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fungal infection

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Pharmacology

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Universiti Kebangsaan Malaysia

Academic year: 2022/2023

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UNIVERSITI KEBANGSAAN MALAYSIA

NFNF 2623

CASE STUDY

TITLE: CUTANEOUS FUNGAL INFECTION

DATE: 22/5/

Group 21 Name 1 A/P SIVA KUMAR (A185973) 2. HAIESHWARYYA LAXMY A/P RAJENDREN (A189188) 3. PRAVENNA A/P SUPRAMANIAM (A188502)

Lecturer’s Name Dr bin Mohd Tahir

FACULTY OF PHARMACY

UNIVERSITI KEBANGSAAN MALAYSIA

Trigger 1 Mr LK, a 20-year-old professional cyclist, came to the chain drugstore where you occasionally work as a locum pharmacist. He showed you the scaly plaques, about 1-3 cm in diameter, that developed over the past few weeks on his legs and knees. Some of the plaques were pink or red, and some were hypopigmented and very scaly (Fig. 1). There were also follicular pustules on his thighs (Fig. 2). When asked about treatments he had tried, Mr LK told you that Ecocort resulted in some improvement but not complete resolution of the skin lesions. But he admitted that he did not apply the antifungal cream as instructed. You then asked Mr LK to stop using Ecocort, as you thought it was not suitable for his condition, and referred him to a dermatologist.

Trigger 2 At the dermatology clinic, skin scrapings obtained from the plaques on Mr LK’s legs and knees were found, by microscopic examination (with 30% KOH), to harbour septate, branched hyphae. Examination of the hairs obtained from the follicular pustules on his thighs revealed small-spore ectothrix invasion. A fungal culture on the Sabouraud glucose agar identified the causative fungus to be Microsporum canis. Mycological and clinical cure was achieved after oral treatment with griseofulvin 500 mg daily for one month. No recurrent lesions were observed during a follow- up examination three months later. Adapted from: Gorani A, Schiera A, Oriani A, Barbareschi M. Case report. Tinea corporis due to Microsporum canis in a professional cyclist. Mycoses. 2002;45(1‐2):55-7.

epidermophyton, trichophyton, and microsporum. It also helps to differentiate fungal and non fungal infections with similar clinical manifestations such as tinea pedis and eczema. This is because KOH solution is alkaline and it destroys all non-fungal cells. Accurate identification of the fungus is important to ensure the most effective antifungal will be selected. Fungal cultures involve the growth of fungal organisms from the sample on an agar culture media. Its role in establishing a diagnosis of skin fungal infection is to isolate and identify the specific species of the fungi that causes the infection. This is important for identifying the specific treatment approach and management. Fungal cultures also can be used to confirm a diagnosis as it provides a definitive confirmation of a fungal infection based on the fungal growth on the culture media.

● Guiding antifungal treatments. The role of KOH microscopy in guiding antifungal treatments is, it provides monitoring treatment response whereby it can monitor the response of the fungi towards the antifungal treatment given. After the treatment is given, the continuous microscopic examination of the sample can help to assess the progress of the fungal growth whether it is decreasing in number or not. A reduction of fungi over time indicates that the antifungal therapy is suitable to be used. Next, it can also be used to estimate the treatment duration by monitoring the persistence of the fungal elements. If the presence of the fungus is ongoing, it indicates that the infection is also ongoing and the antifungal treatment should be given for a longer course or other treatment options should be given. KOH microscopy can also be used to confirm treatment success. When there are negative or clear microscopy findings, it shows the absence of fungal elements which indicates that the infection has been treated effectively. Fungal culture roles in guiding the antifungal treatment is it can monitor the reinfection of the fungal infection after completing the treatment. The follow-up cultures can help to determine if the infection is completely eliminated or if there is still risk of recurrence. This helps to decide if additional treatment or other preventive measures are required to be taken. Other than that, it can also be used to alter the treatment based on the antifungal resistance patterns. When resistance is detected through culture and susceptibility testing, alternative antifungal treatment can be determined. The alternative treatment such as other antifungal or

combination therapies selected will be more specific towards the identified resistant species to enhance its efficacy to treat the infection.

