A Review Of Testing Methods And Medications Used
In The Treatment Of Commonly Seen Bacterial And
Fungal Conditions In Podiatry
Jack Hutter DPM, C.ped, FACFAS, FPWCA,
Diplomate, ABPFAS
Gram Stain
- gram + or –
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Morphology
-coccus, bacillus, single, clusters, chains, encapsulation, spore
forming
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Growth oxygen requirements
-aerobic, anaerobic, intermediate, facultative, obligate
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Genetic information
-RNA, DNA
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Coagulase testing
-coagulase positive, coagulase negative
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Growth on culture medium
Tests above are taken in totality when attempting to establish organism
identity
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Gram Stain – the ability of the organism to take up
stain
Crystal violet/safranin microscope slide test used to
determine absence or presence of organism
Also provides information on organism morphology
( rods, cocci, single, chain, cluster, pleomorphic )
Bacteria stain either purple ( gram positive ), or pink
(gram negative )
Gram positive bacteria can withstand drying out, gram
negative thrive in a moist environment
Gram negative bacteria have multiple cell walls and
withstand strong inhibitory chemicals
(psuedomonas can grow in chlorinated water )
A negative gram stain does not rule out infection as
some organisms do not take up stain
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Coagulase testing - presence of a protein
produced by several microorganisms enabling
the conversion of fibrinogen to fibrin
Used to differentiate between different types of
Staphylococcus species
Coagulase negativity excludes Staphylococcus
aureus ( staph aureus is coagulase positive )
Other less frequently encountered Staphylcocci
are also coagulase positive including
Staphylococcus aureus anaerobius
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Growth oxygen requirements - survival in the presence
or absence of oxygen
Aerobic organisms thrive in a oxygen rich environment
Anaerobic organisms die if in an oxygen rich
environment
Some organisms are intermediate in their oxygen
requirements
Bacteria are also classified as facultative or obligate
anaerobes
Facultative anaerobes are organisms that can make
ATP by aerobic respiration if oxygen is present, but
without oxygen are also capable of switching to
fermentation for cell function
Obligate anaerobes die when oxygen is present
GROWTH ON CULTURE MEDIUM
-SOURCES FOR OBTAINING THE SPECIMEN
Drainage, whatever the source
 Aspirate
 Blood Draw
 Tissue biopsy
Remember that the testing and culture identify the
organism(s), whereas the sensitivity determines the
appropriate antimicrobial choice

Drainage
-Sterile swab and preservative medium contained in aerobic or
anaerobic culturette
-Swab drainage if possible, skin alone without drainage may produce
a false result
-Preliminary result in 24 hours usually reported along with gram stain
, provide basic information about whether organisms are present
and what type
-Usually at least 48 hours for final result which identifies organism(s)
AND provides antimicrobial sensitivity pattern (MIC)
-Aseptic debridement of overlying necrotic tissue allows a more
reliable culture, reduces contaminant
-Amount of growth ( heavy, moderate, few ) on the culture medium
helps in determining pathogen from contaminant
-Be on guard for results reported “ strains suggest normal flora “, as
even Staph epidermidis can be a pathogen, request sensitivities ,
-Supply your lab with appropriate clinical information along with the
specimen
-Process the culture immediately, delay causes degradation
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Aerobic, Anaerobic Culture Transfer
ASPIRATE
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Sterile prep of area to be
aspirated
Draw aspirate into a 3cc
syringe
Either submit aspirate
within drawing syringe,
capped off and without
the needle, or deposit an
appropriate amount of the
aspirate aseptically onto
the tip of a culturette, cap
off and process
immediately
BLOOD DRAW
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Done in the case of
suspected septicemia
The best time to draw is
just before or at the rise in
oral temperature
Three cultures are drawn,
each every three hours for
the most reliable results
Preferably done before
beginning antobiotics
Most common bacteria to
cause septicemia are gram
(-) rods ( E. coli,
enterobacter ), second is
gram (+) cocci staph
aureus
KIRBY-BAUER AGAR DIFFUSION TECHNIQUE
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1. Isolate a bacterial colony from the original growth media
2.Allow the bacteria to grow in broth medium
3.Cover a Mueller-Hinton agar plate completely with the bacterial
isolate
4.Place antibiotic impregnated sensitivity plates at intervals on the
