Fungal Infections Flashcards
Fungal infections are described as being pooutunistic, what does this mean?
They tend to thrive when the patient’s immune systems are weaker
When may a patient have a weaker immune system and be at increased risk of a fungal infcetion?
Primary immunodeficiency
HIV/AIDS
Malignancy and transplants
Premature neonate
Another group of patients at risk of fungal infections are those with chronic lung conditions.
Which type of fungal infection may affect them?
Inhalation of fungi e.g. mould
What are the tow main types of fungal skin infection?
Candidiasis
Tinea
What is Candidiasis?
Yeast like infection
Uniform commensal of mouth/GIT
Opportunistic
What is tinea?
Superficial skin infection caused by dermatophytes
Candida is asymptomatic until when?
Until disrupted e.g. in lowering of the immune system or disrupted mucosal barriers
What are some of the risk factors for candida infection?
Moist areas
Skin folds
Obesity
Diabetes
Neonates
Pregnancy
Poor hygiene
Occupation in wet environments
Patients who have recently had which drug may be more likely to develop a Candida infection?
Patients on broad spectrum antibiotics
What type of rash is common in babies?
Nappy rash aka napkin dermatitis
What is genital candidiasis often known as?
Thrush
What are the symptoms of thrush?
Itch
Soreness and burning discomfort
Vulval oedema
Cottage cheese/white curd discharge
Bright red rash
What are some risk factors of thrush?
Just before and during menstruation
Obesity
Diabetes
Iron deficiency anaemia
Immunodeficiency
Recent course of broad spectrum antibiotics
High dose OCP/ oestrogen based HRT
Pregnancy
How is a diagnosis of thrush made?
Clinically but vaginal swab can be done
What is the management of thrush?
Clotrimazole - topical antifungal cream
Oral fluconazole
Supportive measures e.g. loose clothing, avoiding soap
What is non-specific balanitis?
Inflammation of the glans penis
->bacterial or candida infection
Treatment of candida balanitis?
Topical clotrimazole
What are the risk factors for oral candidiasis aka oral thrush?
Extremes of age
Immunocompromised
Diabetes
Dental prosthesis
Smoking
Poor oral hygiene
Local trauma
Nutritional deficiency
Impaired salivary function
Which two types of drugs increase risks of oral thrush?
Broad spectrum antibiotics
Inhaled or oral corticosteroids
What are the symptoms of oral thrush?
White or yellow plaques in mouth
Mild burning
Erythema
Altered taste
‘Furry tongue’
What is the management of oral thrush?
Topical antifungal e.g. nystatin or miconazole gel
Smoking cessation
Good oral hygeine
Systemic candida infections can occur in the immunosuppressed. Who would fall into this catergory?
Those with HIV, malignancy or those having chemo
What are some other risks of systemic candida infection?
Recent abdominal surgery
Renal failure
Low birth weight infants
Neutropoenia
Diabetes
Candidaemia?
Candida infection in the bloodstream
Systemic candida infection can spread to any body part.
When should you be clinically suspicious of a systemic candida infection?
Fever which doesn’t respond to antibiotics
Invasive candidiasis?
Gut commensal, common bloodstream infection
How is a diagnosis of invasive candidiasis made?
Blood cultures
What is the treatment of invasive candidiasis?
IV/oral antifungals
What is tinea caused by?
Direct spread from infected individual or animal
Indirect spread by clothing or bedding etc
What are some risk factors of tinea?
Hot humid environments
Obesity
Tight fitting clothing
Immunocompromised
Hyperhidrosis (excess sweating)
How do tinea infections usually present?
Scaly itchy skin
Upon examination of a tinea infection, what would be seen?
Single or multiple flat or slightly raised patches
Typically central clearing
Asymmetrical distribution
Investigations are not usually required for tinea infections but would could be done if unsure?
Skin flaking or swab
List some common types of tinea infection.
Athlete’s foot
Ringworm
Tinea Capitis (scalp and hair)
What is the management of tinea infections?
Supportive e.g. loose fitting clothing, good hygiene
Topical anti-fungal creams
How can a diagnosis of fungal nail infection by made?
Nail clippings to send off
What are the management options for fungal nail infections?
Can just be left
Keep nails trimmed and have well fitting shoes
Cotton absorbent socks
Topical nail lacquer
Oral terbinafine
If a patient in on oral terbinafine, what needs to be monitored?
LFTs
Aspergillus?
A type of mould
Where can aspergillus be found?
Soil, compost, other organic matter
Dust and bedding
Damp buildings
Air conditioning systems
How is aspergillus transmitted?
Inhalation by spores
Inhalation of aspergillus can be harmful to those with which underlying health conditions?
Cystic fibrosis
COPD
TB
Sarcoidosis
Weakened immune syste,
What does aspergillus cause?
Aspergillosis
What are the symptoms of Aspergillosis?
Cough
SOB
Wheeze
Pyrexia
General malaise
Headache
What are the four types of aspergillosis?
Allergic bronchopulmonary aspergillosis
Chronic pulmonary aspergillosis
Aspergilloma
Invasive pulmonary aspergillosis
Which type of aspergillosis is most common in patients with asthma and cystic fibrosis?
Allergic bronchopulmonary aspergillosis
What is allergic bronchopulmonary aspergillosis due to?
Allergy to aspergillus mould
What are the symptoms of allergic bronchopulmonary aspergillosis?
Cough > 3 weeks
What can allergic bronchopulmonary aspergillosis lead to?
Pulmonary fibrosis
How can a diagnosis of allergic bronchopulmonary aspergillosis be made?
Bloods
Sputum culture
Positive skin test
Positive serology
CXR/CT
What is the management of allergic bronchopulmonary aspergillosis?
Oral long term high dose prednisolone
Antifungal treatment
Chronic pulmonary aspergillosis means symptoms have been ongoing for > 3 months.
Which type of patients does it affect?
Patients with underlying lung conditions
How can chronic pulmonary aspergillosis present?
Exacerbations not responding to antibiotics
Decline in lung function
Increased resp. symptoms
How is a diagnosis of chronic pulmonary aspergillosis made?
Sputum culture
Refer for CXR
What is used in the management of chronic pulmonary aspergillosis?
Oral anti-fungals
Aspergilloma?
Fungal mass which grows in lung cavities
Who is at risk of an aspergilloma?
Patients with:
TB
Sarcoidosis
Bronchiectasis
After pulmonary infection
Bronchial cyst or bullae
How does aspergilloma present?
Commonest presentation is haemoptysis
Cough and fever sometimes
Can be asymptomatic and only picked up on CXR
Who is at risk of acute invasive pulmonary aspergillosis?
Neutropenic patients
Post transplant patients
Patients w defects in phagocytes
How can acute invasive pulmonary aspergillosis present?
Any organ can be involved so symptoms vary but:
Cough
SOB
Fever
Haemoptysis
Pleuritic chest pain
Nasal congestion and pain, sinusitis can develop
How can acute invasive pulmonary aspergillosis spread?
Haematogenously
-> can spread to kidneys, brain, GIT, skin, eyes so presentation varies
High mortality rate 50%
What is the management of acute invasive pulmonary aspergillosis?
IV anti-fungals
