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