Fungal Infection Flashcards
What puts you at risk of fungal infections
Immunocompromised Neutropenia Chronic lung - asthma / CF / COPD Previous TB Chemo Post-transplant ICU HIV Broad spec Ax
What do azole anti-fungals do
Block ergosterol synthesis
p450 inhibitor
Liver toxic
What does Amphotericin B do
Acts on ergosterol causing lysis
Very broad spec
Systemic fungal infections / meningitis
IV only
SE of amphotericin B
Nephrotoxic
Flu
Hypo K and glucose
What can aspergillus cause
Aspergillosis
Aspergilloma
Allergic bronchopulmonary aspergillosis
How does fungal transmit
Spores
Airborne
Inhalation
What does Aspergillosis cause
SOB Cough Wheeze Fever Weight loss
What is leading cause of death in neutropenic patients
Acute invasive aspergillosis
Who is at risk
HIV
Leukaemia
Broad spec Ax
Post transplant
What happens
Fungus destroys lung Dissemination Thrombosis Haemorrhage Persistent febrile neutropenia despite Ax 50% mortality
When does sub-acute occur
Non-neutropenic host
Limited fungal growth but tissue necrosis due to inflammation
What is Chronic
> 3 months
Who is at risk of chronic
Chronic lung
Leads to lung function decline
Pulmonary exacerbations which don’t respond to Rx
How do you Dx non-neutropenic aspergillosis
Culture of sputum
Aspergillis IgG and IgE
Biopsy
Bronchoscopy
How do you Dx neutropenic
No sputum as no inflammation CT PCR Biopsy Bronchoscopy
How do you treat invasive
IV azole
Amphotericin B
What do you do for chronic
Life long anti-fungal
What can fungal infection be a symptom of
Primary immunodeficiency disorder Congenital neutropenia Granulomatous Hyper IgE CARD-9
What is ABPA
Allergy to fungal mould
Who is at risk of ABPA
CF
Asthma
What does APBA
Acute deterioration in lung fucntion
Resp symptoms
How do you Dx APBA
CXR = bronchiectasis
Increased IgE
+ve skin
+ve IgG
How do you treat
Steroids
What is a pulmonary aspergilloma
Fungal mass in lung
Usually forms in pre-exisiting cavity
What causes a pre-existing cavity
TB Lung cancer CF Sarcoid Bronchiectasis
What are the symptom
Cough
Haemoptysis
How do you Dx
CXR
How do you Rx
Surgery
How does invasive candidiasis present
Same presentation as bacterial
What is mucocutaneous candida a symptom of
Immune deficiency
What are RF for candidiasis
Broad spec Ax Catheter Parenteral nutrition Moist area Premature LBW H2 blocker Steroid Hyperglycaemia Surgery
How do you Dx
Blood culture
PCR
B-d-glucan high NPV
How do you Rx
Echinocandin
Fluconazole
IV or oral
How do you get cryptococcus neoformans
Inhalation
How does it present
Headache Confusion Altered behaviour Visual Raised ICP Coma
How does it present in HIV
Meningoencephalitis
How do you Dx
India ink CFS
Blood culture
Cryptococcus antigen
How do you Rx
Amphotericin B
Azole
CO-trimoxazole
