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Infection > Fungal infections > Flashcards

Fungal infections Flashcards

1
Q

Who is typically affected by fungal infections?

A

Impaired immune system
Chronic lung disease
ICU settings

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2
Q

What is mucocutaneous candidiasis associated with?

A

Antibiotic use
Moist areas
Inhalation steroids
Neonate <3mo

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3
Q

What is mucocutaneous candidiasis characterised by?

A

Neutropenia
Low CD4+ T-cells
Impaired IL-17 immunity

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4
Q

What is mucocutaneous candidiasis a presenting symptom of?

A

Primary immunodeficiency disorders

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5
Q

What are risk factors for invasive candidiasis?

A

Broad-spectrum antibiotics
Intravascular catheters
Total parenteral nutrition
Abdominal surgery

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6
Q

How is a diagnosis of invasive candidiasis made?

A

Blood culture

Beta-d-glucan high NPV

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7
Q

How is aspergillus transmitted?

A

Sporulation -> airborne/inhalation

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8
Q

What can aspergillus cause?

A

Invasive pulmonary aspergillosis

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9
Q

What are the types of pulmonary Aspergillus disease?

A

Acute invasive pulmonary aspergillosis
Chronic pulmonary aspergillosis
Allergic aspergillosis

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10
Q

Who typically gets acute invasive pulmonary aspergillosis?

A

Neutropenic patients (acute leukaemia, hamatopoietic stem cell transplant)
Post-transplant
Defects in phagocytes

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11
Q

Who typically gets chronic pulmonary aspergillosis?

A

Underlying chronic lung conditions

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12
Q

Who typically gets allergic aspergillosis?

A

Allergic bronchopulmonary aspergillosis: CF and asthma

Asthma or CF with fungal sensitisation

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13
Q

What is the presentation of acute invasive pulmonary aspergillosis?

A

Absent on non-specific clinical signs/symptoms

Persistant febrile neutropenia despite broad-spectrum antibiotics

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14
Q

What is the presentation of (sub)acute invasive pulmonary aspergillosis?

A

Non-specific clinical signs/symptoms

Mild-moderate systemic illness

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15
Q

What is the difference between acute and subacute invasive pulmonary aspergillosis?

A

Acute - angio-invasive, rapid/extensive fungal growth

Subacute - non-angioinvasive, limited fungal growth

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16
Q

How might invasive aspergillosis present as a symptoms of primary immunodeficiency?

A

Congenital neutropenia
Chronic granulomatous disease
Hyper IgE syndrome
CARD-9 deficiency

17
Q

What are signs of chronic pulmonary aspergillosis (often in asthma, CF, COPD)?

A

Pulmonary exacerbations
Lung function decline
Increased respiratory symptoms
Positive sputum cultures for Aspergillus

18
Q

What are signs of allergic bronchopulmonary aspergillosis?

A

Acute/subacute deterioration of lung function and respiratory symptoms
New abnormalities on chest imaging
Elevated IgE level
Increased Aspergillus specific IgE or positive skin-test
Positive Aspergillus specific IgG

19
Q

What are signs of pulmonary aspergilloma?

A

Fungal mass that usually grows in lung cavities

20
Q

When might a patient have pulmonary aspergilloma?

A 
TB
Sarcoidosis
Bronchiectasis
Bronchial cysts and bullae
After pulmonary infections
21
Q

How would you make diagnosis of pulmonary aspergillosis in non-neutropenic patients?

A

Cultures of sputum
Biopsy
Aspergillus specific IgG and IgE in chronic or allergic pulmonary aspergillosis

22
Q

How would you make diagnosis of pulmonary aspergillosis in neutropenic patients?

A

CT-chest = ‘halo-sign’ and ‘air-crescent sign’
Molecular markers in blood
BAL and biopsies

23
Q

How is cryptococcus transmitted?

A

Inhalation

24
Q

Where is cryptococcus found?

A

Trees, bird faeces, organic matter

25
Q

What are signs/symptoms of cryptococcal infection?

A

Pulmonary infection from asymptomatic to pneumonia

26
Q

What can dissemination of cryptococcus to brain cause in HIV/AIDs patients?

A

Meningoencephalitis

27
Q

What is the clinical presentation of meningoencephalitis?

A 
Headache
Confusion
Altered behaviour
Visual disturbances
Coma
28
Q

How do you make a diagnosis of cryptococcal disease?

A

CSF: culture, high protein and low glucose, Cryptococus antigen
Blood: culture, Crytococcus antigen

29
Q

What are anti fungal agents to treat invasive fungal infections?

A

Amphotericin B formulations
Azoles
Echinocandins
Flucytosine

30
Q

What anti-fungals would you use as the broadest anti fungal activity?

A

Amphotericin B formulations

31
Q

What anti-fungals would you use for invasive candidiasis?

A

Echinocandins and fluconazole

32
Q

What anti-fungals would you use for invasive aspergillosis?

A

Voriconazole and Isavuconazole

33
Q

What anti-fungals would you use for anti fungal prophylaxis?

A

Itraconazole and posaconazole

34
Q

What anti-fungals would you use for cryptococcal meningitis?

A

AmB + flucytosine followed by fluconazole maintenance

Infection (13 decks)

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