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Cutaneous Candidiasis

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141. Psoriasis

) Frequent Oral herpes, rhinorrhea, diarrhea, urticaria Occasional Oral candidiasis, neutropenia, tinea pedis, otitis externa, conjunctivitis Infections: In the placebo-controlled period of clinical studies in plaque psoriasis infections were reported in 28.7% of patients treated with secukinumab and 18.9% of patients with placebo. Most cases of infection were mild or moderate upper respiratory tract infections which did not require treatment discontinuation. Mucosal or cutaneous candidiasis were 17more

2017 European Dermatology Forum

142. Complex regional pain syndrome in adults. UK guidelines for diagnosis, referral and management in primary and secondary care 2018 (2nd edition)

Consultant in sport and exercise medicine, Centre for Spinal Rehabilitation, Defence Medical Rehabilitation Centre Headley Court © Royal College of Physicians 2018 v Professor Candida S McCabe PhD RGN Florence Nightingale Foundation clinical professor in nursing, University of the West of England, Bristol; RNHRD, Royal United Hospitals NHS Foundation Trust, Bath Miriam Parkinson BSc(Hons)OT Extended scope practitioner occupational therapist (member of BAHT), East Lancashire Hospitals NHS Trust Col Rhodri

2018 British Society of Rehabilitation Medicine

143. Biologic therapy for psoriasis

or subsequent biologic therapy fails in adults R21 When a person s psoriasis responds inadequately to a second or subsequent biologic agent seek advice from a clinician with expertise in biologic therapy and consider any of the following strategies: · reiterate advice about modifiable factors contributing to poor response (for example, obesity and poor adherence) · optimise adjunctive therapy (for example, switch from oral to sub-cutaneous methotrexate) · switch to an alternative biologic agent · consider (...) for biologic therapy for psoriasis 2017 19 IX Major congenital malformations reported in 3.6 5.0 % of women exposed to anti-TNF compared with 1.5 4.7 % in control groups (odds ratios [OR] = 1.32 1.64) · optimise adjunctive therapy (for example, switch from oral to sub-cutaneous methotrexate) · switch to an alternative biologic agent · consider non-biologic therapy approaches (for example inpatient topical therapy or standard systemic therapy) Transitioning to/between biologic therapies R25 When choosing

2017 British Association of Dermatologists

144. CRACKCast Episode 132 – HIV/AIDS

Kaposi’s sarcoma Extrapulmonary cryptococcosis Disseminated mycosis Atypical disseminated leishmaniasis Disseminated nontuberculous mycobacterial infection Extrapulmonary cryptococcosis including meningitis Box 124.3: Cutaneous Findings Highly Suggestive of HIV Disease Any WHO criteria for stage 4 HIV disease Facial molluscum in an adult Proximal subungual onychomycosis Herpes zoster scarring Oral hairy leukoplakia Bacillary angiomatosis Widespread dermatophytosis Severe seborrheic dermatitis See (...) are infected, the virus spreads to draining lymph nodes and infection is established, usually within 48 to 72 hours. [3] List 10 AIDS defining conditions Box 124.1 – AIDS-Defining Conditions Bacterial infections, multiple or recurrent Candidiasis of bronchi, trachea, or lungs Candidiasis of esophagus Cervical cancer, invasive Coccidioidomycosis, disseminated or extrapulmonary Cryptococcosis, extrapulmonary Cryptosporidiosis, chronic intestinal (>1 mo duration) Cytomegalovirus disease (other than liver

2017 CandiEM

145. CRACKCast E109 – CNS Infections

● Leptospirosis Drugs ● Nonsteroidal anti-inflammatory drugs (NSAIDs) ● Trimethoprim-sulfamethoxazole, amoxicillin ● Muromonab CD3 (OKT3) ● Azathioprine ● Intravenous (IV) immunoglobulin ● Isoniazid ● Intrathecal methotrexate ● Intrathecal cytosine arabinoside ● Allopurinol ● Carbamazepine ● Sulfasalazine Fungi ● Cryptococcus neoformans ● Histoplasma capsulatum ● Coccidioides immitis ● Blastomyces dermatitides ● Candida Systemic Disease ● Collagen vascular disorders ● Systemic lupus erythematosus ● Wegener’s (...) factors useful in increasing the likelihood of bacterial meningitis included bulging fontanel, neck stiffness, and seizures in children outside the age typical for febrile convulsions. No combination of factors have been identified that rule in or rule out the disease, which is not surprising given the diversity of presentations in children.” “Petechiae and cutaneous hemorrhages are widely reported with meningococ- cemia but also occur with Hib, pneumococcal organisms, L. monocytogenes, and echovirus

2017 CandiEM

146. BSR guideline Management of Adults with Primary Sjögren's Syndrome Full Text available with Trip Pro

in the mouth with sore, ulcerated gums as a consequence of rubbing. Many patients suffer recurrent infections including parotitis, intraoral candidiasis and angular cheilitis. Dysarthria, dysphagia and dysgeusia (distorted sense of taste) are seen in established disease. The evidence surrounding periodontal disease in Sjögren’s is conflicting, with some studies suggesting an increased prevalence of periodontal disease [ ] but others not [ ]. Effective management of the dry mouth is important