surface
5.Incubate 18 – 20 hours
6.Examine for clear areas around the individual discs which represent
bacterial growth inhibition
7.Results are reported as resistant, intermediate or non-resistant
8. Anaerobes are cultured in appropriate oxygen free conditions
MINIMUM INHIBITORY CONCENTRATION
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More specific than simply
reporting resistant or nonresistant
Will determine the degree of
sensitivity of a bacterial species
to a particular antibiotic
Gives the practitioner the ability
to chose the most effective
antibiotic for a particular
organism
The lower the number, the more
sensitive the antibiotic and
more susceptible the organism
to it
Also reports if the organism is
resistant to the antibiotic
THE TEST PROTOCOL
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A pure culture of a single organism is grown on Mueller-Hinton
broth
The culture is standardized to 1,000,000 cells per milliliter
The antibiotics to be tested are diluted a number of times
A 1:1 mixture of the bacteria and the antibiotic to be tested is created
in separate multiple dilution vials
A series of inoculated vials is used for each tested antibiotic
The inoculated vials with serially diluted antibiotic are incubated 18
hours
After incubation, the series of dilution vials is observed for bacterial
growth
The last vial in the series that does not demonstrate growth
corresponds with the minimum inhibitory concentration of the
antibiotic
Comparison of MIC values allows the practitioner to determine
appropriate antibiotic coverage
ULCERATIVE WOUNDS
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Diabetic
Venous
Pressure
TRAUMATIC WOUNDS
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Acute injury
Chronic trauma
(repetitive skin trauma,
web space breakdown,
fissures )
Post operative
ULCERATIVE WOUNDS
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Diabetic wounds
-Perform bacterial aerobic ( and anaerobic if deep,
sinus tract and chronic ), and fungal culture and
sensitivity
-gram stain is helpful for preliminary confirmation of
infection ( reported as many vs. few of a particular type
of organism ), but culture is necessary for ID of the
organism
-Debridement of necrotic, overlying tissue before
culture provides a more reliable result
ULCERATIVE WOUNDS
Venous wounds
-Often chronic, with mixed bag of pathogens combined
with contaminant
-Anaerobes less frequent than aerobes unless extensive
necrosis
-Culture also for fungi, especially yeast, more common in
elderly and immuno-compromised patients
-Be aware of mixed diabetic and venous wound
-Gram stain helps to determine if temporary antibiotic
coverage is indicated, culture results will confirm the
proper antibiotic and dosage
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ULCERATIVE WOUNDS
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Pressure ulcer
-Frequently chronic
-Debilitated or wheelchair bound patient
-Mixed pressure and diabetic etiologies not uncommon
-Undermining, sinus tract, deep involvement,
-Anaerobic and aerobic culture after debridement
TRAUMATIC WOUNDS
Acute injury
 Less necrosis
 Unless deep puncture,
aerobic culture
primarily
 If infection, cultures
likely to be skin
structure flora staph,
strep
Chronic injury
 Repetitive trauma to skin
 Web space with maceration,
heel fissures with
dyshydrosis
 Culture mixed bag of
organisms, not necessarily all
pathogens
 Aerobic culture and
sensitivity if drainage
 Skin specimen biopsy with
culture if no drainage but
suspect infection
SURGICAL WOUND
Immediate post operative
infection
 24 to 72 hours post op
 Pain, rubor, swelling,
gapping of incision, drainage
 Patient may be febrile, chills,
night sweats if septic
 Remove sutures, express
drainage, gram stain and
aerobic C&S
 Start broad spectrum
antibiotic ( penicillinase
resistant, Augmentin or
cephalosporin, clindamycin if
penicillin allergy ) and watch
for C&S results 48 hours
Chronic post operative
infection
 Dehiscence
 More tissue necrosis,
deeper involvement
 Debridement, gram
stain, aerobic and
anaerobic culture and
sensitivity
 Start broad spectrum
antibiotic but may likely
change pending culture
and sensitivity results
AEROBIC BACTERIA
GRAM POSITIVE COCCI
Streptococcus
 Facultative anaerobe
 Colony appearance describes three basic forms, alpha,
beta, gamma
-Alpha - strep viridans, causes incomplete hemolysis
surrounding the colony
-Beta – causes complete hemolysis, the highest
incidence of pathogenicity
-Gamma – no hemolysis, enterococcus group
 Lancefield classification of beta hemolytic strep ( group A
and Group D ) based on the presence of a particular
carbohydrate produced by antibodies
AEROBIC BACTERIA
GRAM POSITIVE COCCI
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Staphylococcus
-Gram (+), occur in clusters
-Facultative anaerobe
-Normal skin flora
-Three groups depending upon colony appearance
-Staph epidermidis ( coagulase negative, white
colonies )
