Fungal Infections

Question 1

What do pneumocystis and aspergillus cause?

Answer 1

RTI, Bone marrow infiltrates, infiltrates within spleen, liver or kidney

Question 2

What do candida and cryptococcus cause?

Answer 2

Thrush, meningitis, candidaemia, endocarditis, hepatic and renal abcesses

Question 3

What are the presenations of mucocutaneous candidiasis?

Answer 3

Neutropenia, Low CD4+ Tcells,impaired IL-17 immunity

Question 4

What are the risk factors for invasive candidiasis?

Answer 4

Broad spectrum antibiotics, intravascular catheters, Total parenteral nutrition, abdominal surgery

Question 5

How do you diagnose invasive candidiasis?

Answer 5

Blood culture, Beta-D-glucan testing, NPV, PCR

Question 6

How is aspergillus transmitted?

Answer 6

sporulation, hydrophobic conidia, airborne or inhalation

Question 7

How is acute invasive pulmonary aspergillosis classified?

Answer 7

Neutropenic patients (incidence 1-10%)
• Post transplants: stem cell > solid organ (incidence up to 8%)
• Patients with defects in phagocytes

Question 8

How is chronic pulmonary aspergillosis classified?

Answer 8

must last longer than three months

Patients with underlying chronic lung conditions

Question 9

How is allergic aspergillosis classified?

Answer 9

Allergic bronchopulmonary aspergillosis in CF and ashtma (10-15%), asthma or CF with fungal sensitisation (incidence 5-15%)

Question 10

What is Acute Invasive Pulmonary Aspergillosis?

Answer 10

Rapid and extensive hyphal growth
• Thrombosis and hemorrhage
• Angio-invasive and dissemination
• Absent or non-specific clinical signs and symptoms
• Persistent febrile neutropenia despite broad-spectrum antibiotics
• Mortality rates around 50% (but depending on immune recovery)

Question 11

What is sub acute invasive pulmonary aspergillosis?

Answer 11

Non-angioinvasive
 Limited fungal growth
 Pyogranulomatous infiltrates
 Tissue necrosis
 Excessive inflammation
 Non-specific clinical signs and symptoms
 Mild to moderate systemic illness
 Mortality 20-50%

Question 12

What is invasive aspergillosis a presenting symptom of?

Answer 12

Primary immuodeficiency

Question 13

What is chronic pulmonary aspergillosis?

Answer 13

Pulmonary exacerbations (not responding to
antibiotics)
 Lung function decline
 Increased respiratory symptoms as cough,
decreased exercise tolerance and dyspnea
 Positive sputum cultures for Aspergillus
 50% of CF patients are infected
 High morbidity but causative mortality rates less
clear

Question 14

How do you diagnose pulmonary aspergillosis?

Answer 14

Non neutropenic patients

• Cultures of sputum and brochoalveolar lavage/biopsy
• Aspergillus specific IgG and IgE in chronic and allergic pulmonary aspergillosis

Neutropenic patients

• High resolution CT chest
• Molecular markers in blood and PCR
• BAL and biopsies

Question 15

How is cryptococcus transmitted?

Answer 15

Inhalation

Can be found on tree bark, bird faeces and organic matter

Question 16

What is the clinical infection of a cryptococcus infection?

Answer 16

Headache, confusion, altered behaviour, visual disturbances, coma (due to raised ICP)

Question 17

How is cryptococcal disease diagnosed?

Answer 17

CSF culture, indian ink preparation, cryptococcus antigen, blood culture and antigens

Question 18

How can fungal infections be treated?

Answer 18

Amphotericin B, IV or oral Azoles, IV Echinocandins, IV or Oral Flucytosine

Question 19

What should invasive candidiasis be treated with?

Answer 19

Echiocadins and fluconazole

Question 20

What should invasive aspergillosis be treated with?

Answer 20

Voriconazole and isavuconazole

Question 21

What should cryptococcal meningitis be treated with?

Answer 21

Amphociterin B and Flucytosine