Vaginal discharge candidiasis
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This document discusses vaginal candidiasis, commonly known as a yeast infection. It notes that Candida species are a common cause of vaginal discharge. Some key predisposing factors that can cause an overgrowth of Candida include pregnancy, contraceptive use, diabetes, antibiotic use, and immunosuppression. Clinical manifestations include cottage cheese-like discharge and vaginal irritation or burning. Diagnosis involves microscopic examination of a vaginal sample for evidence of Candida hyphae or clue cells. Treatment recommendations include topical or oral antifungal azole drugs like clotrimazole or fluconazole depending on severity.
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The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Vaginal discharge candidiasis
- 2. • Candida species - common cause of vaginal discharge • Most common species - Candida albicans -Candida glabrata -C. parapsilosis • 20% women normally have asymptomatic candida in vagina • Candida can multiply & cause infection because of change in hormones,medicine & immune status
- 3. PREDISPOSING FACTORS 1. PREGNANCY • Higher prevalence during pregnancy • Maximally increased in the third trimester • High levels of reproductive hormones a higher glycogen content in the vagina excellent carbon source for Candida
- 4. 2. CONTRACEPTIVES Many studies have shown increased vaginal colonization with Candida following high estrogen-content oral contraceptive use 3. DIABETES MELLITUS Uncontrolled diabetes predisposes to vaginal candidiasis
- 5. 4. ANTIBIOTICS Antibiotics act by eliminating protecting bacterial flora like Lactobacillus Overgrowth of candida in vagina 5. IMMUNOSUPPRESION 6. CORTICOSTEROIDS
- 6. CLINICAL MANIFESTATIONS • Typical discharge is Cottage-Cheese like in character May vary from watery to homogeneous thick • Vaginal pruritus • Vaginal soreness • Irritation & vulvar burning • Dyspareunia & dysuria
- 7. ON EXAMINATION • Examination reveals -erythema of vaginal epithe -inflammation -adherent whitish discharge
- 8. DIAGNOSIS • 10% KOH wet mount of vaginal secretion reveals hyphae Also exclude clue cells and motile trichomoniasis • Vaginal culture is most sensitive & specific method for detecting Candida • Other characteristics are -Vaginal pH less than 4.5 -Lack of odor in discharge
- 9. However since the majority are unable or unwilling to measure vaginal pH and perform microscopy So current diagnosis worldwide is empiric and extremely inaccurate
- 10. TREATMENT (CDC) Uncomplicated VVC Azoles intravaginally are first line drugs - also effective & safe in pregnancy • Clotrimazole 1% 5g for 7-14 days • Miconazole 2% 5gv for 7 days Complicated VVC • Oral fluconazole 100 -200mg every third day for total 3 dose • Along with topical azole therapy for 7-14 days
- 11. TREATMENT(NACO) • NACO recommends kit 2 ( green) for Vaginal discharge under syndromic approach
- 12. Thank You