2017 British Society for Rheumatology

147. CrackCAST E129 – Bacteria

Vincent’s Angina Acute epiglottitis Mononucleosis Laryngitis Bronchitis Tracheitis Candida thrush Rhinitis [2] List 8 causes of a non-blanching rash Infectious: meningococcemia pneumococcemia Viral exanthems Rocky Mountain spotted fever Typhus Typhoid fever Endocarditis Toxic shock syndrome (TSS) Acute rheumatic fever Dengue fever Non-infectious Drug reactions Idiopathic thrombocytopenic purpura Thrombotic thrombocytopenic purpura Vasculitis syndromes (polyarteritis nodosa and Henoch-Schönlein purpura (...) for the primary location of infection. Cutaneous diphtheria can occur as a primary skin infection or as a secondary infection of a preexisting wound. Circulating exotoxin causes the systemic symptoms of diphtheria, most profoundly affecting the nervous system, heart, and kidneys. Progression of symptoms/signs: Generic URTI symptoms Low grade fever and sore throat are the most frequent presenting complaints. Weakness, dysphagia, headache, voice changes, and loss of appetite ⅓ develop cervical lymphadenopathy

2017 CandiEM

148. CRACKCast E120 – Dermatologic presentations

or vesicles should be treated with cool wet compresses of Domeboro or Burow’s solutions (aluminum acetate). Topical baths, available over the counter, may also be comforting. Systemic antihistamines, such as hydroxyzine and diphenhydramine, may help control pruritus; nonsedating antihistamines are preferred for use during the day. If present, secondary bacterial infection must also be treated. Know your ddx: Cutaneous candidiasis Contact dermatitis Atopic dermatitis Tinea cruris Intertrigo HSV (...) stockings reduce pain and edema. Aspirin in a dosage of 650 mg every 4 hours or other NSAIDs may also afford some relief. Erythema nodosum is a self-limited process that usually resolves in 3 to 8 weeks. Patients with severe pain may be treated with potassium iodide daily for 3 or 4 weeks.” – Rosen’s 9 th edition [19] List a 6 ddx for vesicular lesions Herpes simplex virus Varicella zoster virus (either varicella form or zoster form) Contact dermatitis Allergic dermatitis Cutaneous candida Dermatitis

2017 CandiEM

149. British Association of Dermatologists guidelines for the management of pemphigus vulgaris

with cutaneous erosions, but oral erosions will, eventually, occur in most cases. PV presents across a wide age range with peak fre- quency in the third to sixth decades. 7.0 Laboratory diagnosis Perilesional skin biopsies should be taken for histology and direct immuno?uorescence (DIF). In patients with isolated oral disease, a histology specimen should be taken from per- ilesional mucosa and a DIF sample taken from an uninvolved area, ideally from the buccal mucosa. 18 Suprabasal acantholysis with blister (...) be considerably longer if there is extensive cutaneous ulceration. Healing of oral ulceration tends to take longer than that for skin, with the oral cavity often the last site to clear in those with mucocutaneous PV. The end of the consolidation phase is the point at which most clinicians would begin to taper treatment, usually the corticosteroid dose. Premature tapering of corticosteroids, before disease control is established and consolidated, is not recommended. 11.2 Remission maintenance After induction

2017 British Association of Dermatologists

150. Prevention, Diagnosis & Management of infective endocarditis

Enterococcus species 88 4.2.2.5 HACEK microorganisms 91 4.2.2.6 Candida 92 4.2.2.7 Non-HACEK Gram-negative microorganisms 93 4.2.2.8 Other microorganisms 94 4.2.3 Empirical therapy 95 4.2.4 Outpatient parenteral antimicrobial therapy for infective endocarditis 99 5.0 SURGICAL INTERVENTION 100 5.1 Indications 100 5.2 Timing of surgery 102 5.2.1 Preventing systemic embolism 103 5.3 Sur gery in specific conditions 104 5.3.1 Cerebral infarction or haemorrhage 104 5.3.2 Right-sided endocarditis 105 5.3.3 (...) singly or in combination: 18 F-FDG PET/CT, acute, adult, adverse effects, antiplatelet therapy, antibiotics, anticoagulant, anticoagulation, anti-fungal, antimicrobial, bacteraemia, blood culture, blood culture negative, blood culture negative infective endocarditis, blood culture positive, blood culture positive infective endocarditis, body piercing, Candida, cardiac implantable electronic device, challenges, classification, clinical, clinical manifestation, culture negative, Coagulase- negative

2017 Ministry of Health, Malaysia

152. Practice Advisory for the Prevention, Diagnosis, and Management of Infectious Complications Associated with Neuraxial Technique

Specialists to Determine Optimal Treatment. Literature findings. The literature is insufficient to evaluate the impact of collaborating with appropriate medical spe- cialists. A retrospective analysis of 57 cases of spinal epidural abscess reported that the use of either antibiotic therapy, per- cutaneous drainage, or surgical interventions were equally as effective regarding patient recovery (Category B1-B evi- dence). 172 The Task Force believes that consultation with a physician with expertise

