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Infection > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

What makes fungal infections opportunistic?

A

Pateints with impaired immune system - HIV/ AIDS, malignancy, transplant, and premature neonates
Chronic lung disease - asthma, COPD, cystic fibrosis and sarcoidosis
Patients in ICU

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2
Q

What fungal infections mainly present to GP?

A

Body, nails, mucous membrane and invasive fungal infections

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3
Q

What are the 2 main types of fungal skin infections?

A

Candidiasis - yeast like infection, uniform commensal of mouth/ GI tract and opportunistic
Tinea - superficial skin infection caused by dermatophytes

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4
Q

Describe Candida

A

Not part of normal skin flora
Asymptomatic until disruption
Non life threatening mucotaneous infections to severe invasive disseminated disease

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5
Q

What are the risk factors for candida?

A

Moist areas, skin folds, diabetes, neonates, pregnancy, poor hygiene, occupation in wet environments and recent spectrum antibiotic

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6
Q

What are the symptoms of genital candidiasis (vaginal thrush)?

A

Itch, soreness and burning discomfort, vulval oedema, fissures and excoriations, cottage curd/ white curd discharge and bright red rash

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7
Q

What are the risk factors of genital candidiasis?

A

Before and during menstruation, obesity, diabetes, iron deficiency anaemia, immunodeficiency, recent course of wide spectrum antibiotics, high dose OCP and pregnancy

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8
Q

How is genital candidiasis diagnosed and managed?

A

Clinical and vaginal swab
Management - clotrimazole (topical, oral fluconazole and supportive measures

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9
Q

Describe non specific balanitis

A

Inflammation of glans penis
Bacterial or candida infection
If candida - topical clotrimazole
Good hygiene

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10
Q

What are the risk factors for oral candidiasis?

A

Extremes of ages, immunocompromised, inhaled or oral corticosteroids, diabetes, dental prosthesis, poor oral hygiene, local trauma, impaired salivary function, smoking and broad spectrum antibiotics

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11
Q

What are the symptoms of oral candidiasis?

A

White or yellow plaques in mouth, mild burning, erythema, altered taste, furry tongue, and chronic can cause dysphagia

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12
Q

What is the management of oral candidiasis?

A

Topical anti-fungal - nystatin and miconazole
Extensive then oral fluconazole
Smoking cessation and good oral hygiene

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13
Q

When does systemic candida infections occur?

A

HIV, malignancy and chemo
Other - recent abdominal surgery, renal failure, low birth weight infants, neutropoenia and diabetes

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14
Q

What is the presentation of systemic candida infection?

A

Candidemia - bloodstream
Can effect any body part so presentation can vary
Typically fever and chills
Does not respond to antibiotics

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15
Q

Describe invasive candidiasis

A

Gut commensal and infections are mostly endogenous in origin
4th most common bloodstream infection
Mortality up to 40%

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16
Q

How is infective candidiasis diagnosed and treated?

A

Blood cultures
Treatment is IV/ oral antifungals

17
Q

What is tinea caused by?

A

Direct spread from infected individual or animal
Indirect contact with objects/ material which carry infection
Rare is contact with soil

18
Q

What are the risk factors of tinea?

A

Hot humid environment, obesity, tight fitting clothing, immunocompromised and hyperhidrosis (excess sweating)

19
Q

How is tinea diagnosed?

A

Scaly itchy skin
Exam - single or multiple flat/ slight raised annular patches, typically central clearing and asymmetrical distribution
Investigations not required but if uncertain then skin scrapping or swab

20
Q

What is the management for tinea?

A

Topical anti-fungal cream
If extensive or positive culture then oral terbinafine or itraconazole
Derm review
Loose fitting clothes, good hygiene, don’t share towels and clean wed linens

21
Q

How is fungal nail infection diagnosed?

A

Nail clippings

22
Q

What are the management options for fungal nail infection?

A

Conservative
Keep short nails, cotton absorbent socks and well fitting shoes
Topical nail lacquer - amorolfine
Oral amorolfine - need to monitor LFTs

23
Q

Describe aspergillus

A

Type of mould
Found in soil, compost and organic matter, damp buildings and air conditioning systems
Transmission by inhalation of spores

24
Q

What are the risk factors for aspergillus?

A

CF, CPOD, TB, sarcoidosis and weakened immune system

25
Q

What are the symptoms of aspergillosis?

A

Cough, SOB, wheeze, pyrexia, general malaise and headache

26
Q

What are the types of aspergillosis?

A

Allergic bronchopulmonary aspergillosis
Chronic pulmonary aspergillosis
Aspergilloma
Invasive pulmonary aspergillosis

27
Q

Describe allergic bronchopulmonary aspergillosis

A

Commonest in asthma and CF
Due to allergic response to aspergillus mould
Longstanding cough for longer than 3 weeks
Complications can lead to pulmonary fibrosis

28
Q

When is allergic bronchopulmonary aspergillosis suspected?

A

Patients clinical condition deteriorating
Failure to respond to normal treatment
Longstanding cough more than 3 weeks

29
Q

How is allergic bronchopulmonary aspergillosis diagnosed?

A

Bloods - eosinophilia
Sputum culture
Positive skin test for aspergillosis
Positive serology for aspergillosis species
CXR/ CT scan

30
Q

What is the management for allergic bronchopulmonary aspergillosis?

A

Oral long term dose oral prednisolone
Anti-fungal treatment of itraconazole also of benefit

31
Q

Describe chronic pulmonary aspergillosis

A

More than 3 months
Affects patients with underlying lung conditions
High morbidity
Diagnosis with sputum culture and refer for CXR

32
Q

What is the presentation of chronic pulmonary aspergillosis?

A

Exacerbations not responding to antibiotics
Decline in lung function
Increased resp. symptoms - cough, decreased exercise tolerance and SOB

33
Q

What is the management for chronic pulmonary aspergillosis?

A

Guided by secondary care with oral anti-fungal

34
Q

Describe aspergilloma

A

Fungal mass - grows in lung cavities
Risk - TB, sarcoidosis, bronchiectasis, after pulmonary infection and bronchial cyst or bullae

35
Q

How does an aspergilloma present?

A

Haemoptysis - common
Cough and fever less frequent
Asymptomatic and found on CXR - mass with pulmonary cavity

36
Q

What is the management for aspergilloma?

A

CT scan
Surgical resection and long term anti-fungal

37
Q

Who is at risk of acute invasive pulmonary aspergillosis?

A

Neutropenic patients
Post transplant
Patients with defects in phagocytes

38
Q

What is the presentation of acute invasive pulmonary aspergillosis?

A

Cough, SOB, fever, haemoptysis, pleuritic chest pain and nasal congestion and pain
Any organ can be involved
Can spread haematogenous - kidneys, brain, thyroid, GI tract, eyes and skin

39
Q

What is the management for acute invasive pulmonary aspergillosis?

A

IV anti-fungal
Mortality rate is 50%
Can present as persistent febrile neutropoenia despite broad spectrum antibiotics

Infection (13 decks)

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