse.

elevated

Trichomonas vaginalis

Yellow-green, foamy, and bad-smelling discharge. There is pain upon urination, painful intercourse, and inflammation of the external genitals.

elevated

VAGINAL WET MOUNT

Normally, there are no yeast, bacteria,

trichomons, or clue cells are found on the

slide

White blood cells are normally absent or very

low in number (presence of white blood cells

is a general sign of infection)

Candida in vaginal smear

VALIDATION OF A SIMPLIFIED GRADING OF GRAM STAINED VAGINAL SMEARS

Smears made of vaginal fluid and Gram

stained and then assessed qualitatively as

normal (grade I), intermediate (grade II), or

consistent with BV (grade III)

a, b: grade Ia, i.e. mainly Lactobacillus crispatus cell types, plump quite homogeneous lactobacilli. c, d: grade Ib, i.e. non-L. crispatus cell types, long or short, thin lactobacilli.

i, j: grade II, i.e. mixture of Lactobacillus cell types and bacterial vaginosis-associated bacteria (Gardnerella, Bacteroides-Prevotella and Mobiluncus cell types). k, l: grade III, i.e. bacterial vaginosis.

Clue cells of Gardnerella vaginalis infection

Gardnerella Vaginalis Clue Cells

TREATMENT

Numerous topical treatments: Almost all azoles such as clotrimazole

Azole drugs do not work for C. glabrata

Oral therapies (not to be used in pregnancy)

include fluconazole and itraconazole