Fungal Infections Flashcards
What makes fungal infections opportunistic?
Pateints with impaired immune system - HIV/ AIDS, malignancy, transplant, and premature neonates
Chronic lung disease - asthma, COPD, cystic fibrosis and sarcoidosis
Patients in ICU
What fungal infections mainly present to GP?
Body, nails, mucous membrane and invasive fungal infections
What are the 2 main types of fungal skin infections?
Candidiasis - yeast like infection, uniform commensal of mouth/ GI tract and opportunistic
Tinea - superficial skin infection caused by dermatophytes
Describe Candida
Not part of normal skin flora
Asymptomatic until disruption
Non life threatening mucotaneous infections to severe invasive disseminated disease
What are the risk factors for candida?
Moist areas, skin folds, diabetes, neonates, pregnancy, poor hygiene, occupation in wet environments and recent spectrum antibiotic
What are the symptoms of genital candidiasis (vaginal thrush)?
Itch, soreness and burning discomfort, vulval oedema, fissures and excoriations, cottage curd/ white curd discharge and bright red rash
What are the risk factors of genital candidiasis?
Before and during menstruation, obesity, diabetes, iron deficiency anaemia, immunodeficiency, recent course of wide spectrum antibiotics, high dose OCP and pregnancy
How is genital candidiasis diagnosed and managed?
Clinical and vaginal swab
Management - clotrimazole (topical, oral fluconazole and supportive measures
Describe non specific balanitis
Inflammation of glans penis
Bacterial or candida infection
If candida - topical clotrimazole
Good hygiene
What are the risk factors for oral candidiasis?
Extremes of ages, immunocompromised, inhaled or oral corticosteroids, diabetes, dental prosthesis, poor oral hygiene, local trauma, impaired salivary function, smoking and broad spectrum antibiotics
What are the symptoms of oral candidiasis?
White or yellow plaques in mouth, mild burning, erythema, altered taste, furry tongue, and chronic can cause dysphagia
What is the management of oral candidiasis?
Topical anti-fungal - nystatin and miconazole
Extensive then oral fluconazole
Smoking cessation and good oral hygiene
When does systemic candida infections occur?
HIV, malignancy and chemo
Other - recent abdominal surgery, renal failure, low birth weight infants, neutropoenia and diabetes
What is the presentation of systemic candida infection?
Candidemia - bloodstream
Can effect any body part so presentation can vary
Typically fever and chills
Does not respond to antibiotics
Describe invasive candidiasis
Gut commensal and infections are mostly endogenous in origin
4th most common bloodstream infection
Mortality up to 40%
How is infective candidiasis diagnosed and treated?
Blood cultures
Treatment is IV/ oral antifungals
What is tinea caused by?
Direct spread from infected individual or animal
Indirect contact with objects/ material which carry infection
Rare is contact with soil
What are the risk factors of tinea?
Hot humid environment, obesity, tight fitting clothing, immunocompromised and hyperhidrosis (excess sweating)
How is tinea diagnosed?
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
What is the management for tinea?
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
How is fungal nail infection diagnosed?
Nail clippings
What are the management options for fungal nail infection?
Conservative
Keep short nails, cotton absorbent socks and well fitting shoes
Topical nail lacquer - amorolfine
Oral amorolfine - need to monitor LFTs
Describe aspergillus
Type of mould
Found in soil, compost and organic matter, damp buildings and air conditioning systems
Transmission by inhalation of spores
What are the risk factors for aspergillus?
CF, CPOD, TB, sarcoidosis and weakened immune system
What are the symptoms of aspergillosis?
Cough, SOB, wheeze, pyrexia, general malaise and headache
What are the types of aspergillosis?
Allergic bronchopulmonary aspergillosis
Chronic pulmonary aspergillosis
Aspergilloma
Invasive pulmonary aspergillosis
Describe allergic bronchopulmonary aspergillosis
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
When is allergic bronchopulmonary aspergillosis suspected?
Patients clinical condition deteriorating
Failure to respond to normal treatment
Longstanding cough more than 3 weeks
How is allergic bronchopulmonary aspergillosis diagnosed?
Bloods - eosinophilia
Sputum culture
Positive skin test for aspergillosis
Positive serology for aspergillosis species
CXR/ CT scan
What is the management for allergic bronchopulmonary aspergillosis?
Oral long term dose oral prednisolone
Anti-fungal treatment of itraconazole also of benefit
Describe chronic pulmonary aspergillosis
More than 3 months
Affects patients with underlying lung conditions
High morbidity
Diagnosis with sputum culture and refer for CXR
What is the presentation of chronic pulmonary aspergillosis?
Exacerbations not responding to antibiotics
Decline in lung function
Increased resp. symptoms - cough, decreased exercise tolerance and SOB
What is the management for chronic pulmonary aspergillosis?
Guided by secondary care with oral anti-fungal
Describe aspergilloma
Fungal mass - grows in lung cavities
Risk - TB, sarcoidosis, bronchiectasis, after pulmonary infection and bronchial cyst or bullae
How does an aspergilloma present?
Haemoptysis - common
Cough and fever less frequent
Asymptomatic and found on CXR - mass with pulmonary cavity
What is the management for aspergilloma?
CT scan
Surgical resection and long term anti-fungal
Who is at risk of acute invasive pulmonary aspergillosis?
Neutropenic patients
Post transplant
Patients with defects in phagocytes
What is the presentation of acute invasive pulmonary aspergillosis?
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
What is the management for acute invasive pulmonary aspergillosis?
IV anti-fungal
Mortality rate is 50%
Can present as persistent febrile neutropoenia despite broad spectrum antibiotics
