AIDS and Headache

Question 1

Fungal classification: Yeasts and moulds examples, very simple classification

Answer 1

Yeasts: Candida albicans and other candida. Crytptococcus neformans

Moulds: dermatophytes, aspergillus species

Question 2

Candida albicans features

Answer 2

• commensal in mouth, gut and vagina
• overgrowth occurs when antibacterial therapy, hormone level changes, immunosuppresion

Causes: thrush (oral/vaginal); cutaneous/nail candidiasis; urinary catheter bladder relate; rare systemic

Question 3

Candidiasis treatment

Answer 3

Usually topical, sometimes oral

Nystatin suspension or pastilles; amphotericin B pastilles; azole pessaries or cream

Question 4

Cryptococcus neoformans features

Answer 4

• Yeast
• Environmental (pigeon faeces, eucalyptus trees
• Pulmonary infection due to inhalation
• Spreads to CSF via blood in immunodeficiency
• Meningitis in people with AIDS (corticosteroids therapy long term)
• Chronic lymphocytic meningitis: slow deterioration, head ache and fever

Question 5

C. neoformans diagnosis

Answer 5

• 10-100 WBC’s in CSF. Not PMN predominance. High protein, low glucose
• antigen + in CSF and serum
• india ink stain

Question 6

Cryptococcus meningitis treatment

Answer 6

IV amphotericin
IV or oral fluconazole
6 weeks therapy

Question 7

Dermatophytes and what they cause

Answer 7

Tinea: ringworm =capitis, corporis, cruris, pedis (athletes foot). Never invasive

sourced from animals and humans

Question 8

Common dermatophytes

Answer 8

trichophtyon rubrum >70%
“ mentagrophytes 20%
Microsporum canis 5%
Epidermophyton floccosum 3%

Question 9

Dermatophyte treatment

Answer 9

SKIN: topical azole (clotrimazole, econazole, ketoconazole, micoanzole)
Nails: oral agent- terbinafine or itraconazle

Question 10

Other common skin fungal infections

Answer 10

Pityriasis versicolor: Malassezia furfur. Hyperpigmented macules on trunk, depigmenting rash. 2 week topical or 1 week oral azole

Seborrheic dermatitis: pityrosporum species. Greasy facial rash, dandruff. Topical azole

Question 11

Rare mould disease and features

Answer 11

Aspergillus fumigatus

• rare cause of severe disease in neutropenic patient
• amphotericin to treat

Question 12

Anti-fungal drugs

Answer 12

Amphotericin B: binds to ergosterol, disrupts cytoplasmic membrane. Can cause anaphylaxis. IV
Azoles: inhibit ergosterol synthesis