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DTMH Block 3 > Candidiasis > Flashcards

Candidiasis Flashcards

1
Q

What are the virulence factors of candidiasis?

A

GIT commensals - hospitalised patient’s skin and mucosa
Opportunistic - immunosuppression
Biofilm formers (lines, devices)

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2
Q

What is the 4th cause of BSI in hospitalised patients?

A

Candidiasis, 50% of which are ICU patients

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3
Q

What is the definition of invasive candidiasis?

A

Isolation of candida from a sterile site
1. Candidemia
2. Deep seated

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4
Q

What is the number 1 cause of systemic fungal infections?

A

Candida

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5
Q

What is the in hospital mortality of invasive candidiasis?

A

50%
Outcomes are worse if treatment is delayed

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6
Q

What are the intra-abdominal types of invasive candidiasis?

A
  1. Peritonitis
  2. Abscess (post-surgery)
  3. Cholecystitis
  4. Choleangitis
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7
Q

What does the diagnosis of invasive candidiasis require?

A

Isolation from sterile site
AND
Clinical evidence

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8
Q

If diagnosing an invasive candidiasis, what is the maximum length of time of the drain from which the fluid is taken allowed to be?

A

<24h

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9
Q

Can you use swabs to diagnose invasive candidiasis?

A

No

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10
Q

What are disease related breaches in barrier defence?

A

Burns
Mucositis
GI perforation
Pancreatitis
Anastomotic leak

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11
Q

What are intervention related breeches in barrier defence?

A

IV lines
TPN
GI surgery
Urological intervention

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12
Q

How can candida colonise the body?

A

Antibiotic use
Environmental acquisition

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13
Q

To which organs does candidemia often disseminate to haematongeously?

A

Endocarditis
Endopthalmitis
Renal
Brain
Hepatosplenic

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14
Q

Which host factor co-morbidities increase the risk of candida infection?

A

Cancer (haem>solid organ)
Diabetes
Transplant (BM>solid organ)
Liver failure
Renal failure

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15
Q

Which host factor drugs increase the risk of candida infection?

A

Corticosteroids
Chemotherapy
Anti-rejection
Biologics

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16
Q

Which host factor genes increase the risk of candida infection?

A

SNPs at loci
- CD58
- LCE4A-C1orf68
- TAGAP

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17
Q

What is the gold standard of candida diagnosis?

A

Culture

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18
Q

What is the sensitivity and specificity of BDG?

A

60-80%

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19
Q

What is the NPV and PPV of BDG?

A

NPV - high (use to exclude)
PPV - low (anti-fungal overuse)

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20
Q

Which circumstances can cause a false positive BDG

A

Hemodialysis
Immunoglobulin infusion
Albumin
Surgical gauze

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21
Q

What improves the performance of BDG?

A

Serial samples
Cut off >250

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22
Q

What is the benefit of BDG combined with other biomarkers?

A

Inconclusive benefit

23
Q

What is the Candida Colonisation Index?

A

Ratio of the number of non-blood sites colonised with candida spp/total number of sites

24
Q

What are adjuncts to diagnosis invasive candidiasis?

A
  1. Candida Colonisation Index
  2. Candida Score
  3. Ostrosky-Zeichner Clinical Prediction Rule
25
Q

What is the Candida Score?

A

TPN (1)
Surgery (1)
Severe sepsis (2)
Multifocal candida colonisation (1)
>2.5 is positive

26
Q

What is the Ostrosky-Zeichner Clinical Prediction Rule?

A

Mechanical ventilation >48h AND systemic ABs AND CVP PLUS 1 of any
- major surgery
- pancreatitis
- immunosuppressive agents
- TPN
- dialysis

27
Q

Which strategy is used when patient has risk factors for candidiasis?

A

Prophylactic strategy

28
Q

Which strategy is used when patient has clinical features of fungal sepsis?

A

Empiric strategy

29
Q

Which strategy is used when patient has fungal biomarkers?

A

Pre-emptive strategy

30
Q

Which strategy is used when patient has positive fungal culture, PCR or histology?

A

Targeted strategy

31
Q

Which sites do echinocandins not penetrate?

A

CNS
Urine

32
Q

What is the preferred initial therapy for all candida species?

A

Echinocandins

33
Q

Which candida species can fluconazole be considered as an alternative therapy?

A

C. albicans
C. tropicalis
C. parapsilosis

34
Q

Which candida species can amphotericin B be considered as an alternative therapy?

A

C. glabrata
C. krusei
C. auris

35
Q

What is the preferred agent for candida krusei?

A

Voriconazole

36
Q

Which drugs interact with triazoles?

A

CYP450 inhibitors

37
Q

Which anti-fungal treatments need TDM?

A

Voriconazole
Flucytosine

38
Q

What is the target site of terbinafine?

A

Squalene -> squalene epoxide

39
Q

What is the target site of azoles?

A

Lanosterol -> ergosterol

40
Q

What is the target site of amphotericin B?

A

Cell membrane

41
Q

What is the target site of nystatin?

A

Cell membrane

42
Q

What is the target site of echinocandins?

A

Beta-glucan synthase

43
Q

What is the target site of flucytosine?

A

Fungal RNA

44
Q

How do you monitor for candidiasis resolution?

A

Clearance cultures
Clinical
Radiological

45
Q

What are poor prognostic factors for invasive candidiasis?

A

GI source
Lack of source control
Short BC TTP
Delayed treatment
Lack of ID consult
Severe sepsis
Severe comorbidities

46
Q

Which candida species are intrinsically resistance to the azaleas?

A

C. kruseii
C. guillermondi
C. glabrata

47
Q

Which candida species has acquired resistance to echinocandins?

A

C. glabrata

48
Q

What are the most common mechanisms of acquired resistance?

A

Target alteration (aspergillus)
Drug efflux regulation (glabrata)

49
Q

Which gene mutation is seen in azole resistant aspergillus?

A

ERG11

50
Q

What are the drivers of anti fungal resistance?

A

Widespread human use
Agricultural crop spraying

51
Q

Which gene mutation is seen in echinocandin resistance?

A

FKS 1/2

52
Q

What is the most common cause of candidemia in SA?

A

C. parapsilosis

53
Q

How many candida species are on the WHO fungal priority pathogens list?

A

4/11
1. C.auris
2. C. albicans
3. C. parapsilosis
4. C. tropicalis

54
Q
A

DTMH Block 3 (18 decks)

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