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Microbiologie > Fungal infections > Flashcards

Fungal infections Flashcards

1
Q

What are fungi?

A

Eukaryotic organisms with chitinous cell wall and ergosterol containing plasma membranes

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2
Q

How to categorise fungi?

A

Yeasts - Sing cell that reproduces by budding (Candida, cryptococcus)

Moulds - Grow by branching and extension (Dermatophytes, apergillus)

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3
Q

Commonest cause of fungal infections in humans?

A

Candida

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4
Q

When does oral candida usually present?

A

If you are immunocompromised or if you have broad spectrum abx

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5
Q

How does superficial candida infection present?

A

Oral thrush, candida oesophagitis, vulkvovaginit or even cutaneous

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6
Q

How to treat superficial candida?

A

Topical:
Nystatin - Oral
Cotrimazole - Vulvovaginitis, localised cutaneous

Oral:
Fluconazole

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7
Q

How does microscopy of yeast look like?

A

Large clusters

Gram +ve

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8
Q

Which patients have a high risk of candidaemia?

A

(Haem) malignancies
Burns patients
Post op
Long lines

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9
Q

What investigations would you do for candida?

A

Imaging
Beta D glucan serology
Echo to look for endocarditis
Fundoscopy for candida endophthalmitis

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10
Q

What is the management for candida?

A

Echinocandin - Anidulafungin

Remove line or prosthetic materials

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11
Q

How to treat candida infection in the CNS?

A

Ambisome or voriconazole

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12
Q

How to treat candida infection in the bones and joints?

A

Ambisome or voriconazole

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13
Q

How to treat candida infection in endocarditis?

A

Ambisome or voriconazole

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14
Q

How to treat candida infection in the urinary tract?

A

Fluconazole

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15
Q

How to treat intra abdominal candida infection?

A

Peritoneal dialysis with echinocandin or fluconazole

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16
Q

What is cryptococcus?

A

Encapsulated yeast

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17
Q

What are the different serotypes of cryptococcus?

A

A and D - C Neoformans (Immunodeficient)

B and C - C Gattii (Immunocompetent)

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18
Q

How is cryptococcus transmitted?

A

Inhalation of aerosolised organisms

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19
Q

Which animal is cryptococcus associated with?

A

Pigeons

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20
Q

What is a risk factor for cryptococcus?

A

HIV

Organ transplant - Patients taking T cell immunosuppresants (Tacrolimus) - May have menegitis due to this

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21
Q

What does a C Gatti infection commonly cause?

A

Space occupying lesions in brain and lungs

Meningitis

22
Q

What ink is used for cryptococcus stain?

A

India

23
Q

What serum test / CSF would you do for cryptococcus?

A

Cryptococcal antigen

24
Q

How to treat cryptococcal meningitis?

A

Amphotericin B + Flucystosine - 2 weeks

High does fluconazole - 8 weeks

Low does fluconazole - 1 year

Due to high opening CSF pressure, need to repeat lumbar punctures to relieve the pressure

25
Q

On a side note, what can you find on a CSF sample in sub arachanoid haemorrhage?

A

Xanthochromia - break down of blood products

26
Q

Why do you ask patients to lie down after lumbar puncture?

A

You may have low CSF pressure so you can get a headache

27
Q

How to test for Aspergillosis

A

Aspergillus antibodies - Galactomannan

28
Q

How to treat aspergillus

A

Voriconazole

Ambisome

29
Q

What is pneumocystis jiroveci?

A

Lacks ergosterol in cell wall

30
Q

Who is at risk of getting pneumocystis jiroveci?

A

Debilitated infants

Severe protein malnutrition

31
Q

How to diagnose pneumocystis jiroveci?

A

Microscopy
PCR
Serum Beta D Glucan

32
Q

How to treat pneumocystis jiroveci?

A

High dose cotrimoxazole

Steroids if hypoxia is present

33
Q

Who is at risk of getting mucormycoses?

A

Immunosuppresed and diabetic patients

34
Q

How does mucormycoses present?

A

Rhinocerebral - Cellulitis of orbit and face, black pus form palate and nose, opthalmoplegia, low GCS

Pulmonary

Cutaneous

35
Q

How to treat mucormycoses?

A

Broad spectrum anti fungals

Surgery

36
Q

How do dermatophytes invade?

A

Invades dead keratin of skin, hair and nails

37
Q

Name some sites where dermatophytes grow and what the condition is called?

A

Tinea pedis - Feets
Tinea capitis - Scalp
Tinea cruris - groin
Tinea corporis - abdo

38
Q

What is onichomycosis commonly caused by?

A

Trichophyton spp

39
Q

What is pitrriasis versicolor caused by?

A

Malassezia furfur

40
Q

How to treat pityriasis and onichomycosis?

A

Topical - clotrimazole, ketoconazole

41
Q

What side effects do azoles cause?

A

Abnormal LFTs

42
Q

What side effects do polyenes cause?

A

Nephrotoxicity - Potassium, sodium and magnesium wasting

43
Q

What side effects do echinocandins cause?

A

Relatively innocuous

44
Q

What side effects do pyrimidine analogues cause?

A

Blood disorders

45
Q

Which part od the fungal cell do polyenes and azoles attacks?

A

Cell membrane

46
Q

Are azoles P450 inducers or inhibitors?

A

Inducers

47
Q

Which part of the fungal cell do echinocandins attack?

A

cell wall - inhibits Beta 1-3 d glucan synthase enzyme

48
Q

Which fungi does echinocandins cover?

A

Candida
Aspergillus

Does NOT cover cryptococcus

49
Q

Which part of the fungal cell does pyrmidine analogues such as Flucytosine attack?

A

DNA RNA synthase

50
Q

What is Flucytosine used for?

A

Candida and cryptococcal meningitis in combination with ambisome/fluconazole

51
Q

When do you need to monitor Flucytosine blood levels?

A

When used in conjunction with amphotericin

Microbiologie (11 decks)

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