Explain the counselling points pharmacists should make when teaching patients how to apply topical antifungals. How may this impact treatment efficacy? The pharmacist should evaluate a patient's understanding of his condition and course of treatment and offer personalized advice and guidance to help the patient take medication in the safest and most effective way. The patient must adhere to plenty of guidelines in order to appropriately use topical antifungal medications. Prior to applying the medication, the patient must clean and dry the affected area. The medicine should then be evenly and sparingly applied to the entire afflicted area. To stop the spread of infection, the patient must wash their hands both before and after the application. In addition, he should avoid bandaging or dressing the treated region unless instructed to do so by a healthcare professional. Even if their symptoms become better, patients should always take their medication as prescribed and keep taking it for the entire duration of their therapy. To preserve the stability of the drug, he should store it in a cool, dry location away from heat and moisture.

The effectiveness of treatment depends on the proper administration of topical antifungals. Proper administration of medication increases the drug penetration into the targeted area, decreases the possibility of recurrence and also minimizes the risk of adverse effects due to improper application of antifungal agents. The medication may not reach the affected area if it is not administered properly, or it may be diluted by extra moisture or other chemicals. As a result, the infection may not receive proper care and may persist for a long time. Pharmacists can assist patients in achieving the best possible treatment outcomes and halt the spread of infection via providing them clear and succinct counseling points.

Why was Ecocort an incorrect choice of treatment? Ecocort contains corticosteroids. Corticosteroids, due to their immunosuppressive properties, can weaken the body’s immune system, which may hinder the ability to fight off fungal infections. In such cases, using corticosteroids can potentially worsen the infection or delay its resolution. When it comes to the treatment of systemic fungal infections, the appropriate course of action typically involves antifungal medications that specifically target and eradicate

cells that line the outer surface of the body and the surfaces of inner organs. Keratin is found in skin, nail, hair, and hair follicles. Griseofulvin binds with new keratin that forms in the epithelial cells making it highly resistant to fungal growth. The fungal infection clears as the old infected cells are shed and the resistant cells form the new skin layer.

Based on this case, the affected region on this patient has hair follicles , thus griseofulvin will be a suitable antifungal since it has the ability to be absorbed systemically and deposited in keratin, a type of protein in epithelial cells that line the outer surface of the body. Griseofulvin binds with new keratin that forms in the epithelial cells making it highly resistant to fungal growth. The fungal infection clears as the old infected cells are shed and the resistant cells form the new skin layer. This will help the patient to completely heal. In conclusion , griseofulvin is suitable to be given to this patient.

End your report with a suitable conclusion e., commenting on the appropriateness of the antifungal treatments described in this case. In conclusion, the appropriate antifungal treatment given has to be based on the type of fungus that causes the infection and the severity of infection. In this case, Mr LK’s infection is caused by Microsporum canis, hence, systemic therapy of Griseofulvin tablet antifungal is the best treatment to treat his condition as it is a more deeper and severe infection. Topical antifungal like Ecocort is not suitable to be given as it is more preferable for superficial infections for a smaller area of infection. Corticosteroids should not be used alone as the fungus can feed itself on the steroids which makes the infection even worse. So, giving tablet Griseofulvin to Mr LK is the best treatment as it has higher effectiveness as he can have a better adherence to take the tablet throughout the whole treatment term.

References U. National Library of Medicine. (n.). Griseofulvin: Medlineplus drug information. MedlinePlus. medlineplus/druginfo/meds/a682295.html#:~:text=Griseofulvin%20is%20used%20to %20treat,or%20pharmacist%20for%20more%20information.

Heather L. Brannon, M. (2023, April 25). KOH prep test to diagnose fungal skin infections. Verywell Health. verywellhealth/koh-test-dermatology-

MedicineNet. (2022b, July 14). Griseofulvin: Ringworm uses, warnings, side effects, dosage. MedicineNet. medicinenet/griseofulvin/article.htm

U. National Library of Medicine. (n.-a). Fungal culture test: Medlineplus medical test. MedlinePlus. medlineplus/lab-tests/fungal-culture-test/

Fungal culture media: Introduction, principle, preparation, test procedure. universe84a. (2022, December 3).

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