-Staph aureus ( coagulase positive, yellow colonies )
-Staph citreus ( pale green, rarely seen )
METHICILLIN RESISTANT STAPHLOCOCCUS AUREUS
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MRSA, AKA multidrug resistant staph aureus or oxacillin
resistant staph aureus
All the characterictics of Staph aureus , also resistant to
cephalosporins
Emerging as a serious pathogen with resistance to many
antibiotics
First reported in 1961 in UK, 1981 US, 2004 in Canada, world
wide and worsening
2.4 % of healthy children in US are carriers, same percentage in
adults
Studies show that poor hygiene habits with health care
professionals is a principal barrier to spread of MRSA
METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS
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Colonizes in the anterior nares and respiratory tract
Usually purulent, can cause sepsis and shock
Facultative anaerobe8
Two basic forms, community acquired and hospital
acquired
Community form is more virulent, can lead to
necrotizing fascitis, septic arthritis, osteomyelitis
Risk factors include immuno-compromised state,
diabetes mellitus, IV drug use, quinolone antibiotic
usage, children, elderly, healthcare facility workers,
confined spaces with large populations, locker rooms
MRSA DIAGNOSIS
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Colony growth on
Mueller-Hinton
agar shows
resistance to
oxacillin disc
Real time PCR,
quantitative PCR
for rapid detection
Latex
agglutination to
detect PBP2a
protein, a penicillin
binding protein
that gives Staph.
aureus its oxacillin
resistance
MRSA TREATMENT
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Prevention through active patient
screening with anterior nares cultures
( hospitals, nursing homes, long term
care facilities ) (also schools,
workplaces since community form is
more virulent? Controversial )
Isolation of MRSA carrying
patient/resident
Decolonization with chlorhexidine or
Phisohex full body scrub, and
Bactroban 2% ointment in nostrils bid
for one week
Aseptic pecautions in patient care
Terminal cleaning of treatment room
Negative anterior nares cultures three
separate times to confirm
decolonization
MRSA TREATMENT –
NON MEDICATIONS
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Restricted use of
certain antibiotics that
promote colonization,
cephalosporins and
especially
fluoroquinolones
Essential oil effusion
(cinnamon, lemon
myrtle, melissa,
mountain savory all
inhibit MRSA, lemon
grass and tea tree oil
kill MRSA
Cannibinoids
Maggot therapy
extremely effective (fly
larvae debride and
sterilize a wound )
MRSA TREATMENT –
CURRENT MEDICATONS
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The drug of choice for both
community and hospital based
MRSA is vancomycin
Teichoplanin is a structural
congener of vancomycin, but has
a longer ½ life
Administer through a PICC line (
peripherally inserted central
catheter )
Newer drugs Linezolid and
Daptomycin are also effective but
have a greater activity spectrum
A new strain VISA ( vancomycin
intermediate resistant Staph
aureus ) must be treated with
Linezoid, Daptomycin, Synercid,
or Tigecycline,
MRSA TREATMENT – THE FUTURE
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New even more resistant strains are
continuously evolving, requiring novel
treatments that can circumvent the resistance
mechanism
Many drugs are in phase II and phase III trials, (
especially Aurograb, Nemonoxacin )
Phage therapy has been 95% efficient in mice
Platensimycin
AEROBIC BACTERIA
GRAM POSITIVE COCCI
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Enterococcus
-Entercoccus faecalis
-Rods appearing as
pairs or chains
-Facultative anaerobe
GRAM POSITIVE RODS
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Mycobacteria ulcerans
-Gram stain negative
-Long, slender rods
-Obligate anaerobe
AEROBIC BACTERIA
GRAM NEGATIVE RODS
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Enteric bacilli
-Escherichia coli,
enterobacter, klebsiella,
proteus
-May be normal flora in
the GI tract, pathogenic if
contamination of other
location
-Salmonella, Shigella not
normal GI flora, enter
through the environment
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Psuedomonas
-P. Auergeuosa
-Obligate anaerobe
-May live in the GI tract,
contaminate wounds
especially if host is
immunocompromised
-Aquatic environment
-Encapsulated, motile
-Greenish color in clinical
setting
ANAEROBIC BACTERIA
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Clostridium,Perfringens( Welchii ), tetani, botulinum
-Gram positive rod
-Obligate anaerobe
-Normally in GI tract, 20% of the time on the skin
-Gas gangrene, tetanus, botulism
Bacteroides
-Gram negative rod
-Obligate anaerobe
-GI tract, mouth, female GU tract
-Abscess, gangrene , wound contaminant
Streptococcus
-Peptostreptococcus
-Gram positive cocci, single or in chains
-Often mixed aerobic/anaerobic infection, deep wounds,
necrotizing fascitis
-Extremely drug resistant
