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Year 3: Block 1: Infection > Fungal infection > Flashcards

Fungal infection Flashcards

1
Q

What 3 fungal pathogens should you focus on

A

Aspergillus species
 Aspergillus fumigatus

 Candida species
 Candida albicans

 Cryptococcus species
 Cryptococcus neoformans

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2
Q

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

A

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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3
Q

Candida causes

A

thrush (oral too)

candidemia

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4
Q

cryptococcus causes

A

meningitis

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5
Q

Aspergillus- pneumocystis causes?

A

Pneumocystisis, allergic and invasive

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6
Q

Mucocutaneous Candidiasis- seen in

A

nappy rash
red rashes

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

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7
Q

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

A

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

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8
Q

Invasive Candidiasis is

A

Gut commensal

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9
Q

Invasive Candidiasis is the 4th most common

A

bloodstream

infection (BSI) in adults

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10
Q

What are additional risk factors for invasive candidiasis (4)

A

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

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11
Q

Diagnosis of Invasive Candidiasis

A

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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12
Q

Transmission of Aspergillus and Aspergillosis (4)

A

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

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13
Q

Invasive pulmonary aspergillosis can go on to form

A

Neutropenia and tissue damage

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14
Q

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

A

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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15
Q

Acute Invasive Pulmonary Aspergillosis - features (5)

A

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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16
Q

(Sub) Acute Invasive Pulmonary Aspergillosis

A

non-neutropenic host

  • has a limited fungal growth
  • can cause tissue necrosis
  • mild to moderate systemic illness
17
Q 
Invasive aspergillosis as presenting symptom of
primary immunodeficiency (4)
A
  • Congenital neutropenia
     Chronic granulomatous disease
  • Hyper IgE syndrome (Job’s syndrome)
  • CARD-9 deficiency
18
Q

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

A

bones, spine, brain, abdominal

19
Q

Chronic Pulmonary Aspergillosis is often seen in those with

A

asthma, cystic fibrosis, chronic obstructive lung disorders

20
Q

Chronic Pulmonary Aspergillosis characteristics

A 
Pulmonary exacerbations (not responding to
antibiotics)
 Lung function decline
- increased resp symptoms such as cough
- postive sputum culture for aspergillum
21
Q

up to 50% of CF patients will get?

A

chronic pulmonary aspergillosis

22
Q

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

A

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

23
Q

What is Pulmonary Aspergilloma (6)

A 
A fungal mass that usually grows in lung cavities
 Tuberculosis
 In 22% if residual cavities
 Sarcoidosis
 Bronchiectasis
 Bronchial cysts and bullae
 After pulmonary infections
24
Q

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

A

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

25
Q

Diagnosis of Pulmonary Aspergillosis

A

In neutropenic patients:

  • HIGH res CT chest
  • biopsies
26
Q

Cryptococcus and Cryptococcosis symptoms?

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

-

27
Q

Cryptococcus and Cryptocococsis can cause

A

Dissemination to brain: meningoencephalitis in HIV/AIDS

28
Q

Cryptococcus and Cryptocococsis - CLINCIAL presentation

A

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

29
Q

Diagnosis of cryptococcal disease

A

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

 Blood: culture, Cryptococcus antigen

30
Q

Outcome of cryptococcal meningitis

what factors can be associated with mortality ?

A

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
31
Q

Antifungal agents to treat invasive

fungal infections? (4)

A
  • Amphotericin B formulations (iv)
  • Azoles (iv, oral)
  • Echinocandins (iv)
  • Flucytosine (iv, oral)
32
Q

maintenance for cryptococcal meningitis antifungals?

A

AmB + flucytosine followed by fluconazole

33
Q

what anti fungal has the most broadest antifungal activity

A

AmB

34
Q

Antifungals for invasive candidiasis

A

Echinocandins and fluconazole

35
Q

Antifungals for (acute) invasive aspergillosis

A

Voriconazole and Isavuconazole

36
Q

Antifungals for antifungal prophylaxis

A

Itraconazole and Posaconazole

Year 3: Block 1: Infection (14 decks)

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