Abstract
Extensive chronic tinea corporis (EC-TC) is common in people living in tropical environments and in individuals living with diabetes and chronic kidney disease (CKD). However, adults with end-stage kidney disease (ESKD) who seek kidney transplant (KTx) wait-listing require an infection-free medical clearance. Australian clinical care guidelines suggest tinea corporis is cured by antifungal treatment within 2 weeks in the general population, but there are no specific treatment guidelines for adults with severely reduced kidney function who require haemodialysis.
Aim: To describe factors contributing to delayed KTx wait-listing in a patient with EC-TC.
Method: We undertook a case review to address both treatment response for EC-TC for a 43-year-old female with a history of diabetic nephropathy following haemodialysis initiation, and the time it took for her to achieve KTx wait-listing. Follow-up interviews with the client and supporting clinicians were completed in order to learn more about individual perspectives of care.
Results: We observed cure of EC-TC on day 394, and achievement of KTx wait-listing on day 496. The treatment algorithm used to achieve cure involved extended courses of oral terbinafine (250 mg post-dialysis three times weekly, partial response) and oral fluconazole (cure within 3 weeks; 100 mg weekly at dialysis). Holistic care during KTx workup was valued by the patient.
Conclusion: Delayed cure of EC-TC contributed to delayed KTx wait-listing. The in-depth interviews therefore identified healthcare innovations to assist systematic identification and treatment initiation for EC-TC. Furthermore, specific research to improve the treatment response is recommended."
Aim: To describe factors contributing to delayed KTx wait-listing in a patient with EC-TC.
Method: We undertook a case review to address both treatment response for EC-TC for a 43-year-old female with a history of diabetic nephropathy following haemodialysis initiation, and the time it took for her to achieve KTx wait-listing. Follow-up interviews with the client and supporting clinicians were completed in order to learn more about individual perspectives of care.
Results: We observed cure of EC-TC on day 394, and achievement of KTx wait-listing on day 496. The treatment algorithm used to achieve cure involved extended courses of oral terbinafine (250 mg post-dialysis three times weekly, partial response) and oral fluconazole (cure within 3 weeks; 100 mg weekly at dialysis). Holistic care during KTx workup was valued by the patient.
Conclusion: Delayed cure of EC-TC contributed to delayed KTx wait-listing. The in-depth interviews therefore identified healthcare innovations to assist systematic identification and treatment initiation for EC-TC. Furthermore, specific research to improve the treatment response is recommended."
| Original language | English |
|---|---|
| Pages (from-to) | 92-96 |
| Number of pages | 5 |
| Journal | Renal Society of Australasia Journal |
| Volume | 15 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - Nov 2019 |
Bibliographical note
Funding Information:This was an unfunded clinical quality project within Top End Renal Services with assistance from K Dole, M Misener and B Heron. This study is part of the HOT NORTH initiative (NHMRC Grant #1131932). JH was supported by NHMRC Fellowship #1092576. All authors declare there no conflict of interest nor competing interests in the preparation for this manuscript.
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