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Assess liver and kidney function prior to antibiotic therapy
Primary infection caused mostly by two skin structure
bacteria, staphylococcus and streptococcus
Secondary infection by contamination from non-skin
structure organisms is precipitated by loss of skin integrity
Immuno-compromised patients are at increased infection
risk
Antibiotics for treatment of skin infections are either
bacteriocidal or bacteriostatic
Each particular antibiotic acts by inhibiting a particular cell
function or altering cell anatomy
Antibiotic resistance often develops with prolonged
antibiotic use
Occasionally infections are due to a combination of
anaerobic and aerobic organisms, and one must chose the
antibiotic ( or combination of antibiotics ) with the greatest
efficacy
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Some bacteria produce enzymes called beta-lactamases,
which provide resistance to antibiotics containing a
beta-lactam ring such as the penicillins
This occurs by breaking down the lactam ring in the
molecular structure of the antibiotic
Penicillinase is a specific type of beta-lactamase, which
dictates the need for a penicillinase –resistant antibiotic
such as methacillin, oxacillin, dicloxicillin
Ceplalosporins are generally resistant to betalactamase
Clavulonic acid will inhibit penicillinase, and is added
to a –cillin to eliminate the beta-lactamase inactivation
( Augmentin )
GENERALLY RESISTANCE TESTING WILL CONFIRM
THE APPROPRIATE ANTIBIOTIC
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-
Clostridium difficale
-Overgrowth of human
flora in the GI tract
from over use of
antibiotics
Treatment
-D/C predisposing
antibiotics
-Fluids
-Internal
medicine/infectious
disease consult
-Penicillin G,
Metronidazole
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Clostridium tetani
-Puncture wound
-Spores in soil
-Gas gangrene
-Surgical emergency,
hyperbaric oxygen,
PCN G, Doxycycline
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Enterococcus faecalis
-GI tract
-Opportunistic
contaminant of a
wound or surgical site
-Treatment
-Medical management
-Penicillin +
Vancomycin, newer
agents Quinupristin
and Dalfopristin
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Escherichia coli
-Normal GI flora
-Opportunistic
wound
contaminant
-Treatment
-Medical
management
-Co-trimazole,
Fluoroquinolone,
Cephalosporin +
Gentamycin
combination
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Psuedomonas Auerginosa
-Water borne organism
-Infects Damaged tissue,
surgical sites
-Bone, joint, skin, soft
tissue are all
susceptible
-Treatment
- Topical acetic acid,
Aminogyycocide +
beta-lactam, or
Fluoroquinolone,
-Local wound care
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Staphylococcus aureus
-Human mucosal flora
-Wound and surgical
contaminant
-MRSA potential
-Treatment
-Oxacillin,
Cephalosporin,
Augmentin,
-Local wound care
-Surgical invention if
indicated
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Staphylococcus
Epidermidis
-Normal human
mucosal flora
-Wound contaminant,
prosthesis infection
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-Resistant to many
antibiotics
-Often reported as
“normal flora”, if
cultures show
moderate or heavy
growth, consider to be
a pathogen and order
sensitivities
-Treatment
-Clindamycin,
Vancomycin in severe
infections
-Wound care
-Surgical intervention if
indicated
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Streptococcus Agalactiae,
Pyogenes,Beta Group A and Group D
-Human mucosal flora
-Opportunistic wound contaminant
with infection
-Treatment
-Penicillin G, Ampicillin,
Aminoglycocide if severe
infection
-Local wound care
Peptostreptococcus and related gram
(+) anaerobic bacteria
-Deep, chronic wound
-Often mixed infection
-Treatment
-Penicillin G, Cephalosporins,
Clindamycin, Vancomycin, or
newer quinolone ( not cipro )
-Local wound care
-Surgical debridement
HUMAN FUNGAL INFECTIONS
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Internal fungal infection, potentially systemic
-Sporotrichosis,Blastomycosis,Histoplasmosis
Opportunistic fungal infections
-Antibiotics which kill bacteria alter the normal flora,
providing a medium for fungal invasion
-Compromised host with reduced response to fungal
infection ( AIDS, steroid therapy, methotrexate and
similar drugs used to treat autoimmune disorders )
Skin and toenail fungal infection
-What Podiatrists see most of the time
-12% of all Americans have toenail fungus
-Runs in families due to inherited tendencies
-Rare in children unless one or both parents are infected
-Accounts for 50% of all toenail abnormalities
THREE PRINCIPAL TYPES OF FUNGAL ORGANISMS
AFFECTING SKIN AND/OR TOENAILS
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Dermatophytes
-Aerobic
-Trichophyton rubrum most common, T.mentagryphytes
species ( no longer considered a human pathogen, now refers
to mouse ringworm ), T. violaceum, T. interdigitale, T.
