Fungal infections Flashcards
what are fungal infections?
Common mild superficial infections to severe invasive life threatening infections
what is the burden of fungal infections?
Difficult to determine as many mild infections go undiagnosed such as athletes foot, ringworm.
> 1 billion people affected
11.5 million life threatening infections
1.5 million deaths annually
who is susceptible to opportunistic fungal infections?
Patients with impaired immune system
Primary immunodeficiencies
HIV/AIDS
Malignancy and transplants
Premature neonates- immature immune system
Chronic Lung diseases (Aspergillosis and moulds )
Asthma
COPD
Cystic Fibrosis
Sarcoidosis
Patients in ICU –particularly on artificial ventilation
what are the two main types of funal skin infections in the UK?
2 main Types fungal skin infections UK
Candidasis
Yeast like infection
Uniform commensal of mouth/GI tract
Opportunistic Infection
Tinea
Superficial Skin infections caused by Dermatophytes
what is candida fungal infections?
Not part of normal skin flora
Asymptomatic until disruption (Lowering of immune system or mucosal barriers disrupted)
Non life threatening mucotaneous infections to severe invasive disseminated disease
Risk factors-
Moist areas, skin folds, obesity, diabetes, neonates, pregnancy, poor hygiene, occupation in wet environments, recent broad spectrum antibiotic
what are symptoms and risk factors for genital cendidiasis?
Symptoms
Itch
Soreness and burning discomfort
Dysuria
Vulval oedema, fissures and excoriations
Cottage cheese/ white curd discharge
Bright red rash
Risk Factors
Just before and during menstruation
Obesity
Diabetes
Iron deficiency anaemia
Immunodeficiency
Recent course of broad spectrum antibiotic
High dose combined OCP /Oestrogen based HRT
Pregnancy
Non-specific Balanitis – Inflammation of Glans Penis
Bacterial or candida infection
If candida: treatment with topical clotrimazole
Good hygiene
how is genital candidiasis diagnosed?
Diagnosis
Clinical
Vaginal Swab
how is genital candidiasis managed?
Management
Clotrimazole- Topical antifungal pessary or cream
Oral treatment –Fluconazole
Supportive measures- Loose clothing, avoiding soap or bubble baths to wash
No evidence for probiotics or treating sexual partner
what are risk factors for oral candidiasis?
Risk factors
Extreme of ages
Immunocompromised
Inhaled or oral corticosteroids
Broad spectrum antibiotics
Diabetes
Dental prosthesis
Smoking
Poor oral hygiene
Local trauma
Nutritional deficiency
Impaired salivary function
what are symptoms of oral candidiasis?
Symptoms
White or yellow plaques in mouth
Mild burning
Erythema
Altered taste
‘’Furry Tongue’’
If chronic can cause dysphagia
what is the management of oral candidiasis?
Management
Topical Anti-fungal
Nystatin
Miconazole gel
If extensive-oral Fluconazole
Smoking cessation
Good Oral Hygiene
what are systemic candida infections?
Occurs in Immunosuppressed
HIV
Malignancy
Chemotherapy
Other risks:
recent abdominal surgery
Renal failure
Low birth weight infants
Neutropoenia
Diabetes
Candidemia (Bloodstream)
Can affect any body part – therefore presentation can vary
Typically fever and chills doesn’t respond to antibiotics
what is invasive candidiasis?
Gut commensal
Infections mostly endogenous of origin
4th most common bloodstream infection (BSI) in adults: 30/100.000 admissions
Premature neonates (< 1000 g): 150/100.000 admissions
Mortality up to 40%
If concern in primary care admit to hospital
Diagnosis- Blood cultures
Requires IV/Oral antifungals
what is tinea?
Caused by
Diorect spread from nfected individual or animal
Indirect contact with objects/materials which carry infection e.g bedding, clothing
Rare- contact with soil
Risk Factors:
Hot humid environments
Obesity
Tight fitting clothing
Immunocompromised
Hyperhidrosis (excess sweating )
how is tinea diagnosed?
Clinical
Scaly itchy skin
Examination :
Single or multiple flat/slight raised annular patches
Typical central clearing
Asymmetrical distribution
Investigations not normally required primary care
If uncertainty – Skin scrapings or skin swab if pustular/macerated
how is tinea managed?
Supportive – Loose fitting clothing , good hygiene, don’t share towels, washing clothes and bed linen frequently
Patient information leaflets
Topical Anti-fungal cream
If extensive and positive culture or strong clinical suspicion –oral terbinafine first line or itraconazole if not tolerated- Require 4 weeks of treatment
Dermatology review if extensive or persistent infection
what is the diagnosis and management for a fungal nail infections?
Diagnosis – Nail clippings
managment
Conservative can do nothing – if left untreated not harmful infection
Keep nails trimmed short and well fitting shoes
Cotton absorbent socks
Topical Nail Lacquer- amorolifine 5% nail lacquer – treatment for 6 months fingernails and 9-12 months toenails
Oral terbinafine -6-12 weeks fingernails and 3-6 months for toenails- need to monitor LFTS
what is aspergillus?
Type of mould
Found in:
soil, compost and other organic matter
dust and bedding
damp buildings
air conditioning systems and uncovered attic water tanks
Transmission: Inhalation by spores
Rare in healthy individuals
At risk underlying health conditions: CF, COPD, TB, Sarcoidosis or weakened immune system
what does aspergillus cause>
aspergillosis
what are symptoms of aspergillosis?
Symptoms
Cough
Sob
Wheeze
Pyrexia
General malaise
Headache
what are types of aspergillosis?
Allergic bronchopulmonary aspergillosis
Chronic pulmonary aspergillosis
Aspergilloma
Invasive pulmonary aspergilliosis
what is allergic bronchopulmonary aspergillosis?
Commonest in Asthma and CF
Due to allergic response to aspergillus mould
Longstanding cough>3weeks
Complications: can lead to pulmonary fibrosis
Patients clinical condition deteriorating e.g in asthma or C.F
Failure to respond to normal treatment
Longstanding cough>3weeks
how is Allergic Bronchopulmonary Aspergilliosis diagnosed?
Bloods- eosinophilia
Sputum culture
Positive skin test for aspergillosis
Positive serology for Aspergillus spp.
CXR/CT Scan
how is Allergic Bronchopulmonary Aspergilliosis managed?
Oral long term high dose oral prednisolone
Anti fungal treatment of Itraconazole also of benefit
