Fungal infection Flashcards by Sophie C

What 3 fungal pathogens should you focus on

Aspergillus species
 Aspergillus fumigatus

 Candida species
 Candida albicans

 Cryptococcus species
 Cryptococcus neoformans

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Fungal pathogens are opportunistic in nature and affect patients with? give examples of the 3 main groups

impaired immune system
- Patients with primary immunodeficiencies
 Patients with HIV/AIDS
 Patients with malignancies (neutropenia) & transplants
 Premature neonates (immature immune system)

 patients with chronic lung diseases (pulmonary
aspergillosis and other moulds)
 Asthma
 Cystic Fibrosis
 Chronic obstructive lung disorders

Affecting patients in ICU settings

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Candida causes

thrush (oral too)

candidemia

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cryptococcus causes

meningitis

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Aspergillus- pneumocystis causes?

Pneumocystisis, allergic and invasive

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Mucocutaneous Candidiasis- seen in

nappy rash
red rashes

Antibiotic use
 Moist areas
 Inhalation steroids
 Neonates < 3 month

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Mucocutaneous Candidiasis is a Presenting symptom of primary
immunodeficiency disorders
characterised by what? (3 main)

Neutropenia
 Low CD4+ T-cells
 impaired IL-17 immunity

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Invasive Candidiasis is

Gut commensal

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Invasive Candidiasis is the 4th most common

bloodstream

infection (BSI) in adults

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What are additional risk factors for invasive candidiasis (4)

Broad-spectrum antibiotics
 Intravascular catheters
 Total parenteral nutrition
 Abdominal surgery

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Diagnosis of Invasive Candidiasis

Blood culture or culture from normally sterile site
 β-d-glucan high NPV and performs very well to
exclude invasive candidiasis
 Recent developments in PCR assays very promising
 In infants and children performance lower due to
sampling issues

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Transmission of Aspergillus and Aspergillosis (4)

sporulation
• hydrophobic conidia
• diameter 2-3 µm
• airborne / inhalation

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Invasive pulmonary aspergillosis can go on to form

Neutropenia and tissue damage

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Classification of pulmonary Aspergillus disease- name of all 3 plus examples of patients who would be affected

Acute invasive pulmonary aspergillosis - Neutropenic patients (incidence 1-10%)
• Post transplants: stem cell > solid organ (incidence up to 8%)
• Patients with defects in phagocytes

Chronic pulmonary aspergillosis (> 3 months) - Patients with underlying chronic lung conditions

Allergic aspergillosis
• Allergic bronchopulmonary aspergillosis in CF and asthma
(incidence 10-15%)
• Asthma or CF with fungal sensitisation (incidence 5-15%)

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Acute Invasive Pulmonary Aspergillosis - features (5)

Neutropenic host - eg acute leukaemia

Rapid and extensive hyphal growth
• Thrombosis and hemorrhage
• Angio-invasive and dissemination
• Absent or non-specific clinical signs and symptoms
• Persistent febrile neutropenia despite broad-spectrum antibiotics
• Mortality rates around 50% (but depending on immune recovery)

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(Sub) Acute Invasive Pulmonary Aspergillosis

non-neutropenic host

has a limited fungal growth
can cause tissue necrosis
mild to moderate systemic illness

Invasive aspergillosis as presenting symptom of
primary immunodeficiency (4)

Congenital neutropenia
 Chronic granulomatous disease
Hyper IgE syndrome (Job’s syndrome)
CARD-9 deficiency

Invasive aspergillosis often presents clinically outside of the lungs- where else?

bones, spine, brain, abdominal

Chronic Pulmonary Aspergillosis is often seen in those with

asthma, cystic fibrosis, chronic obstructive lung disorders

Chronic Pulmonary Aspergillosis characteristics

Pulmonary exacerbations (not responding to
antibiotics)
 Lung function decline
- increased resp symptoms such as cough
- postive sputum culture for aspergillum

up to 50% of CF patients will get?

chronic pulmonary aspergillosis

Allergic Bronchopulmonary Aspergillosis - immunological responses to a variety of antigens in the CF- host result in: (5)

Acute/subacute deterioration of lung function and
respiratory symptoms
 New abnormalities chest imaging
 Elevated immunoglobulin E (IgE) level
 Increased Aspergillus specific IgE or positive skin-test
 Positive Aspergillus specific IgG

What is Pulmonary Aspergilloma (6)

A fungal mass that usually grows in lung cavities
 Tuberculosis
 In 22% if residual cavities
 Sarcoidosis
 Bronchiectasis
 Bronchial cysts and bullae
 After pulmonary infections

Diagnosis of Pulmonary Aspergillosis - In non-neutropenic patients (2)

Cultures of sputum and/or bronchoalveolar lavage, and/or biopsy
• Aspergillus specific IgG and IgE in chronic and allergic pulmonary
aspergillosis

Diagnosis of Pulmonary Aspergillosis

In neutropenic patients: - HIGH res CT chest - biopsies

Cryptococcus and Cryptococcosis symptoms?

- Transmission by inhalation - faeces, organic matter, birds - Pulmonary infection from asymptomatic to pneumonia -

Cryptococcus and Cryptocococsis can cause

Dissemination to brain: meningoencephalitis in HIV/AIDS

Cryptococcus and Cryptocococsis - CLINCIAL presentation

headache, confusion, altered behaviour, visual disturbances, coma (due to raised intracranial pressure in 60-80%)

Diagnosis of cryptococcal disease

Cerebrospinal fluid: Indian Ink preparation (80% sensitivity), culture, high protein and low glucose, Cryptococcus antigen (lateral flow assay)  Blood: culture, Cryptococcus antigen

Outcome of cryptococcal meningitis what factors can be associated with mortality ?

Africa: 3-month mortality 70%  US: 3-months mortality 25% ``` Delay in presentation and diagnosis  Lack of access to antifungals  Inadequate induction therapy  Delays in starting antiretroviral therapy  Immune reconstitution syndrome ```

Antifungal agents to treat invasive | fungal infections? (4)

- Amphotericin B formulations (iv) - Azoles (iv, oral) - Echinocandins (iv) - Flucytosine (iv, oral)

maintenance for cryptococcal meningitis antifungals?

AmB + flucytosine followed by fluconazole

what anti fungal has the most broadest antifungal activity

AmB

Antifungals for invasive candidiasis

Echinocandins and fluconazole

Antifungals for (acute) invasive aspergillosis

Voriconazole and Isavuconazole

Antifungals for antifungal prophylaxis

Itraconazole and Posaconazole