Fungal Infections Flashcards

1
Q

What are the main fungal infections?

A

Aspergillosis - Aspergillus Fumigatus
Candidiasis - Candida Albicans
Cryptococcosis - Cryptococcus Neoformans

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2
Q

How is Aspergillus transmitted?

A

Airborne Spores

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3
Q

Aspergillosis has several different presentations, how does Acute Invasive Aspergillosis present?

A

Neutropenic & post-transplant patients

They are persistently febrile despite abx

Its angio-invasive and may cause thrombosis & haemorrhage

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4
Q

Aspergillosis has several different presentations, how does chronic pulm. Aspergillosis present?

A

When acute is present for more than 3 months.

Chronic lung disease patient who get an acute exacerbation that unresponsive to abx may be aspergillus.

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5
Q

Aspergillosis has several different presentations, describe Allergic Bronchopulmonary Aspergillosis?

A

It is a Type I/II hypersensitivity to A. fumigatus.

Usually CF or Asthma patients who acutely deteriorate in lung function &resp symptoms

Present with SOB, sputum, cough, dyspnea

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6
Q

Aspergillosis has several different presentations, describe a pulmonary aspergilloma?

A

A non-invasive infection in a pre-existing cavity e.g. post-TB, sarcoid, bronchiectasis or pulm infection.

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7
Q

Aspergillosis has several different presentations, describe influenza associated aspergillosis?

A

Flu patients who get intubation, oseltamavir, CCS and/or Abx can then develop aspergillosis

Literally just aspergillosis in a patient with Flu

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8
Q

How do you test for aspergillus?

A

If they’re neutropenic

  • CT chest
  • PCR
  • Bronchoalveolar lavage + biopsy

If not:

  • Sputum culture
  • Bronchoalveolar Lavage
  • Biopsy
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9
Q

How can test for chronic pulmonary or allergic bronchopulmonary aspergillosis

A

Blood tests for Aspergillus specific IgG & IgE

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10
Q

How is aspergillus treated?

A

Voriconazole & Isavuconazole

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11
Q

Who gets candida infection?

A

Mucocutaneous candiasis:

  • Young neonates
  • Abx/inhalation steroids
  • Primary immunodeficiency disorders

Invasive candidiasis:

  • Broad spectrum Abx
  • Vascular catheters
  • Parenteral nutrition
  • Abdo Surgery
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12
Q

How does candidiasis present?

A

Invasive looks like a bacterial BSI

Mucocutaneous = thrush

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13
Q

How do we test for and treat candidiasis?

A

Blood culture & PCR

We treat with echinocandins and fluconazole

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14
Q

How does cryptococcosis develop?

A

Mostly HIV associated:

Starts with a pulm infection that disseminates to the brain causing meningoencephalitis

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15
Q

How is cryptococcus spread?

A

By inhalation

Its found in some tree bark & bird faeces

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16
Q

How does cryptococcosis present?

A
  • LRT symptoms
  • Consitutional symptoms
  • Headache
  • Confusion
  • Altered behaviour
  • Visual Disturbance
  • Coma (raised ICP)
17
Q

How do we test for cryptococcosis?

A

Get CSF for:

  • India ink preparation
  • Culture
  • High protein/low glucose
  • Cryptococcus Antigen

Get blood for:

  • Culture
  • Cryptococcus Antigen
18
Q

How is cryptococcosis treated?

A

Induce therapy with AmB &a Flucytosine

Maintain it with fluconazole

19
Q

Classes of anti-fungals?

A

Azoles:

  • Fluconazole (Cryptococcosis & Candidiasis)
  • Voriconazole &Isavuconazole (Aspergillosis)

Polyenes:
- Amphotericin B (Cryptococcosis)

Echinocandins (Candidiasis)

Flucytosine (Cryptococcosis)

20
Q

How do azoles work?

A

Prevent ergosterol synthesis

21
Q

How does echinocardins work?

A

prevent synthesis of gluons

22
Q

How does amphoteracin B work?

A

Breaks down ergosterols in cells walls of fungi

23
Q

How does flucytosine work?

A

Inhibits fungal DNA