tonsurans, T. verrucosum (cattle ringworm ),
Epidermphyton floccosum, Microsporum gypseum
Non – dermatophyte molds
-Aerobic
-Opportunistic
-Seen in patients over 60 y/o
-Scopulariopsis, Alternaria,
Penicillium,Aspergillus
Yeast
-Aerobic
-Opportunistic
-Primarily candida species
MAKING THE DIAGNOSIS
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Dermatophytes
-KOH smear demonstrates single hyphae and combined branches
of hyphae called mycelia
-Culture with DTM Saboraud’s agar or Mueller – Hinton agar,
shows diagnostic color change and colony growth
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Non – dermatophyte molds
-KOH shows no presence of hyphae
-Culture as with dermatophyte, shows diagnostic colony growth,
but no color change in Saboraud’s agar
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Yeast
-Can be polymorphic with KOH demonstrating psuedohyphae
formed from budding yeast cells, spores on psuedomycelia
-Gram stain +
-DTM or Mueller – Hinton culture shows creamy white, putty-like
colony, no color change in medium
DTM results
TINEA PEDIS
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AKA athlete’s foot
-Trichophyton rubrum most common
-Acute form at web spaces, moist areas
-Clinically erythema, pruritis, maceration
-Moccasin distribution when tinea unguim is also present
Diagnosis
-Hyphae seen on KOH prep rule out psoriasis, eczema
-Skin culture (DTM scraping ) may confirm organism
Treatment
-Avoid exposure to fungal organisms with appropriate footwear
and foot hygiene
-OTC antifungal cream, ointment or gel for acute cases
-Antifungal powder to reduce moisture and control reoccurrence
-Moisture absorbing, wicking socks, shoes that breathe
-More severe cases may require a short course of oral terbinifine
-Often there is concurrent tinea unguim requiring treatment with
ciclopirox and/or oral terbifine or iatroconazole
TINEA VERSICOLOR
AKA pityriasis versicolor
-Yeast organism, Malassezia
globosa, m. fufur
-Normal skin flora, becomes
pathogenic under warm,
humid conditions
-Presents clinically as
erythematous, ovoid
macular area with fine
scaling
Diagnosis
-KOH shows psuedohyphae
-Culture shows yeast cells
Treatment
-Topically,nizoral,
ciclopirox, ketoconazole,
miconazole
-Orally, fluconazole,
ketoconazole ((Diflucan,
preferred over ketoconazole,
terbinifine, iatroconazole )
CANDIDIASIS
Candida
- Also a yeast infection,
superficially in skin, web spaces
(candidal intertrigo )
-Normal skin flora, controlled by
the immune system and bacteria
that occupy the same niche
- Become pathogenic iatrogenically
through bacterial antibiosis
Diagnosis
- KOH prep displays
psuedohyphae and budding yeast
cells
-Yeast colonies on culture ( DTM
creamy color, creamy in
consistency)
Treatment
-Usually topical for skin,
miconazole, nystatin, clotrimazole,
- Oral fluconazole ( Diflucan ) in
severe cases
ONYCHOMYCOSIS – FOUR BASIC CLINICAL
PRESENTATIONS
1. Distal subungual
- Most common presentation, usually dermatophyte
Trichophyton rubrum
2. White superficial
– 10% of cases
-Superficial white “ islands “ on surface of toenail
3. Proximal subungual
-Toenail is penetrated through the proximal nail fold
-More frequently seen in immuno-compromised patients
4. Candidal
-Opportunistic infection
-develops secondary to trauma to toenail
IT’S NOT ALWAYS A FUNGUS – TOENAIL CHANGES
THAT MAY REVEAL A SYSTEMIC CONDITION
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White toenail – liver disease
Half pink, half white toenail – kidney disease
Toenail is light reddish – heart disease
Yellow and thickened, reduced growth rate – lung disease
Pale nail bed – anemia
Yellowish toenail, slight blush at eponychium – diabetes
mellitus
Thickened, hardened, brittle toenail – peripheral vascular
disease
Thick, brownish yellow, friable, much like a mycotic nail –
psoriasis, lichen planus
MAKING THE DIAGNOSIS
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Involved toenail is thick, discolored, friable, lytic in
appearance
Single or multiple nails
Partial or full nail plate involvement
Look for concurrent skin involvement
