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Year 3 Infection (JK) > Fungal infections > Flashcards

Fungal infections Flashcards

1
Q

3 main fungal pathogens

A

aspergillus - aspergillus fumigus
candida - candida albicans
Cryptococcus - Cryptococcus neoformans

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2
Q

6 groups of patients fungal infections affect and why

A

opportunistic infection affecting those with impaired immunity

  1. primary immunodeficiency
  2. HIV/AIDS
  3. malignancy and transplant
  4. premature neonates
  5. ICU
  6. chronic lung conditions eg asthma, CF, COPD
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3
Q

4 risk factors for mucocutaneous candidiasis

A

antibiotic use
inhaled steroids
moist areas
neonates <3 months old

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4
Q

3 presenting symptoms of primary immunodeficiency

A

neutropenia
low CD4+ T cells
impaired IL-17 immunity

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5
Q

Where is the most common source of invasive candidiasis?

A

it is a gut commensal so invasive candidiasis is usually endogenous in nature

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6
Q

4 risk factors for invasive candidiasis

A

broad spectrum antibiotics
intravascular catheters
total parenteral nutrition
abdominal surgery

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7
Q

diagnosing invasive candidiasis

A

blood culture or culture from usually sterile site
B-d-glucan high NPV to exclude
PCR, assays

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8
Q

Why is diagnosing invasive candidiasis more difficult in children?

A

sampling issues

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9
Q

List the steps of invasive pulmonary aspergillosis infection

A

sporulation
inhalation of airborne conidia
conidial germination in absence of sufficient pulmonary defences

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10
Q

Who does acute invasive pulmonary aspergillosis affect?

A 
neutropenic patients
post transplant (stem cell> solid organ)
defects in phagocytes
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11
Q

how long does chronic pulmonary aspergillosis last and who does it affect?

A

over 3 months

those with underlying chronic lung conditions

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12
Q

Who does allergic aspergillosis affect?

A

CF and asthma

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13
Q

Difference between acute and subacute invasive pulmonary aspergillosis

A

subacute is a non neutropenic host and non angioinvasive with limited fungal growth

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14
Q

How does invasive aspergillosis present as a symptom of primary immunodeficiency?

A

congenital neutropenia
chronic granulomatous disease
often outside lungs eg brain, spine, abdomen, bone

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15
Q

Briefly describe the presentation and findings of chronic pulmonary aspergillosis

A

pulmonary exacerbations, resp symptoms, lung function decline
positive sputum cultures for aspergillus

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16
Q

5 findings on investigations in allergic bronchopulmonary aspergillosis

A

(sub)acute lung function deterioration and resp symptoms
new abnormalities on chest imaging
elevated IgE
increased aspergillus specific IgE or positive skin test
positive aspergillus specific IgG

17
Q

Pulmonary aspergilloma

A

a fungal mass that usually grows in the lung cavities

18
Q

Who does pulmonary aspergilloma affect?

A

TB, sarcoidosis, bronchiectasis etc

19
Q

diagnosing pulmonary aspergillosis in a non neutropenic host

A

sputum culture/bronchoalveolar lavage/biopsy

aspergillus specific IgG and IgE in chronic and allergic pulmonary aspergillosis

20
Q

What types of pulmonary aspergillosis is aspergillis specific IgG and IgE raised?

A

chronic and allergic

21
Q

How to diagnose pulmonary aspergillosis in a neutropenic host

A

high res CT chest - halo sign
molecular markers in blood
BAL and biopsies

22
Q

How is Cryptococcus transmitted?

A

inhalation - bark of trees, bird faeces etc

23
Q

Danger of Cryptococcus infection in those with HIV

A

meningoencephalitis

24
Q

How does meningoencephalitis in those with HIV/AIDS present?

A

headache, confusion, coma, vision

25
Q

2 bodily fluids used in the diagnosis of cryptococcal infection

A

blood and CSF

26
Q

findings of CSF analysis in Cryptococcus

A

india ink preparation
culture, increased protein and decreased glucose
Cryptococcus antigen

27
Q

findings of blood analysis in Cryptococcus

A

culture and Cryptococcus antigen

28
Q

List 4 antifungal agents and route of delivery

A

amphotericin B (IV)
azoles (IV and oral)
echinocandins (IV)
flucytosine (IV and oral)

29
Q

Action of amphotericin B

A

act on ergosterol > lysis

30
Q

Action of azoles

A

inhibit ergosterol synthesis

31
Q

Action of echinocandins

A

inhibit glucan synthesis

32
Q

Action of flucytosine

A

inhibit fungal DNA synthesis

33
Q

Some challenges and needs for future mycology

A

no vaccines or immunotherapies
new antifungals - toxicity, resistance, cost
diagnostics - sensitivity, specificity

Year 3 Infection (JK) (12 decks)

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