Fungal

Question 1

Talaromyces Reservoir

Answer 1

Bamboo rat

Question 2

Dimorphic fungi Feature

Answer 2

Mould in the cold, yeast in the beast

Question 3

Talaromyces Transmission

Answer 3

Inhalation of conidia from soil

Question 4

Talaromyces Disease spectrum

Answer 4

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

Question 5

Talaromyces Symptoms

Answer 5

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

Question 6

Talaromyces Diagnosis

Answer 6

Skin biopsy touch smear

Question 7

Talaromyces Treatment

Answer 7

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

Question 8

Global Fungal Challenges

Answer 8

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

Question 9

Global Fungal Histopathology

Answer 9

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

Question 10

Global Fungal Diagnostics

Answer 10

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

Question 11

Global Fungal BDG use

Answer 11

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

Question 12

Global Fungal AspAg use

Answer 12

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

Question 13

Global Fungal IFI CT findings

Answer 13

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

Question 14

Global Fungal RDTs

Answer 14

CrAg, Histoplasma urine, AspAg serum, Coccidioides

Question 15

Global Fungal Polyenes

Answer 15

Nystatin, Amphotericin B, Lamb

Question 16

Global Fungal Echinocandins

Answer 16

Caspofungin, Anidulafungin, Micafungin

Question 17

Global Fungal Azoles

Answer 17

Fluconazole, Itra, Vori, Posa, Isavu

Question 18

Global Fungal Others

Answer 18

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

Question 19

Global Fungal New drugs

Answer 19

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

Question 20

Global Fungal Heteroresistance

Answer 20

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

Question 21

Global Fungal C auris

Answer 21

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

Question 22

Global Fungal Histoplasma

Answer 22

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

Question 23

Global Fungal Emergomyces

Answer 23

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

Question 24

Global Fungal T indotineae

Answer 24

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

Question 25

Global Fungal COVID fungal infections

Answer 25

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

Question 26

Global Fungal Blastomyces dermatidis

Answer 26

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

Question 27

Global Fungal Summary

Answer 27

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

Question 28

Pneumocystis jirovecii Diagnosis

Answer 28

B-d glucan sens but not spec

Question 29

Pneumocystis jirovecii Treatment

Answer 29

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

Question 30

Pneumocystis jirovecii Pathogenesis

Answer 30

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

Question 31

Microsporidia Clinical

Answer 31

Majority asymptomatic, may cause chronic diarrhoea

Question 32

Microsporidia Treatment

Answer 32

Albendazole for Encephalitozoon (Enterocytozoon - Fumagillin)

Question 33

Microsporidia Names

Answer 33

Enterocytozoon bieneusi, Encephalitozoon intestinalis

Question 34

Microsporidia Pathogenesis

Answer 34

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

Question 35

Talaromyces Umbilicated skin lesion SE Asia DDx

Answer 35

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