Fungal Infections. Diagnosis and Treatment

Transcription

1 Fungal Infections Diagnosis and Treatment This is the first book on cutaneous fungal infections in Indian skin type Richly illustrated with patient scenarios, diagrams and photographs Focus on recalcitrant dermatophytoses A multiclinical perspective with specialized microbiology and pharmacology specialist input on relevant aspects Covers all aspects including superficial and deep systemic fungal infections and antifungal drugs Kabir Sardana MD, DNB, MNAMS is currently Professor, Department of Dermatology, Dr RML Hospital and PGIMER, New Delhi. He was previously a Professor at Maulana Azad Medical College (MAMC), New Delhi. He has to his credit over 130 peer-reviewed papers cited on Pubmed, and is author/editor of a number of books listed on Google books and Amazon, some of which are Diagnosis and Management of Skin Diseases: An Evidence-Based Approach, Comprehensive Textbook of Dermatology, Lasers in Dermatological Practice, Clinical Approach to Pigmentary Disorders, Clinical Approach to Acne Vulgaris,Clinical Approach to Fungal Infections, Handbook of Eczema for Practitioners and Hair Loss: A Primer for Practitioners. His clinical research interests focus on acne vulgaris, psoriasis, alopecia areata, pigmentary disorders, lasers in dermatological practice, hyperandrogenism and pediatric dermatology. Khushbu Mahajan MD is currently Associate Professor, Department of Dermatology, NDMC Medical College and Hindu Rao Hospital, Delhi. She has to her credit over 25 publications in various national and international journals and has also contributed chapters in a few books on dermatology. She has presented papers at various national and international conferences. Pooja Arora Mrig MD, DNB, MNAMS is currently Assistant Professor, Department of Dermatology, Dr RML Hospital and PGIMER. New Delhi. Previously she was Assistant Professor, Chacha Nehru Bal Chikitsalaya, and Hamdard Institute of Medical Sciences and Research, Delhi. She has authored around 25 publications in national and international journals and has written numerous chapters for dermatology books. Her main areas of interest include acne vulgaris, pigmentary disorders, fungal infections and pediatric dermatology. CBS Publishers & Distributors Pvt Ltd 4819/XI, Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi , India delhi@cbspd.com, cbspubs@airtelmail.in; Website: New Delhi Bengaluru Chennai Kochi Kolkata Mumbai Hyderabad Nagpur Patna Pune Vijayawada ISBN: Fungal Infections Diagnosis and Treatment Sardana Mahajan Mrig Fungal Infections Diagnosis and Treatment Focus on Recalcitrant Dermatophytoses CBS Publishers & Distributors Pvt Ltd Kabir Sardana Khushbu Mahajan Pooja Arora Mrig Forewords by R K Gautam Bela shah

2 Fungal Infections Diagnosis and Treatment

3 Fungal Infections Diagnosis and Treatment Kabir Sardana MD DNB MNAMS Professor Department of Dermatology PGIMER, Dr Ram Manohar Lohia Hospital New Delhi Khushbu Mahajan MD Associate Professor North Delhi Municipal Corporation Medical College and Hindu Rao Hospital Delhi Pooja Arora Mrig MD, DNB, MNAMS Assistant Professor Department of Dermatology PGIMER, Dr Ram Manohar Lohia Hospital New Delhi CBS Publishers & Distributors Pvt Ltd New Delhi Bengaluru Chennai Kochi Kolkata Mumbai Hyderabad Nagpur Patna Pune Vijayawada

4 Disclaimer Science and technology are constantly changing fields. New research and experience broaden the scope of information and knowledge. The authors have tried their best in giving information available to them while preparing the material for this book. Although all efforts have been made to ensure optimum accuracy of the material, yet it is quite possible some errors might have been left uncorrected. The publisher, the printer and the authors will not be held responsible for any inadvertent errors or inaccuracies. Fungal Infections Diagnosis and Treatment ISBN: Copyright Authors and Publisher First Edition: 2017 All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the authors and the publisher. Published by Satish Kumar Jain and produced by Varun Jain for CBS Publishers & Distributors Pvt Ltd 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi , India. Ph: , , Website: Fax: Corporate Office: 204 FIE, Industrial Area, Patparganj, Delhi Ph: Fax: Branches Bengaluru: Seema House 2975, 17th Cross, K.R. Road, Banasankari 2nd Stage, Bengaluru , Karnataka Ph: /79 Fax: Chennai: 7, Subbaraya Street, Shenoy Nagar, Chennai , Tamil Nadu Ph: , Fax: Kochi: Ashana House, No. 39/1904, AM Thomas Road, Valanjambalam, Ernakulam , Kochi, Kerala Ph: Fax: Kolkata: 6/B, Ground Floor, Rameswar Shaw Road, Kolkata , West Bengal Ph: , , Mumbai: 83-C, Dr E Moses Road, Worli, Mumbai , Maharashtra Ph: /41 Fax: mumbai@cbspd.com Representatives Hyderabad Nagpur Patna Pune Vijayawada Printed at Magic International Pvt. Ltd., Greator Noida, UP, India

