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Clinical Pathology > CP3 fungal pathogens > Flashcards

CP3 fungal pathogens Flashcards

1
Q

What are 4 types of fungal pathogens?

A

dermatophytes
Malassezia species
Candidia species
Aspergillus species

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2
Q

What are two growth forms of fungi?

A

Hypha (moulds)
Yeasts

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3
Q

Where are fungi found?

A

On decaying organic matter (known as saprophytes)
On plants
On animals

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4
Q

What are 3 types of infection caused by fungal pathogens?

A

Superficial infection (skin hair and/or nails)
Subcutaneous infection (usually following traumatic implantation)
Systemic (affecting deep seated organs)

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5
Q

What are dermatophytes and where do they come from?

A

Group of moulds that cause disease in the hair skin and nails. Come from geophillic (soil), zoophilic (animals) and anthropophilic (other humans) sources.

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6
Q

What fungal pathogen caused inflammatory tinea infections?

A

Trichophyton interdigitale

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7
Q

What is the medical term for a fungal disease?

A

Tinea ______ (blank filled in with body part)

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8
Q

What are 5 examples of dermatophyte infection?

A

Athletes foot
Fungal nail disease
Jock itch
Ringworm
Scalp ringworm

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9
Q

What is the incidence of fungal nail infection?

A

5-25%

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10
Q

Who is most likely to suffer from fungal nail infection?

A

Elderly

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11
Q

Who is most likely to get athletes foot?

A

Adults and sportsmen

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12
Q

Who is most likely to get scalp ringworm?

A

Prepubertal children - 6%

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13
Q

What are presentations of athlete’s foot?

A

Uni or bilateral itching, flaking and fissuring of skin of foot

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14
Q

What can occur secondary to athletes foot?

A

Hyperhidrosis and toe nail infection

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15
Q

What is a typical pathogen that causes athletes foot?

A

Trichophyton rubrum

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16
Q

What is the medical term for athletes foot?

A

Tinea pedis

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17
Q

How is tinea ungumium categorised?

A

Healthy
Distal-lateral infection
Superficial white
Proximal
Total dystrophic

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18
Q

Who is more likely to get tinea cruris (jock itch)?

A

Men

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19
Q

What are symptoms of jock itch?

A

Itching, scaling, erythematous plaques, satellite lesions (sometimes) in the groin which may extend to bum, back and lower abdomen

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20
Q

What fungal pathogens can cause jock itch?

A

Trichophyton rubrum or Trichophyton indotineae

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21
Q

What are the signs/symptoms of tinea capitis athropophilic and zoophilic?

A

Anthropophilic - Range from slight inflammation, scaly patches with alopecia, “black dots” to severe inflammation

Zoophilic - boggy, inflamed lesions

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22
Q

What type of causes are associated with tinea capitis (scalp ringworm)

A

Anthropophilic and zoophilic causes

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23
Q

What are the symptoms of tinea corporis?

A

Circular, single or multiple erythematous plaques

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24
Q

What is it called when ringworm invades the follicle?

A

Majocci’s granuloma

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25
Q

What causes ringworm?

A

Dermatophytes (both anthropophilic and zoophilic)

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26
Q

What do you treat most dermatophyte infections?

A

Topical anti fungal treatments if mild e.g. terbinafine, clotrimazole, micronazole

Systemic anti fungal if severe

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27
Q

How do you treat tinea capitis (scalp ringworm)?

A

NEVER with topical treatment, always systemic oral antifungals e.g. terbinafine, griseofulvin or itraconazole depending on causal species

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28
Q

What is malassezia?

A

A genus of yeasts

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29
Q

What are examples of malassezia?

A

M. Sympodialis
M. Restricta
M. Globosa

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30
Q

Malassezia is a part of normal skin flora, where are the highest levels found?

A

In head and trunk of the body

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31
Q

What disease are caused by malassezia?

A

Pityriasis versicolour and plays a role in seborrhoeic dermatitis and atopic eczema

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32
Q

What are symptoms of pityriasis versicolour?

A

Hyper or hypo pigmented lesions

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33
Q

How do you diagnose and treat pityriasis versicolour?

A

Diagnose with microscopy and treat with topical antifungals like clotrimazole primarily. If unaffective, treat with oral fluconazole or itraconazole

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34
Q

What are candidia?

A

A genus of yeast

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35
Q

Where is candida found in healthy people?

A

Mucosal surfaces and the GI tract

36
Q

What diseases are caused by Candida?

A

Superficial mucosa diseases e.g. oral and vaginal thrush and occasionally skin disease and keratitis
Systemic diseases

37
Q

What are some Candida species?

A

Candida…

… albicans
… glabrata
… parapsilosis
… krusei

38
Q

What type of oral candidosis is found in younger patients? What causes it?

A

Acute pseudo-membranous with a low CD4 count

Asthma with steroid inhalers

39
Q

What type of oral candidosis is found in older patients? What causes it?

A

Chronic atrophic

Age meaning more susceptible to infection

40
Q

What are symptoms of the lips in oral candidosis?

A

Angular cheilitis and chronic hyper plastic oral leukoplakia where lesions may become malignant

41
Q

Who is most likely to get oral candidosis?

A

People with HIV/AIDS
People using antibiotics
People with head and neck cancer
Hospitalised patients

42
Q

Who is affected by candida vulvovaginitis?

A

70-80% of all women during child bearing years

43
Q

What are symptoms of candidia vulvovaginitis?

