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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)

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Fungal Genitourinary System Infections

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  1. Fungal Genitourinary System Infections

  2. Fungal Genitourinary System Infections • Bladder and kidneys infections • Valvovaginal infections

  3. 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

  4. 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) • Histplasmacapsulatum • Blastomycesdermatitidis • Coccidioidesimmitis

  5. 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

  6. Candida cystitis • Mainly Candida • Urinary catheters • After bacteriuria • Antibiotic therapy • C. albicansprostatitis occurs infrequently in patients with diabetes, usually after instrumentation

  7. Candida albicans in urine

  8. 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

  9. Vaginitis • Normal vaginal discharge maintain a normal healthy environment. • Normal discharge is usually clear or milky with no malodour • A change in the amount, coloror smell • Irritation, itchingor burning • Could be due to an imbalance of healthy bacteria in the vagina, leading to vaginitis

  10. Causes of vaginitis • The most common causes of vaginitis in symptomatic women are: • Bacterial vaginosis (40-45%) • Vaginal candidiasis (20-25%) • Trichomoniasis (15-20%)

  11. 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

  12. 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

  13. 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

  14. Pathophysiologyof vaginitis The overgrowth of normally present bacteria, infecting bacteria, or viruses can cause symptoms of vaginitis

  15. Vulvovaginalcandidiasis • C. albicans, C. tropicalis, and C. glabrataare 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

  16. Risk factors of fungal vaginal infection • Oral contraceptive use • Intrauterine device use • Diabetes • HIV or other immunocompromised states • Long-term antibiotic use • Pregnancy

  17. 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)

  18. Candida in vaginal smear

  19. 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)

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

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

  22. Clue cells of Gardnerella vaginalis infection

  23. GardnerellaVaginalisClue Cells

  24. 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

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