Primary Varicella (Chickenpox) and Candidiasis (Yeast Infection)

00:02 The topic here is primary varicella.

00:04 In other words, chicken pox.

00:07 Take a look at the child here.

00:08 We have vesicles that are taking place.

00:11 Seen less frequently now that most children are vaccinated.

00:14 It can be seen adults and that is horrible.

00:17 And dew drops on rose petals perhaps is how you want to think of these vesicles.

00:21 So imagine in the morning that there is dew drops that are on rose petals and this then represents the weeping vesicle that you’d find in chicken pox.

00:30 Complication: VZV pneumonia that may take place.

00:35 Candidiasis, your patient is almost always going to be immunocompromised.

00:39 But candida is a normal skin commensal.

00:43 It can become pathologic when overgrown though and that’s where things become dangerous.

00:48 Your demographics for candidiasis: Diabetic, obese, and those involved with a lot of wet work, on other words, bartenders are predisposed.

01:00 You can have that candida, which is in between your mucosal areas.

01:05 So we call this intertriginous, erythema/pustule in the body folds.

01:10 Think of your groin area, please.

01:12 If it’s thrush, then you’re thinking about the candida, unfortunately, then creating an infection in the oral cavity.

01:19 Creamy white papule, plaques in the oral mucosa in which that can be easily scraped off.

01:25 Oral thrush, you’ve heard of before.

01:28 Or may result in perleche, fissuring and erythema in the oral commissures.

01:35 Candidiasis is your topic.

01:39 If you take a look at the tongue in this particular patient, you’ll notice that the tongue is extremely white and that if once scraped off comes off as opposed to something called leukoplakia.

01:52 Leuokoplakia might be one in which the squamous cells of the tongue that are undergoing hyperplasia and therefore with the tongue depressor, there is no way that that white substance is going to come off.

02:03 This however is oral thrush.

02:05 And on the right, you’ll notice here underneath the nail bed that we have white-like appearance as well for the most part.

02:12 whenever there’s candidiasis, you should be thinking about immunocompromise and wherever candida is located, what you’re going to find superficially is going to be that white-like substance, let it be the tongue, let it be the esophagus, let it be obviously if you have candidal or fungal type of vaginosis, there also you’re going to find white-like -- Well there, if you do a pelvic exam, it may very well look like cottage cheese.

02:40 Management: Topic azoles, topical nystatin powder or cream.

02:45 And if it’s in the mouth, then you’re thinking about nystatin mouth wash or clotrimazole troches.

02:54 Diagnosis: If you were then to take a look at this, yeast overgrowth can be indentified on KOH examination.

03:02 What are you going to find? Pseudohyphae are indicative of pathologic overgrowth.

03:06 So let’s say that you are suspecting candidiasis, you do a KOH examination, and therefore you’ll find pseudohyphae because these yeast might then be elongated.

03:17 It wouldn't be a true hyphae, but a pseudohyphae, which then confirms that your patient is suffering from candidiasis.