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Infection & Immunity > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

what are moulds

A

multicellular, filamentous fungi which produce hyphae

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2
Q

what are yeasts

A

unicellular, round or oval cells, reproduce by budding or fission

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3
Q

what are the common symptoms of tinea infections

A

itching, burning, pain, irritation

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4
Q

what are risk factors for tinea infections

A

environmental, clothing, hyperhidrosis, immunicompromised

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5
Q

what causes tinea infections

A

dermatophytes

moulds and keratinophilic

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6
Q

what are the three types of ringworm

A

tinea corpis = skin
tinea cruris = groin
tinea capitis = scalp

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7
Q

what are some treatments for ringworm

A

corporis and cruris = topical imidazole (clotrimazole, econazole or miconazole) also terbinifine >12s
oral therapy is terbinafine, itraconazole, griseofulvin (rural areas)

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8
Q

treatment for tinea capitis

A

oral treatment in addition to ketoconazole, selenium sulphide shampoos twice weekly

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9
Q

what is griseofulvin used to treat

A

microsporum spp

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10
Q

what is terbinafine used to treat

A

trichophyton

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11
Q

what are the features of griseofulvin

A

short half life
not retained well in keratin so longer therapy needed
narrow therapeutic range
avoid in liver disease/pregnancy/breastfeeding

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12
Q

what are the side effects of griseofulvin

A

GI, headache, cognitive, hepatobiliary, alcohol may potinate effects, interacts with oral contraceptives, take with or after fatty food to improve absorption

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13
Q

what is tinea pedis

A

athletes foot

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14
Q

what is chronic hyperkeratotic tinea

A

patchy fine dry scaling on the bottom of the feet

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15
Q

what are the symptoms of athletes foot

A

moist peeling, irritable skin between toes, clusters of blisters or pustules on the side of the feet or insteps, ringworm like tinea corpis

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16
Q

what people are prone to athletes foot

A

more exposed to the spores at home or during activities, their skin may produce less fatty acid, they wear occlusive footwear, they wear the same pair of shoes or socks for a long period of time, they sweat excessively, they have poor circulation in feet

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17
Q

what species’ can cause athletes foot

A

trichophyton rubrum
trichophyton mentagrophytes
epidermophyton floccosum

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18
Q

what is first line treatment for tinea fungal infection

A

imidazole cream 2-4wks
terbinafine cream 1wk (>12s)
combine with hydrocortisone if inflammed

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19
Q

what to use if topical antifungals are ineffective for tinea infection treatment

A

terbinafine 250mg od 2-6wks
itraconazole 100mg od for 30 days or 200mg bd 7days
griseofulvin 500-1000mg daily o divided dose 4-8wks

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20
Q

what is onychomycosis

A

fungal infection of the nails

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21
Q

what are the common infective species of onychomycosis

A

trichophyton rubrum
epidermophyton floccosum
trichophyton mentagrophytes
candida

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22
Q

what are the most effective therapies for onychomycosis

A

terbinafine and itraconazole

scrapings of the nail are needed

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23
Q

what is the most common subtype of onychomycosis

A 
DLSO
d=distal (top of nail)
l=lateral (side of nail)
s=subungal 
o= oncychomycosis
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24
Q

what is the systemic management of onchomycosis

A

1st line= terbinafine 250mg od

itraconazole 200mg bd for 7 days

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25
Q

what is pulse therapy

A

shorter, high dose

drug still remains in keratinised tissue but lower risk of side effects

26
Q

what is the topical management of onychomycosis

A

mild disease or people who cannot take oral products

amorolfine (once or twice weekly for 6 months)

27
Q

what does pityriasis versicolor look like

A

macules and/or patches of variable appearance (hyperpigmented), surrounded by normal skin
lesions worsen in tropical climates
affected areas include back, chest, abdomen, neck, upper limbs
face commonly affected in children

28
Q

what is pityriasis versicolor

A

colonisation of stratum corneum, starts around puberty as the fungus feeds off fatty acids in sebum - it lives on the skin

29
Q

how is pityriasis versicolor diagnosed

A

using a Wood’s lamp

yellow to yellow-green flouresence

30
Q

what is the treatment for pityriasis versicolor

A

topical shampoos that will cover large areas
imidazole cream if small area
systemic itraconazole if topical insufficient