Tests include KOH, Periodic Acid-Schiff stain, culture on DTM
or Mueller-Hinton agar
MIC values have been established for oral antifungals against,
dermatophytes, molds, yeasts
KOH shows hyphae, mycelia ( dermatophyte ), none ( non –
dermatophyte ),psuedohyphae, psuedomycelia, yeast cells
(yeast )
Periodic acid-Schiff stain used if culture is inconclusive
Culture shows characteristic colony growth and color changes
as with skin culture
-dermatophyte - white, fluffy colony, cherry red color change in agar )
-non-dermatophyte – grayish, fufy colony, no color change in agar
-yeast – creamy white, putty- like, no color change in agar
CURRENT TRENDS IN TREATMENT
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Topical
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Systemic
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OTC , Ciclopirox, Amorolfine
Terbinifine, Iatraconazole, Fluconazole
Combined topical and systemic
Toenail avulsion combined with short course of
systemic
Onychoplasty
Infrared laser
QUANTIFYING TREATMENT SUCCESS
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Clinical cure – Toenail physically appears improved,
less discoloration, thickness, more attached to toenail
bed
Mycologic cure – Toenail culture is negative
Complete cure – The preferred result, physical
appearance is normal and toenail culture is negative
One should perform cultures prior to and at the end
of treatment
OBSERVATIONS ON TREATMENT SUCCESS
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Topical treatment should be reserved for mild cases
Complete nail involvement infers matrix involvement, must
be treated more aggressively than with topical alone
Amorolfine 5% lacquer has shown complete cure rates of 38 46%, more effective than Ciclopirox, and only needs to be
applied twice per week
Amorolfine is only available in Europe
Topical combined with systemic is more effective than
systemic alone
Systemic antifungals create a reservoir effect due a high
affinity to the fat cells under the nail bed and matrix,
arresting fungal growth in the nail bed and matrix
MIC values show terbinifine is the most effective oral
antifungal against dermatophytes, fluconazole is most
effective against yeast
TREATMENT SUCCESS OBSERVATIONS
CONTINUED…
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Monitoring for liver function is necessary with SGOT, SGPT
or liver panel as systemic antifungals can cause liver damage
Systemic antifungals can also can cardiac abnormalities and
heart failure
Pulse dosing is more effective with iatroconazole, daily
dosing is more effective for terbinifine
Terbinifine shows complete cure rates around 60-70%, better
than iatroconazole
High reoccurrance rate is in part due to never reaching a
mycologic cure, and cultures should be done at the end of the
reservoir to confirm a mycologic cure
Frequent aggressive nail debridement and removal of lacquer
film from topical agent using alcohol or nail polish remover
once per week improves treatment outcomes
THE FUTURE
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Improved topical medications ( topical terbinifine )
Amorolfine approval for use in Canada and USA
New oral agents ( Posaconazole )
Nd:YAG infrared lasers very promising, showing at least
80% effectiveness
-Fungicidal, will not harm surrounding tissues
-Pinpointe ( FDA approved )
- Synergy Plus ( FDA approval anticipated )
-Cutera Genesis Plus ( FDA approval anticipated )
-Noveon laser ( dual infrared laser )
Ontario Osteopathic and Alternative Medicine Association “
LAFT “, laser based method of treatment
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Bacterial and fungal infections are conditions
frequently seen in Podiatry practice
Knowledge about the indications for performing
specific laboratory tests is necessary in the
appropriate treatment of these conditions
Sensitivity testing is of critical importance in
antibiotic selection
Proper interpretation of test results allows for
successful pairing of the infective organism with
the appropriate antibiotic treatment regime
Thank you !