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DTM&H 2024 > Fungal > Flashcards

Fungal Flashcards

1
Q

Talaromyces Reservoir

A

Bamboo rat

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2
Q

Dimorphic fungi Feature

A

Mould in the cold, yeast in the beast

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3
Q

Talaromyces Transmission

A

Inhalation of conidia from soil

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4
Q

Talaromyces Disease spectrum

A

Healthy - self clearance, non-HIV immunosuppressed - localised infection, advanced HIV - disseminated

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5
Q

Talaromyces Symptoms

A

Fever (92%), skin lesions (67%), respiratory (cough 49%), GI, CNS, anaemia (77%), weight loss (76%), LN (56%), hepatomegaly 51%

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6
Q

Talaromyces Diagnosis

A

Skin biopsy touch smear

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7
Q

Talaromyces Treatment

A

Severe: Induction Amphotericin 10-14d -> Consolidation Itraconazole 10w, Mild-moderate Itraconazole 8-10w, Maintenance Itraconazole daily lifelong or once CD4>100 for 6m on ART

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8
Q

Global Fungal Challenges

A

Legacy of underfunding and underresearch, diagnostics are bad, antifungals are not great, many do not have access to the drugs, and climate change is likely to present a huge issue

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9
Q

Global Fungal Histopathology

A

Gold standard, Aspergillus - angioinvasion - thin septate hyphae with acute-angle branching; Mucor wide ribbon aseptate

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10
Q

Global Fungal Diagnostics

A

3% patients treated for IFI had ‘proven’, remaining were diagnosed on surrogate markers

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11
Q

Global Fungal BDG use

A

Aspergillus, Histoplasma, Talaromyces, Invasive Candidiasis, PCP (NOT Crypto or Mucor)

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12
Q

Global Fungal AspAg use

A

Aspergillus, Histoplasma, Talaromyces (NOT Candidiasis, PCP, Crypto or Mucor)

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13
Q

Global Fungal IFI CT findings

A

Halo – area of consolidation with surrounding ground glass (surrounding haemorrhage) – eventually leave long enough, will get an area of air (the crescent sign) – the textbook presentations are rare! Especially in immunocompromised! Present in odd ways

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14
Q

Global Fungal RDTs

A

CrAg, Histoplasma urine, AspAg serum, Coccidioides

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15
Q

Global Fungal Polyenes

A

Nystatin, Amphotericin B, Lamb

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16
Q

Global Fungal Echinocandins

A

Caspofungin, Anidulafungin, Micafungin

17
Q

Global Fungal Azoles

A

Fluconazole, Itra, Vori, Posa, Isavu

18
Q

Global Fungal Others

A

Flucytosine (low barrier to resistance), Terbinafine (skin and nails), Griseofulvin (LFTs)

19
Q

Global Fungal New drugs

A

Fosmanogepix & Olorofim are new MOA, SUBA - super bioavailable itraconazole, Rezafungin long acting echinocandin, Ibrexafungerp oral echinocandin

20
Q

Global Fungal Heteroresistance

A

Subpopulations of resistance, monotherapy will eventually select out the resistant subpopulation, in general aneuploidy (duplication of chromosomes) - change due to environmental pressure

21
Q

Global Fungal C auris

A

C auris has likely always existed, we just didn’t know about it because it didn’t affect humans, but then the change in the ecological function, spread into urban environment due to warm

22
Q

Global Fungal Histoplasma

A

Environmental dimorphic fungus, theory that warming surface temperature will see expansion of endemic mycoses

23
Q

Global Fungal Emergomyces

A

Brand new species, similar to Histoplasma (dimorphic) may be because diagnostics have improved, but also the theory that changing environment leads to changing diseases

24
Q

Global Fungal T indotineae

A

Terbinafine resistant, topical steroids are a risk, long course itraconazole

25
Q

Global Fungal COVID fungal infections

A

Aspergillus, Mucormycosis (risks - neutropaenia, steroid use (uncontrolled), severe diabetes - major issue in India

26
Q

Global Fungal Blastomyces dermatidis

A

Pneumonia most common (60-90%), extrapulmonary manifestations common inc myalgia, arthralgia, chills, dissemination to skin also reported frequently (38-75%)

27
Q

Global Fungal Summary

A

Fungal infections are a global threat to health, antifungal resistance is rising, new species are emerging as is their geographical range. Resource limited settings are particularly affected. One health approach and antifungal stewardship is essential

28
Q

Pneumocystis jirovecii Diagnosis

A

B-d glucan sens but not spec

29
Q

Pneumocystis jirovecii Treatment

A

SXT, second line = pentamidine, dapsone-trim, clinda-primaquine, atovaquone

30
Q

Pneumocystis jirovecii Pathogenesis

A

Adheres to type 1 pneumocytes, inflammatory response is responsible for significant part of pathology

31
Q

Microsporidia Clinical

A

Majority asymptomatic, may cause chronic diarrhoea

32
Q

Microsporidia Treatment

A

Albendazole for Encephalitozoon (Enterocytozoon - Fumagillin)

33
Q

Microsporidia Names

A

Enterocytozoon bieneusi, Encephalitozoon intestinalis

34
Q

Microsporidia Pathogenesis

A

Hatched spores with extruded polar filaments, eject and impale target cell and pass into cytoplasm

35
Q

Talaromyces Umbilicated skin lesion SE Asia DDx

A

Virus M contagiosum, CMV, Fungi Crypto, Histo/Tmarneffei, Bacteria TP, TB, Non-infectious trichoepitheliomas, tuberous sclerosis

DTM&H 2024 (32 decks)

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