Fungal infections Flashcards
Who is typically affected by fungal infections?
Impaired immune system
Chronic lung disease
ICU settings
What is mucocutaneous candidiasis associated with?
Antibiotic use
Moist areas
Inhalation steroids
Neonate <3mo
What is mucocutaneous candidiasis characterised by?
Neutropenia
Low CD4+ T-cells
Impaired IL-17 immunity
What is mucocutaneous candidiasis a presenting symptom of?
Primary immunodeficiency disorders
What are risk factors for invasive candidiasis?
Broad-spectrum antibiotics
Intravascular catheters
Total parenteral nutrition
Abdominal surgery
How is a diagnosis of invasive candidiasis made?
Blood culture
Beta-d-glucan high NPV
How is aspergillus transmitted?
Sporulation -> airborne/inhalation
What can aspergillus cause?
Invasive pulmonary aspergillosis
What are the types of pulmonary Aspergillus disease?
Acute invasive pulmonary aspergillosis
Chronic pulmonary aspergillosis
Allergic aspergillosis
Who typically gets acute invasive pulmonary aspergillosis?
Neutropenic patients (acute leukaemia, hamatopoietic stem cell transplant)
Post-transplant
Defects in phagocytes
Who typically gets chronic pulmonary aspergillosis?
Underlying chronic lung conditions
Who typically gets allergic aspergillosis?
Allergic bronchopulmonary aspergillosis: CF and asthma
Asthma or CF with fungal sensitisation
What is the presentation of acute invasive pulmonary aspergillosis?
Absent on non-specific clinical signs/symptoms
Persistant febrile neutropenia despite broad-spectrum antibiotics
What is the presentation of (sub)acute invasive pulmonary aspergillosis?
Non-specific clinical signs/symptoms
Mild-moderate systemic illness
What is the difference between acute and subacute invasive pulmonary aspergillosis?
Acute - angio-invasive, rapid/extensive fungal growth
Subacute - non-angioinvasive, limited fungal growth
How might invasive aspergillosis present as a symptoms of primary immunodeficiency?
Congenital neutropenia
Chronic granulomatous disease
Hyper IgE syndrome
CARD-9 deficiency
What are signs of chronic pulmonary aspergillosis (often in asthma, CF, COPD)?
Pulmonary exacerbations
Lung function decline
Increased respiratory symptoms
Positive sputum cultures for Aspergillus
What are signs of allergic bronchopulmonary aspergillosis?
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
What are signs of pulmonary aspergilloma?
Fungal mass that usually grows in lung cavities
When might a patient have pulmonary aspergilloma?
TB Sarcoidosis Bronchiectasis Bronchial cysts and bullae After pulmonary infections
How would you make diagnosis of pulmonary aspergillosis in non-neutropenic patients?
Cultures of sputum
Biopsy
Aspergillus specific IgG and IgE in chronic or allergic pulmonary aspergillosis
How would you make diagnosis of pulmonary aspergillosis in neutropenic patients?
CT-chest = ‘halo-sign’ and ‘air-crescent sign’
Molecular markers in blood
BAL and biopsies
How is cryptococcus transmitted?
Inhalation
Where is cryptococcus found?
Trees, bird faeces, organic matter
What are signs/symptoms of cryptococcal infection?
Pulmonary infection from asymptomatic to pneumonia
What can dissemination of cryptococcus to brain cause in HIV/AIDs patients?
Meningoencephalitis
What is the clinical presentation of meningoencephalitis?
Headache Confusion Altered behaviour Visual disturbances Coma
How do you make a diagnosis of cryptococcal disease?
CSF: culture, high protein and low glucose, Cryptococus antigen
Blood: culture, Crytococcus antigen
What are anti fungal agents to treat invasive fungal infections?
Amphotericin B formulations
Azoles
Echinocandins
Flucytosine
What anti-fungals would you use as the broadest anti fungal activity?
Amphotericin B formulations
What anti-fungals would you use for invasive candidiasis?
Echinocandins and fluconazole
What anti-fungals would you use for invasive aspergillosis?
Voriconazole and Isavuconazole
What anti-fungals would you use for anti fungal prophylaxis?
Itraconazole and posaconazole
What anti-fungals would you use for cryptococcal meningitis?
AmB + flucytosine followed by fluconazole maintenance
