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Infection > Fungal Infection > Flashcards

Fungal Infection Flashcards

1
Q

which patients are at higher risk of fungal infections?

A

> patients in ICU
impaired immune system (malignancies, HIV, premature neonates, transplants)
chronic lung disease (cystic fibrosis, asthma, COPD)

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2
Q

what are some risks for mucocutaneous candidiasis?

A

> antibiotic use
moist areas
inhalation steroids
neonates <3months

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3
Q

how may mucocutaneous candidiasis present?

A

> neutropenia
low CD4 ++ cells
impaired IL-17 immunity

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4
Q

what are some risk factors for invasive candidiasis?

A

> IV catheters
broad spectrum antibiotics
abdominal surgery
total parental nutrition

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5
Q

how does invasive candidiasis present?

A

bacterial blood stream infection

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6
Q

how is invasive candidiasis diagnosed?

A

> culture from a normally sterile site

> b-ol-glucan excludes invasive candidiasis

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7
Q

how is invasive candidiasis treated?

A

echinocandins and fluconazole

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8
Q

how is cryptococcosis meningitis spread?

A

via inhalation from bird faeces and tree bark

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9
Q

what is the pathophysiology of cryptococcosis meningitis?

A

a pulmonary infection that then disseminates to the brain

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10
Q

how does cryptococcosis meningitis present?

A 
> confusion
> headache
> altered behaviour
> visual disturbance
> coma
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11
Q

hoe is cryptococcosis meningitis diagnosed?

A

> CSF culture

> blood culture

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12
Q

what factor in a cryptococcosis meningitis infection are associated with mortality?

A 
> lack of antifungal access
> delay in presentation
> inadequate induction therapy
> delays in starting antiretroviral therapy (HIV)
> immune reconstitution syndrome
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13
Q

how is a cryptococcosis meningitis infection treated?

A

flucytosine followed by fluconazole maintenance

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14
Q

how is aspergillus aspergillosis transmitted?

A

> sporulation

> airborne

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15
Q

describe the pathophysiology of aspergillus aspergillosis

A

there is conidial germination in absence of sufficient pulmonary defences leading to neutropenia and excessive hyphal growth and dissemination

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16
Q

what are the risk factors for acute invasive pulmonary aspergillosis?

A

a neutropenic host (acute leukaemia or hemopoietic stem cell transplant)

17
Q

how does acute invasive pulmonary aspergillosis present?

A

> absent or non-specific symptoms

> persistent febrile neutropenia despite broad spectrum antibiotics

18
Q

describe the pathophysiology of acute invasive pulmonary aspergillosis

A

> angioivasive and dissemination
thrombosis and haemorrhage
rapid and extensive hyphal growth

19
Q

how is acute invasive pulmonary aspergillosis treated?

A

voriconazole and isaruconazole

20
Q

what are the risk factors for subacute invasive pulmonary aspergillosis?

A

a non-neutropenic host (neutrophil disorder)

21
Q

describe the pathophysiology of subacute invasive pulmonary aspergillosis?

A

> excessive inflammation
pyogranulomatous infiltrates
tissue necrosis

22
Q

what are the risk factors for chronic pulmonary aspergillosis?

A

> asthma
cystic fibrosis
COPD

23
Q

what is the presentation of chronic pulmonary aspergillosis?

A 
> pulmonary exacerbation not responding to antibiotics
> lung function decline
> increased resp. symptoms
> decreased exercise tolerance
> high morbidity
24
Q

what investigation would you carry out for suspected chronic pulmonary aspergillosis?

A

sputum culture

25
Q

how does allergic bronchopulmonary aspergillosis present?

A

> deterioration of lung function and resp. symptoms
increased IgE
positive aspergillosis specific IgG
new abnormalities of chest imaging

26
Q

what is a pulmonary aspergilloma?

A

a fungal mass grown in lungs

27
Q

what risk factors are there for a pulmonary aspergilloma?

A

> TB
sarcoidosis
bronchial cysts and bullae
bronchiectasis

28
Q

how would you diagnose aspergillus aspergillosis in a non-neutropenic patient?

A

> aspergillus specific IgG and IgE
bronchoalveolar lavage
cultures of sputum
biopsy

29
Q

how would you diagnose aspergillus aspergillosis in a neutropenic patient?

A

> high resolution chest x-ray (halo sign)
bronchioalveolar biopsy if conditions allow
molecular markers in the blood: galactomannan, PCR aspergillus

30
Q

what can be used for antifungal prophylaxis?

A

> itraconazole

> posaconazole

31
Q

what does flucytosine inhibit?

A

fungal DNA synthesis

32
Q

what does echinocandins inhibit?

A

glucan synthesis

33
Q

what do azoles inhibit?

A

ergosterol synthesis

34
Q

what do amphotericin B formulations act on?

A

ergosterol (more than lysis)???

Infection (13 decks)

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