5 to my parents Amba Sardana and Maj Gen KN Sardana at Dehradun my wife Dr Supriya Mahajan and my daughter Zoya my seniors teachers, colleagues and students at LHMC, MAMC, CNBC and RML Hospital Kabir Sardana my grandfather, whose pure admiration for profession inspired me to strive harder and dream to be here my daughter, whose innocence helped me rekindle honesty and purity in words and actions my teachers and students, whose questions always inspired me to constantly seek knowledge to the core of the subject my friends and family, who by their sheer presence and unending support have made everything look and feel so simple. Khushbu Mahajan my family for their continuous love and support my parents for being my inspiration since childhood my husband Dr Sumit Mrig for being the pillar of strength my guru Dr Kabir Sardana for having faith in me in such projects Pooja Arora Mrig

6 Everything is predetermined Success and failure are due to prarabdha karma, and not to willpower or the lack of it. One should try to gain equipoise of mind under all circumstances. That is willpower. Man is always free not to identify himself with the body, and not to be affected by the pleasures or pains consequent on the body s activities. Free will and destiny are inconsequential if one understands the transience of the body and mind and the eternity of the spirit Shri Raman Maharishi

7 Contributors Aastha Gupta MD Senior Resident Department of Dermatology PGIMER, Dr Ram Manohar Lohia Hospital New Delhi Autar K Miskeen Director, Dr Miskeen s Central Clinical Microbiology Laboratory Thane, India Bhavna Garg Professor, Department of Pathology Dayanand Medical College and Hospital Ludhiana, Punjab C Srinivas CMD, DM Manager Medical Affairs Global Generics-India Dr Reddy s Laboratories Ltd. G Raghu Rama Rao Prof and HOD, DVL GSL Medical College Rajahumandry, AP. Harpreet Kaur Professor, Department of Pathology Dayanand Medical College and Hospital Ludhiana, Punjab Khushbu Mahajan MD Associate Professor North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, Delhi Neena Sood Prof and Head Department of Pathology, Dayanand Medical College and Hospital Ludhiana, Punjab Priya Uppuluri Los Angeles Biomedical Research Institute Harbor-UCLA, 1124 W. Carson St., Torrance, CA Pooja Agarwal MD Consultant Dermatologist Shifa Multispeciality Hospital, Ahmedabad Pooja Arora Mrig MD, DNB, MNAMS Assistant Professor Department of Dermatology PGIMER, Dr Ram Manohar Lohia Hospital New Delhi Shukla Das Director Professor Department of Microbiology UCMS & GTB Hospital Dilshad Garden, Delhi SN Bhattacharya Prof and Head Department Dermatology & STD UCMS & GTB Hospital, Dilshad Garden, Delhi Suchita Gawde MBBS, MD (Pharmacology.), DBM Mumbai Sukriti Sharma DNB student, Hindu Rao hospital Delhi Sumit Mrig MS, DNB, MNAMS Senior Consultant and Head Department of ENT and Cochlear Implant Surgery Max Smart Superspeciality Hospital Delhi

8 viii Fungal Infections: Diagnosis and Treatment Surabhi Sinha MD, DNB Specialist, Department of Dermatology PGIMER, Dr Ram Manohar Lohia Hospital New Delhi Thurakkal Salim Clinical Head and Medical Director Cutis Institute of Advanced Dermatology Calicut, India Veena Chandran MD, DNB Dermatology Medical Officer, Royal Perth Hospital Perth, WA, Australia Vineet Narula MS, DNB Associate Consultant Department of ENT and Cochlear Implant Surgery Max Smart Superspeciality Hospital Delhi Vikram Narang Asstt Professor Department of Pathology Dayanand Medical College and Hospital Ludhiana, Punjab

9 Contents ix Government of India Ministry of Health & Family Welfare Department of Dermatology, STD & Leprosy PGIMER, Dr Ram Manohar Lohia Hospital New Delhi Foreword It is my privilege to write the Foreword to the book Fungal Infections: Diagnosis and Treatment by Dr Kabir Sardana and 18 other contributors who are eminent in the field of microbiology, with special interest in mycology, dermatology, ENT and pharmacology. Fungal infections are important for dermatologists and nowadays, resistance to treatment for fungal infections is encountered due to various factors, eloquently detailed in this book. This book by Dr Kabir Sardana and others covers all aspects related to superficial and deep fungal infections and also highlights the treatment. This book is yet another compilation on fungal infections and is important for postgraduates as well as the faculty. The photographic documentation of various fungal disorders shall help in identifying these conditions and was much desired from an Indian perspective by an Indian author. I am sure the book shall not only be read by practitioners, but be recommended for reading to all postgraduates by their teachers. I hope the authors shall also write similar books on bacterial and viral infections. Dr. (Prof.) RK Gautam MD, MNAMS Professor and Consultant Dr RML Hospital, Delhi

