Fungal Infections

Question 1

Which 3 fungal organisms cause the majority of invasive fungal infections?

What other organism may be of particular importance?

Answer 1

Aspergillus fumigatus
Candida albicans
Cryptococcus neoformans

Pneumocystis also of relevance

Question 2

What groups of people are at risk from opportunistic fungal infections?

Answer 2

Immunocompromised - primary, HIV/AIDS, malignancies, premature neonates
Chronic lung diseases e.g. asthma, CF, COPD
ICU patients

Question 3

What are the significant illnesses caused by the main fungal organisms?

Answer 3

Candidiasis - mucocutaneous or invasive

Aspergillosis - (sub)acute/chronic invasive pulmonary, allergic bronchopulmonary, pulmonary aspergilloma

Cryptococcosis - pneumonia, meningitis

Question 4

What are the classes of antifungals available?

Answer 4

Ergosterol synthesis inhibitors - azoles and amphotericin B formulations

Inhibiting glucan synthesis - echinocandins

Inhibiting DNA synthesis - flucytosine

Question 5

Which antifungals would be used for what?

Answer 5

Amphotericin B broad spectrum
Echinocandins and fluconazole for invasive candidiasis
Other azoles for invasive aspergillosis and antifungal prophylaxis
AmB + flucytosine (then fluconazole maintenance) for cryptococcal meningitis