A

Pruritis, burning sensations with or without discharge and inflammation of the vaginal epithelium which may extend to the labia majora

44
Q

What percentage of women will suffer recurrent vulvovaginal candidosis?

A

10%

45
Q

How many times a year do you have to have vulvovaginal candidosis to be diagnosed with recurrent vulvovaginal candidosis?

A

4

46
Q

How is vulvovaginal candidosis diagnosed?

A

By a positive culture in symptomatic patients

47
Q

What do you treat vulvovaginal candidosis with in non-pregnant women? What can you use for pregnant women?

A

Azoles- either orally with fluconazole or topically with clotrimazole pessaries.

Topical treatments ONLY - NO AZOLES!!!

48
Q

What causes systemic candidosis?

A

Infection of candida species from colonised skin or muscosal sites, or from the GI tract

49
Q

What is the most common species of Candida causing systemic candidosis?

A

Candida albicans

50
Q

How can you diagnose systemic candidosis?

A

Blood culture

51
Q

Who is most likely to get candida oesophagitis?

A

People with HIV
10-20% of people with oropharyngeal disease

52
Q

How is Candida oesophagitis diagnoses?

A

With endoscopy and biopsy

53
Q

What are symptoms of candida oesophagitis?

A

Pain (odynophagia) and difficulty upon swallowing/eating (dysphagia)

54
Q

What is the incidence of candidaemia?

A

3.3 cases per 1000 ICU admissions

55
Q

What should you do if a patient is diagnosed with candidaemia?

A

Remove lines and catheters where possible, start antifungal therapy and check eyes and heart

56
Q

What are two secondary diseases to candidaemia?

A

Ocular candidosis- 75% of which cause chorioretinis and 25% cause endophthalmitis
Candidia endocarditis (in 2-3% of cases)

57
Q

Who is most likely to have candida endocarditis?

A

IV drug users and those who have undergone valve surgery

58
Q

What are signs and symptoms of candida endocarditis?

A

Fever, weight loss, fatigue and heart murmur and vegetations on heart valves

59
Q

How do you most effectively treat candida endocarditis?

A

Valve replacement

60
Q

Who is most likely to get candida UTI?

A

Women
Diabetics
Damaged/abnormal urinary tracts
ICU patients (usually because of catheters)

61
Q

What is candiduria?

A

Isolation of candida from urine

62
Q

Why are candida UTI’s hard to treat?

A

Because few antifungals are secreted in urine

63
Q

What percentage of patient in ICU develop candiduria within 7 days?

A

22%

64
Q

What causes candida peritonitis?

A

It’s a complication of peritoneal dialysis or from a perforation of the bowel during surgery

65
Q

What are symptoms of candida peritonitis?

A

Fever, abdominal pain, nausea and vomiting

66
Q

How is candida peritonitis diagnosed?

A

By sampling peritoneal fluid and culturing candida

67
Q

How do you treat candida peritonitis?

A

Source control and drainage as well as antifungals

68
Q

How do you treat candida infection?

A

Determined by each species and their sensitivity and severity by include azoles, echinocandins (e.g. anidulafungin via IV) and liposomal amphotericin B (by IV)

69
Q

What are aspergillus?

A

A genus of mould - filamentous fungi

70
Q

How do aspergillus spread?

A

By producing airborne spores what are inhaled

71
Q

What are examples of medically important aspergillus species?

A

Aspergillus…
… fumigatus
… niger
… flavus
… terreus

72
Q

What causes aspergillosis?

A

The body reacts to the presence of aspergillus in the airways

73
Q

What are 4 reactions in the airways to aspergillus?

A
  1. Space occupying/non-invasive infection e.g. aspergilloma
  2. Allergic reaction
  3. Chronic infection e.g. CPA
  4. Invasive infection
74
Q

What is aspergilloma?

A

A fungal ball

75
Q

What can aspergillomas cause?

A

Break up and cause haemoptysis which can be fatal

76
Q

Who is likely to get allergic forms of aspergillosis?

A

Patients with cavities, a Hx of TB, sarcoid or lung surgery

77
Q

What are symptoms of allergic aspergillosis?

A

Wheezing, breathlessness, loss of lung function, bronchiectasis

78
Q

What are clinical signs of allergic aspergillosis?

A

Airways inflammation, increase total IgE

79
Q

How do you treat allergic aspergillosis?

A

With steroids with or without antifungals

80
Q

Who is susceptible to chronic pulmonary aspergillosis (CPA)?

A

Those with COPD

81
Q

What are symptoms of CPA?

A

Chronic respiratory symptoms like wheezing, cough, breathlessness and chest pain

82
Q

How is CPA diagnosed?

A

By CT observing consolidation and cavitation, a positive culture of aspergillus from sputum and BAL and a positive result for aspergillus IgG

83
Q

Who is susceptible to invasive aspergillosis?

A

Those with haematological malignancy or have had a stem cell or organ transplant

84
Q

What are clinical signs of invasive aspergillosis?

A

Low neutrophil count and angioinvasion of lung tissue, halo and air crescent signs on CT

85
Q

What is the prognosis for invasive aspergillosis?

A

Moderate to poor (even with aggressive antifungal therapy)

86
Q

What are some examples of medication used to treat CPA and invasive aspergillosis?

A

Itraconazole, voriconazole and amphotercin B

Clinical Pathology (65 decks)

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