2017 American Society of Regional Anesthesia and Pain Medicine

153. Antibacterial-coated sutures versus non-antibacterial-coated sutures for the prevention of abdominal, superficial and deep, surgical site infection (SSI)

%), Escherichia coli (9.4%) and Enterococcus faecalis (5.9%) [91]. Antimicrobial-resistant pathogens, such as methicillin-resistant S.aureus (MRSA), vancomycin- resistant Enterococcus, gram-negative bacilli or Candida albicans, are recognized as a major problem, since they are causing an ever increasing proportion of SSIs [42,92]. Outbreaks or clusters of SSIs have also been caused by unusual pathogens, such as Rhizopus oryzae, Clostridium perfringens, Rhodococcus bronchialis, Nocardia farcinica, Legionella

2017 EUnetHTA

154. CRACKCast E066 – Child Maltreatment

is the , (24hr hotline: 1-800-663-9122) Although we are mainly focused on determining intentional versus unintentional injury versus underlying medical pathophysiology, the hallmarks of intentional or non-accidental trauma in children are: cutaneous bruises, burns, skeletal fractures, internal hemorrhage, organ perforation, and brain injury (coup-contrecoup/SAH/SDH/DAI) Remember, accidental bruising tends to be over bony prominences: think forehead, elbows, shins, bruises over the neck, medial thighs, behind (...) – hypopigmentation with adjacent skin developing blood blisters and petechiae Hymen is unaffected May involve the anus or perihymenal areas Impetigo, Urethral prolapse Usually african american girls aged 5-8 yrs Should get urology consultation for ligation Anal fissures Infectious causes: STI’s Shigella Group A beta-hemolytic strep – causing perianal strep infection Candida Pinworm infestation Chigger infestation Vaginal foreign bodies Priapism (due to sickle cell disease) 4) What are some conditions that may

2017 CandiEM

157. Cresemba - isavuconazole

Candida spp. was 0.5 mg/L, with the highest activity against C. albicans (MIC90 0.03 mg/L), C. parapsilosis (MIC90 0.06 mg/L) and C. tropicalis (MIC90 0.06 mg/L) and slightly lower activity against C. krusei (MIC90 0.5 mg/L), C. glabrata (MIC90 2 mg/L), and C. guilliermondii (MIC90 1 mg/L). Overall, the in vitro activity of isavuconazole against Candida was approximately comparable to that of other azoles. Against fluconazole-resistant Candida isolates, the MICs of isavuconazole were increased (...) load in lungs and brain. Isavuconazole at 1.5 – 36 mg/kg (subcutaneous, single dose) significantly reduced the kidney burden of C. albicans in neutropenic mice. Isavuconazole at 15 – 120 mg/kg/day (oral) was effective against C. tropicalis in a neutropenic mice kidney burden model. Isavuconazole at 30 – 120 mg/kg/day (oral) reduced the kidney and brain burden of C. krusei in neutropenic mice. Assessment report EMA/596950/2015 Page 27/162 In a neutropenic mouse model of disseminated candidiasis

2015 European Medicines Agency - EPARs

158. Guidelines on Prevention, Diagnosis and Treatment of Infective Endocarditis Full Text available with Trip Pro

Force. Antibiotic prophylaxis is not recommended for patients at intermediate risk of IE, i.e. any other form of native valve disease (including the most commonly identified conditions: bicuspid aortic valve, mitral valve prolapse and calcific aortic stenosis). Nevertheless, both intermediate- and high-risk patients should be advised of the importance of dental and cutaneous hygiene ( Table ). These measures of general hygiene apply to patients and healthcare workers and should ideally be applied (...) of this healthcare-associated IE. In summary, these guidelines propose continuing to limit antibiotic prophylaxis to patients at high risk of IE undergoing the highest-risk dental procedures. They highlight the importance of hygiene measures, in particular oral and cutaneous hygiene. Epidemiological changes are marked by an increase in IE due to staphylococcus and of healthcare-associated IE, thereby highlighting the importance of non-specific infection control measures . , This should concern not only high-risk

2015 European Society of Cardiology

159. Cellulitis - acute

to the dermal and subcutaneous tissues via disruptions in the cutaneous barrier. Risk factors include skin trauma, ulceration, and obesity. Complications of cellulitis include necrotizing fasciitis, sepsis, persistent leg ulceration, and recurrent cellulitis. Most episodes of cellulitis resolve with treatment, and major complications are absent. However, recurrence is common, and each episode increases the likelihood of subsequent recurrence. The diagnosis of cellulitis can usually be made on history (...) , but other areas, such as the upper limbs, face, ears, and trunk, can also be affected [ ]. [ ; ; ; ; ; ] Causes What causes it? Cellulitis develops when microorganisms gain entry to the dermal and subcutaneous tissues via disruptions in the cutaneous barrier. The most common causative organisms are: Streptococcus pyogenes . Staphylococcus aureus . Less common causative organisms include: Pseudomonas aeruginosa — following exposure to contaminated hot tubs, sponges, or nail puncture. Vibrio vulnificus

2019 NICE Clinical Knowledge Summaries

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