31
Q

what causes superficial candida infections

A

candida albicans

c. glabrata
c. krusei

32
Q

what topical therapies are used for oropharyngeal candida (oral thrush)

A 
topical = imidazole like miconazole oral gel, polyene antifungals like nystatin
oral= fluconazole
33
Q

what is genital candidiasis

A

vaginal thrush

34
Q

how does genital candidiasis present

A

intense vaginal and vulval pruritus, thick white discharge, pain on intercourse and urination

35
Q

what treatment is used for genital candidiasis

A

imidazoles like clotrimazole

oral fluconazole or itraconazole

36
Q

what is cutaneous candidiasis

A

folds of the skin, especially areas that chafe

37
Q

what are the risk factors for cutaneous candidiasis

A

systemic antibiotics, HIV, skin conditions, skin maceration

38
Q

what does disseminated mean

A

spread from initial localised source of infection

39
Q

what is fungaemia

A

fungus detected in blood

40
Q

what is severe sepsis

A

sepsis in addition to induced organ dysfunction/tissue hypo-perfusion

41
Q

what is sceptic shock

A

sepsis induced hypotension persisting despite adequate fluid resuscitation

42
Q

what happens during sepsis

A

circulatory system cannot handle supply demands of the body, inflammatory mediators compromise integrity of blood vessels, leaky blood vessels (intravascular fluid leaks out and reduces blood pressure)
reduction in blood pressure leads to hypoperfusion of organs
multi-organ failure and death

43
Q

why are fungi more toxic

A

there is less specificity between fungal and mammalian cells as they are both eukaryotic

44
Q

what are the types of fungal infection

A

invasive, disseminated, fungaemia, distant site infection

45
Q

what indirect tests can confirm an invasive fungal infection

A

galactomannan antigen detected in sample
beta D glucan detected in serum
MC&S in sputum

46
Q

what are the main causative organisms of invasive fungal infections

A

candida spp, aspergillus spp, cryptococcus spp, histoplasma capsulatum

47
Q

what is apergillus

A

a mould that is common in the environment and can cause pulmonary infection (opportunistic)
blood cultures are difficult to obtain but antibody detection can be used

48
Q

what is aspergillosis

A

invasive aspergillosis has lung origin

49
Q

what is aspergilloma

A

a fungal ball growing in preexisting cavity

saprophytic

50
Q

what are the complications of invasive pulmonary aspergillus

A

pneumonia, dissemination to CNS, local invasion to heart/vessels
surgery to remove locally invasive regions

51
Q

what is the most common species of yeast

A

cryptococcus neoformans

cause pulmonary and invasive CNS infections

52
Q

what is histoplasma capsulatum

A

environmental pathogen that causes pulmonary disease

53
Q

what drugs are in the azole category

A

imidazoles (topical), triazoles (fluconazole, itraconazole, posaconazole, voriconazole)

54
Q

what drugs are in the echinocandins category

A

caspofungin, anidulafungin

55
Q

what drugs are in the polyenes category

A

amphoterocin

56
Q

what is the triazoles mechanism of action

A

decreased ergosterol production throug inhibition of fungal cytochrome p450 enzymes, most are stativ

57
Q

what are the side effects of triazoles

A

hepatic derangement, QT prolongation

58
Q

what is the mechanism of action of amphoterocin

A

beinds to ergosterol in fungal cell membrance, creates pores, increasing permeability
cidal
broad spectrum but poor oral absorption so IV only
lipid formulation has reduced renal toxicity

59
Q

what are the side effects of amphoterocin

A

renal toxicity, electrolyte disturbances, infusion reactions, cardiotoxicity, hepatotoxicity, blood dyscrasias

60
Q

what are echinocandins

A

inhibit 1,3-beta-glucan synthase, prevent beta-glucan synthesis

61
Q

what are some examples of echinocandins

A

capsofungin, anidulafungin, micafungin

62
Q

what is flucytosine

A

nucleoside analogue, synergism with amphoterocin, need to do plasma levels, large problem with resistance

Infection & Immunity (22 decks)

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