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fungal infections Flashcards

1
Q

what are the three main fungal pathogens ?

A

Aspergillus fumigatus
Candida albicans
Cryptococcus neoformans

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2
Q

Who is at risk of fungal infection ?

A

Impaired immune system
Chronic lung disease
Patients in ICU setting

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3
Q

what diseases does pneumocystis spp. cause ?

A

pneumocyctitis

pneumonia

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4
Q

what diseases does aspergillus spp. cause ?

A

allergic
aspergillosis
aspergilloma

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5
Q

what disease does candida spp. cause ?

A

thrush

candidemia

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6
Q

what does cyrptococcus spp. cause ?

A

meningitis

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7
Q

when is mucocutaneous candidiasis seen ?

A

antibiotic use
moist areas
inhalation steroids
neonates <3months

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8
Q

what are presenting symptoms of mucocutaneous candidiasis

A

primary immunodeficiency disorders
neutropenia
low CD4+ Tcells
impaired IL-17immunity

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9
Q

what are the different types of impaired IL-17 immunity

A

AD-Hyper IgE syndrome - deficit of IL-17 producing cells
Dectin-1 deficiency - reduced levels of IL-17
CARD9 deficiency - low proportion of circulating IL-17 T-cells
APECED syndrome - high titres of neutralising Ab against IL-17

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10
Q

what is invasive candidiasis and how does it present

A

a blood stream infection usually from gut commensal, common in premature neonates, high mortality 40%
presents as bacterial BSI

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11
Q

what are other risk factors of invasive candidiasis

A

broad spectrum antibiotics
intravascular catheters
total parenteral nutrition
abdominal surgery

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12
Q

how is invasive candidiasis diagnosed

A

blood culture or culture from normally sterile site.
Beta-d-glucan high NPV excludes
recent PCR development

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13
Q

how is aspergillus spread

A

airborne inhalation
sporulation
hydrophobic conidia
diameter 2-3 um

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14
Q

what are the different classifications of aspergillus disease

A

acute invasive pulmonary aspergillosis - neutropenic patients, post transplant stem cell, phagocyte defects
chronic pulmonary aspergillosis - >3 months, underlying lung condition
allergic aspergillosis - allergic bronchopulmonary aspergillosis in CF and asthma

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15
Q

what are features of acute invasive pulmonary aspergillosis ?

A

rapid and extensive hyphen growth
thrombosis and haemorrhage
angio-invasive and dissemination
absent or non-specific clinical signs and symptoms
persistent febrile neutropenia despite broad spectrum Abx
mortality 50%

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16
Q

who is susceptible to sub-acute invasive pulmonary aspergillosis ?

A

non-neutropenic host
graft-vs-host disease -stem cell
neutrophil disorders

17
Q

what are the features of sub acute invasive pulmonary aspergillosis ?

A 
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%
18
Q

what are feature of invasive aspergillosis as presenting symptom of primary immunodeficiency ?

A

congenital neutropenia
chronic granulomatous disease - phagocytic disorder
hyper IgE syndrome
CARD-9 deficiency
clinical presentation outside lungs - bone, spine, brain, abdominal

19
Q

what are features of chronic pulmonary aspergillosis ?

A

pulmonary exacerbations
lung function decline
increased respiratory symptoms - cough, exercise tolerance, SOB
positive sputum cultures for aspergillus, 50% of CF patients infected

20
Q

what are features of allergic bronchopulmonary aspergillosis ?

A

acute/subacute deterioration of lung function and respiratory symptoms
new abnormal chest imaging
elevated IgE
increased aspergillus specific IgE of positive skin-test
positive aspergillus specific IgG

21
Q

what is pulmonary aspergilloma ?

A

a fungal mass that usually grows in lung cavities

22
Q

when is pulmonary aspergilloma seen ?

A 
tuberculosis
sarcoidosis
bronchiectasis
bronchial cysts and bullae
after pulmonary infections
23
Q

how is aspergillosis diagnosed in non-neutropenic patients ?

A

cultures of sputum and/or bronchoalveolar lavage, biopsy

aspergillus specific IgG and IgE in chronic and allergic pulmonary aspergillosis

24
Q

how is aspergillosis diagnosed in neutropenic patients ?

A

high resolution CT chest - halo/air-cresent sign
molecular markers in blood - galactomannan and PCR
BAL and biopsies

25
Q

how is crypto coccus transmitted ?

A

inhalation

found in bark, bird faeces, organic matter

26
Q

what are the range of infections cryptococcus can cause ?

A

pulmonary infection from asymptomatic to pneumonia

meningoencephalitis in HIV/AIDS

27
Q

what is the clinical presentation of meningoencephalitis ?

A 
headache
confusion
altered behaviour
visual disturbance
coma
raised ICP
28
Q

how is cryptococcal disease diagnosed ?

A

cerebrospinal fluid - indian ink prep, culture, high protein, low glucose, crypto coccus antigen
blood - culture crypto coccus antigen

29
Q

what is the mortality of cryptococcal meningitis ?

A

africa - 3 month 70%

US - 3 month 25%

30
Q

what factors are associated with cryptococcal mortality /

A 
delay in presentation and diagnosis
lack of anti fungal access
inadequate induction therapy
delays in starting antiretroviral therapy
immune reconstitution syndrome
31
Q

what antifungals can be used to treat invasive infections and what is their action ?

A

Amphotericin B (iv) - act on ergosterol > lysis
Azoles (iv, oral) - inhibit ergosterol synthesis
Echinocandins (iv) - inhibit gluten synthesis
Flucytosine (iv, oral) - inhibit fungal DNA synthesis

32
Q

what are the broadest antifungal ?

A

Amphotericin B

33
Q

what drugs are used for invasive candidiasis ?

A

echinocandins and fluconazole

34
Q

what drugs are used for acute invasive aspergillosis ?

A

voriconazole and isavuconazole

35
Q

what drugs are used for anti fungal prophylaxis ?

A

itraconazole and posaconazole

36
Q

what drugs are used for cryptococcal meningitis ?

A

Amphotericin B and fluconazole

37
Q

what anti fungal is most commonly resistant to ?

A

fluconazole 90%

infection (2 decks)

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