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Infection > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

What does pneumocystis spp. cause?

A

Pneumocystitis

Pneumonia

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2
Q

What does aspergillus spp. cause?

A

Allergic and invasive pulmonary aspergillosis

Aspergilloma

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3
Q

What does candida spp. cause?

A

Thrush

Candidemia

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4
Q

What does Cryptococcus spp. cause?

A

Meningitis

Renal abscess

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5
Q

Who especially gets mucocutaneous candidiasis?

A

Neonates < 3 months

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6
Q

Causes of mucocutaneous candidiasis

A

Antibiotic use

Inhalation steroids

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7
Q

Where is mucocutaneous candidiasis found?

A

Nappy rash
Flexural/intertriginous e.g. behind knee
Interdigital candidiasis of the hands

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8
Q

Presenting symptom of primary immunodeficiency disorders characterised by…..

A

Neutropenia
Low CD4+ cells
Impaired IL-17 immunity

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9
Q

Risk factors for invasive candidiasis

A 
Premature neonates
Broad spectrum antibiotics
Intravascular catheters
Total parenteral nutrition 
Abdominal surgery
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10
Q

Presentation of invasive candidiasis

A

As bacterial bloodstream infection

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11
Q

Investigations for invasive candidiasis

A

Blood culture or culture from normally sterile site

B-d-glucan high NPV

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12
Q

How is aspergillus transmitted?

A

Sporulation - hydrophobic conidia

Airborne - inhalation

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13
Q

Pathology of invasive pulmonary aspergillosis

A
  1. sporulation
  2. inhalation of airborne conidia
  3. Conidial germination in absence of sufficient pulmonary defences
  4. Corticosteriod induced immunosuppression; PMN recruitment and tissue damage and neutropenia; excessive hyphal growth and dissemination
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14
Q

Types of pulmonary aspergillus disease

A

Acute invasive pulmonary aspergillosis
Chronic pulmonary aspergillosis
Allergic aspergillosis

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15
Q

Who gets acute invasive pulmonary aspergillosis?

A

Neutropenic patients
Post transplants; stem cell > solid organ
Patients with defects in phagocytes

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16
Q

Definition of neutropenia

A

Abnormally low concentration of neutrophils (type of white blood cells) in the blood

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17
Q

Who gets chronic pulmonary aspergillosis?

A

Patients with underlying chronic lung conditions

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18
Q

Types of allergic aspergillosis

A

Allergic bronchopulmonary aspergillosis in CF and asthma

Asthma or CF with fungal sensitisation

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19
Q

Pathology of acute invasive pulmonary aspergillosis

A
  1. Rapid and extensive hyphal growth
  2. Thrombosis and haemorrhage
  3. Angio-invasive + dissemination
20
Q

What could cause a host to be neutropenic?

A

Acute leukaemia

Haematopoietic stem cell transplant

21
Q

Presentation of acute invasive pulmonary aspergillosis

A

Absent or non-specific clinical signs and symptoms

Persistent febrile neutropenia despite broad spectrum antibiotics

22
Q

Prognosis of acute invasive pulmonary aspergillosis

A

Mortality rates 50%

Although depends on immune recovery

23
Q

Who gets (sub) acute invasive pulmonary aspergillosis?

A

Non-neutropenic hosts

  • graft vs host disease
  • neutrophil disorders
24
Q

Pathology of (sub) acute invasive pulmonary aspergillosis

A 
Non-angioinvasive 
Limited fungal growth 
Pyogranulomatous infiltrates
Tissue necrosis 
Excessive inflammation
25
Q

Presentation of (sub) acute invasive pulmonary aspergillosis

A

Non-specific clinical signs and symptoms

Mild to moderate systemic illness

26
Q

Prognosis of (sub) acute invasive pulmonary aspergillosis

A

mortality 20-50%

27
Q

Invasive aspergillosis can be a presenting symptom of what?

A

Primary immunodeficiency

28
Q

Causes of primary immunodeficiency

A

Congenital neutropenia
Chronic granulomatous disorder (phagocytic disorder)
Hyper IgE syndrome
CARD-9 deficiency

29
Q

Presentation of invasive aspergillosis as a presentation of primary immunodeficiency

A

Often outside of the lungs e.g.

- bones, spine, brain, abdominal

30
Q

What conditions does chronic pulmonary aspergillus affect?

A

Asthma
Cystic Fibrosis
Chronic obstructive lung disorders

31
Q

Presentation of chronic pulmonary aspergillosis

A 
Pulmonary exacerbations (not responding to antibiotics)
Lung function decline
Increased respiratory symptoms
Cough 
Decreased exercise tolerance 
Dyspnoea
32
Q

Investigations for chronic pulmonary aspergillosis

A

Positive sputum culture for aspergillosis

33
Q

Are a proportion of CF patients infected with aspergillosis?

A

Yes - 50% are infected

34
Q

Pathology of allergic bronchopulmonary aspergillosis

A

immunological responses to a variety of A. fumigatus antigens in the CF- host (10-15%) results in multiple presentations

35
Q

Symptoms/signs of allergic bronchopulmonary aspergillosis

A

Acute/subacute deterioration of lung function and respiratory symptoms
New abnormalities of chest imaging
Elevated IgE level
Increased aspergillus specific IgE or positive skin test
Positive aspergillus specific IgG

36
Q

What is pulmonary aspergilloma?

A

A fungal mass that usually grows in lung cavities

37
Q

What conditions does pulmonary aspergilloma grow in?

A 
TB
Sarcoidosis 
Bronchiectasis 
Bronchial cysts and bullae
After pulmonary infections
38
Q

Investigations for pulmonary aspergillosis

A

Non-neutropenic patients
- cultures of sputum and/or bronchoalveolar lavage, and/or biopsy
- aspergillosis specific IgG and IgE in chronic and allergic pulmonary aspergillus
Neutropenic patients
- High resolution CT chest (halo sign and air crescent sign)
- molecular markers in the blood (galactomannan and PCR)
- BAL and biopsies if clinical conditions allow

39
Q

Cryptococcus has caused a huge global burden of what disease?

A

HIV-associated cryptococcal meningitis

40
Q

Transmission of cryptococcal infection is done by…

A

Inhalation
Bark of a variety of trees
Bird faeces
Organic matter

41
Q

Presentation of cryptococcal infection

A 
pulmonary infection - asymptomatic to pneumonia
dissemination to brain 
- meningoencephalitis in HIV/AIDs patients 
Headache
confusion 
altered behaviour
visual disturbances
coma (due to raised ICP in 60-80%)
42
Q

Investigations for cryptococcal disease

A

CSF

Blood culture

43
Q

Factors associated with mortality of cryptococcal meningitis

A 
Delay in presentation or diagnosis
Lack of access to antifungals
Inadequate induction therapy 
Delays in starting anti-retrovirals
Immune reconstitution syndrome
44
Q

Who is affected by fungal pathogens that are opportunistic in nature?

A 
Impaired immune system 
- primary immunodeficiencies 
- HIV/AIDs
- malignancies (neutropenia) and transplants 
- premature neonates (immature immune system)
Chronic lung disease
- CF
- chronic obstructive lung disorders
- asthma 
ICU settings
45
Q

Antifungals that treat invasive fungal infections

A

Amphotericin B (IV)
Azoles (IV, oral)
Echinocandins (IV)
Flucytosine (IV, oral)

46
Q

Which antifungal drug has the broadest anti-fungal activity?

A

Amphotericin B

Infection (16 decks)

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