10 Foreword It gives me immense pleasure and privilege to contribute a foreword for this book, which has been written by an eminent dermatologist, Dr Kabir Sardana. Superficial fungal infections have never been so critical arena for dermatologist for many years. Even during HIV epidemic across India; dermatologists did not face much problem to manage extensive dermatophytoses. India is experiencing massive epidemic of relapsing dermatophytosis for the past few years. Most of us find these infections difficult to treat due to inadequate response to the available therapies and frequent relapses. Changing antifungals, giving high doses, adding oral retinoids; all have been tried with variable efficacy. This book is the result of intense hard work and reflects the knowledge and dedication of Dr Sardana in the field of dermatology. The authors have provided a substantial and crystal clear understanding to the Fungal infections, immunology, pathogenesis, diagnosis, resistance, relapse and management. They have given an in-depth analysis of not just superficial fungal infections but also subcutaneous and deep fungal infections prevalent in India and has offered solutions as well in a very scientific and crisp manner which will be able to clear the prevailing dilemmas. This book will contribute to the field of mycology greatly and will be useful to the clinicians, academicians and postgraduates in the field. I compliment Dr Sardana and his team for their excellent effort and wish them all the success. Dr. Bela J Shah Professor and Head Department of Dermatology, STD, AIDS and Leprosy BJ Medical College and Civil Hospital, Asarwa, Ahmedabad

11 Preface Fungal infections have two basic divisions, the superficial infections and deep infections. The former has always been simple to treat, but in recent times, recalcitrant dermatophytosis has been an issue and a large number of clinicians believe that resistance is a cause but there is very little data to support this with concrete mycological proof in direct proportion to the extent of the problem. The problem lies in the intricate host fungal interaction and a change in the species to anthropophilic from zoophilic which helps it to evade the host immune response. In this quest we have had the privilege of involving two mycologists in this book to add their views on this issue. Dermatologists both in clinical practice and from institutions have added their wisdom to cover the clinical aspects of superficial infections. A chapter on recalcitrant infections has been added to put this problem in the right perspective. Of course, some of the readers may have a different perspective which mirrors the eternal truth of life Don t believe in everything that you hear. There are always three sides to a story. Yours, theirs and the truth. For the deep infections, we have taken chapters written by authors who have studied and seen these disorders and the list encompasses dermatologists and ENT specialists to make it a multiopinionated input. For the drug section, we have two pharmacologists, working for national companies who have added inputs on itraconazole and terbinafine. A big thanks to CBS Publishers & Distributors, Mr SK Jain (CMD) and Mr YN Arjuna (Senior Vice President Publishing, Editorial and Publicity) and their team, Mrs Ritu Chawla (Assistant General Manager Production), Mr Vikrant Sharma, Neeraj Prasad, Mr Sanjay Chauhan (Sanju), Mr Kshirod Sahoo and Mr Ananda Mohanty, Mr SK Verma and the endless cups of tea and coffee, all of which played a role in this book. In the end we would like to emphasize that the intricacies of the host immune response and the evasion of the same by the fungus

12 xiv Fungal Infections: Diagnosis and Treatment proves that there is a power much more intelligent that all of us that determines the way things run in this world. Lastly a big thanks to the contributors and the support of the Department of Dermatology at RML Hospital and PGIMER. Happy reading! Kabir Sardana Khushbu Mahajan Pooja Arora Mrig

13 Contents xv Contents Contributors Foreword by Dr RK Gautam Foreword by Dr Bela J Shah Preface vii ix xi xiii 1. Introduction to Fungal Infections: Focus on Dermatophytoses 1 2. Immunology and Pathogenesis of Dermatophytoses Laboratory Diagnosis of Fungal Infections: A Primer Microbiological Aspects of Dermatophytes: Clinical Relevance Superficial Fungal Infections 52 (A) Dermatophytoses 52 Classification 54 Pathogenesis 54 Tinea capitis 62 Tinea faciei 72 Tinea barbae 75 Tinea corporis 78 Tinea mannum (tinea of the hand) 83 Tinea crusis 84 Tinea incognito 89 Tinea pedis 91 Tinea unguium (onychomycosis) 97 (B) Malassezia infections: Skin manifestations 112 Tinea versicolor/pityriasis versicolor 112 Pityrosporum/Malassezia folliculitis 119 Seborrheic dermatitis 120 (C) Candidiasis (moniliasis) 129 Vulvovaginitis 132

14 xvi Fungal Infections: Diagnosis and Treatment Oral candidiasis 135 Candida balanitis 143 Cutaneous candidiasis 144 (D) Recalcitrant dermatomycosis: Focus on tinea corporis/cruris/pedis Subcutaneous Mycoses Mycetoma Chromoblastomycosis Sporotrichosis Subcutaneous zygomycosis due to basidiobolus and conidiobolus Phaeohyphomycosis Cutanous rhinosporidiosis Lobomycosis Systemic Fungal Infections Histoplasmosis Bastomycosis Coccidioidomycosis Mucormycosis Cryptococcosis Hyalohyphomycosis Other opportunistic infections Approach to diagnosis and treatment of systemic fungal infections Antifungal Drugs Introduction Systemic antifungal drugs Topical antifungal drugs 305 Index 319