Fungal Infections Flashcards
Which groups of patients are most at risk for fungal infections?
Patients with an impaired immune system:
- Primary immunodeficiencies
- HIV/AIDs
- Malignancies and transplants
- Premature neonates
Chronic Lung Diseases
- Asthma
- CF
- COPD
Patients in ICU
What are the features of mucocutaneous candidiasis?
- Antibiotic use
- Moist areas
- Inhalation steroids
- Neonates < 3 months
- Presenting symptom of Primary Immunodeficiency Disorders: Neutropenia, low CD4+ T cells and impaired IL-17 immunity
What are the additional risk factors for invasive candidiasis?
- Broad spectrum antibiotics
- IV catheters
- TPN
- Abdominal surgery
How can invasive candidiasis be diagnosed?
- Blood culture or culture from normally sterile site
- Beta-d-glucan high NPV (to exclude invasive candidiasis)
- Potentially PCR assays
How can Pulmonary Aspergillus be diagnosed?
- Acute Invasive: neutropenic patients, post transplants (stem cell > solid organ) and patients with defects in phagocytes
- Chronic: patients with underlying chronic lung conditions
- Allergic: in patients with CF and asthma
What are the features of Acute Invasive Pulmonary Aspergillosis?
- Rapid and extensive hyphal growth
- Thrombosis and haemorrhage
- Absent/non-specific signs and symptoms
- Persistent febrile neutropenia despite broad-spectrum antibiotics
What are the features of Subacute Invasive Pulmonary Aspergillosis?
- Non-angioinvasive
- Limited fungal growth
- Pyogranulomatous infiltrates
- Tissue necrosis
- Excessive inflamm.
- Non specific signs and symptoms
Which Primary Immunodeficieny conditions can have invasive aspergillosisi as a symptom?
- Congenital neutropenia
- Chronic granulomatous disease
- Hyper IgE syndrome
- CARD-9 Deficiency
What are the features of Chronic Pulmonary Aspergillosis?
- Pulmonary exacerbations not responding to antibiotics
- Lung function decline
- Increased resp. symptoms
- Positive sputum cultures
What are the features of Allergic Bronchopulmonary Aspergillosis?
- Acute/subacute deterioration of lung function and resp. symptoms
- New abnormalities on chest imaging
- Elevated IgE level
- Increased Aspergillus specific IgE or positive skin test
- Positive Aspergillus specific IgE
What is a Pulmonary Aspergilloma?
A fungal mass that usually grows in lung cavities
Which virus can cause a pulmonary aspergilloma?
Influenza
How can pulmonary aspergillosis be diagnosed in non-neutropenic patients?
- Sputum cultures +/- bronchoalveolar lavage +/- biopsy
- Aspergillus specific IgG and IgE
How can pulmonary aspergillosis be diagnosed in neutropenic patients?
- High resolution CT chest
- Molecular markers in blood
- BAL and biopsies
What are the features of Cryptococcosis?
- Transmitted by inhalation
- Pulmonary infection: asymptomatic to pneumonia
- Dissemination to brain causing meningoencephalitis in HIV/AIDS patients
- Presentation: headache, confusion, altered behaviour, visual disturbances and coma
