CANDIDIASIS - Is a mild superficial fungal infection caused by genus candida - Most often, Candidiasis infects the nails (onchomycosis),

the skin (diaper rash), mucous membrane, particularly the oropharynx (thrush), vagina (monillasis), esophagus, and the GIT. Causative Agent: - Candida albicans - These organisms are part of the normal flora of the GIT, mouth vagina and skin They cause infection when: There is rise in glucose in DM The persons resistance is lowered esp. When due to cancer The person is taking an immunosupperssive drug, exposed to radiation, aging or when infected with HIV The level of estrogen rises in pregnant women These org. Are introduced systematically by IV or Urinary cath., drug abuse, hyperalimentation or surgery. Broad expectrum antibiotics are used, as these depress normal flora and aloow candida microbes to proliferate. Signs and Symptoms: - Scaly skin, erythematous and papular rash - Nails are red and swollen - Oropharyngeal mucosa (thrush) - The pt. Feels retrosternal pain and regurgitation - Vaginal mucosa - Renal system-fever, flank pain, dysuria, hematuria, pyuria - Pulmonary-hemoptysis, fever, cough - Brain-headache, nuchal rigidity, seizures - Endocardium-systolic or diastolic murmur, fever, chest pain - Eyes- blurred vision, orbital or periorbital pain DIAGNOSTIC EXAM 1. Stool Culture 2. Gram staining of skin, vaginal discharge or scrappings Nursing Management: 1. Avoid sharing utensils 2. Meticulous mouth care

3. Proper disposal of oral secretions Medical Management: 1. Pharmacologic therapy PROPHYLAXIS 1. Fluconazole 400 mg daily preventing deeply invasive candidiasis in some high risk postop px. 2. Fluconazole 3-6mg/kg or Itraconazole solution 5mg/kg recommended daily oral dose Treatment: 1. Nystatin 2. Clitrimasole, fluconasole, ketoconasole 3. fluconasole or amphothericine Prevention: 1. Check high risk pt. Daily for patchy areas of irritation, soar throat and gum bleeding 2. Check vaginal discharge and note the color, odor and amount PATHOPHYSIOLOGY Candida is unicellular yeast whose cells reproduce by budding. This organism can flourish in most environments. It frequently colonizes the oropharynx, skin, mucous membranes, and lower respiratory, and gastrointestinal and genitourinary tracts. Pathogenesis: -increased fungal burden and colonization, such as in the setting of broad-spectrum antimicrobial agents -breakdown of normal mucosal and skin barriers, which can occur with indwelling intravascular devices, recent surgery/trauma or tissue damage secondary to chemotherapy or radiation -immune dysfunction secondary to disease states or iatrogenic conditions. The first step in the development of a candidal infection is colonization of the mucocutaneous surfaces. The routes of candidal invasion include; Disruption of a colonized surface (skin or mucosa), allowing the organisms access to the bloodstream. colonized surface (skin or mucosa), allowing

the organisms access to the bloodstream adsorption via the gastrointestinal wall, which may occur following massive colonization with large numbers of organisms that pass directly into the bloodstream

HERPES ZOSTER - is an acute viral infection of the sensory nerve caused by a variety of chickenpox virus Etiologic Agent -Varicella zoster (V-Z) virus 1. This agent has been found to cause two diseases, varicella and herpes zoster 2. The virus still occurs in partially immune individuals due to previous varicella infection MODE OF TRANSMISSION: - it can be transmitted through direct contact, through droplet infection and airborne spread - it can also be transmitted through indirect contact, through articles freshly soiled by secretions and discharge from the infected person PATHOGENESIS The virus is identical with the causative agent of varicella zoster virus may persist in a dormant state in the dorsal nerve root ganglia. The virus may emerge from the site in later years either spontaneously or in association with immunosuppression to cause herpes zoster. It produces localized vesicular skin lesions confined to a dermatone and severe neurologic pain in the peripheral areas innervated by the nerves arising in the inflammed root ganglia. This infection occurs in adults. CLINICAL MANIFESTATION - Erythematous base skin lesions - Pain - Fever, malaise, anorexia headache - Regional lymph nodes - Gasserian ganglionitis - Ramsay Hunt Syndrome

NURSING MANAGEMENT: 1. Keep pt. Comfortable, maintain meticulous hygiene 2. Put patient on strcit isolation 3. Apply cool, wet dressings with NSS to pruritic lesions 4. Efforts should be made to prevent secondary infection 5. Prevent entrance of microorganism into the lesions especially if they break 6. Assess degree of pain and to avoid neuralgic pain do not delay the administration of pain relievers as prescribed 7. Encourage sufficient bed rest and supportive care to promote proper healing of lesions 8. Provide patient with diversionary activity to take his mind off pain and pruritus. PREVENTION: Immunization against chicken pox Avoid exposure to patient suffering from either varicella or herpes zoster Increase resistance MEDICAL TREATMENT Antiviral medicines Pain medicine, antidepressant and topical creams

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DIAGNOSTIC EXAM 1. Characteristic skin rash may be diagnostic 2. Tissue culture technique 3. Smear of vesicle fluid 4. Microscopy