Fungal infections

Question 1

Main three pathogens

Answer 1

Aspergillus fumifatus
Candida albicans
Crytococcus neoformans

Question 2

Mucocutaneous candidiasis risks (4)

Answer 2

Antibiotic use
Moist areas
Inhaled steroids
Neonates- nappy rash

Question 3

Primary immunodeficiency disorder presentation

Answer 3

Neutropenia (low neutrophils)
Low CD4+ T cells
Impaired IL-17 immunity

Question 4

Invasive candidiasis risks

Answer 4

Broad spectrum antibs
Intravasuclar catheters
Total parenteral nutrition
Abdo surgery
Premature neonates

Question 5

Invasive candida found

Answer 5

Found in the gut commensal

Question 6

Diagnose invasive candidiasis

Answer 6

Blood cultures or culture from normally sterile site
PCR assays
Beta-d-glucan high NPV can exclude

Question 7

Aspergillus and aspergillosis transmission

Answer 7

Sporulation
Hydrophobic conidia
2-3 microns
Airborne/inhaled

Question 8

Acute invasive pulmonary aspirgillosis

Answer 8

Neutropenic host (acute leukemia)
Post transplant patients- stem cell mroe than solid organ
Patients w defects in phagocytes
Rapid and causes thrombosis and haemorrhage
Persistent febrile neutropenia despite broad spectrum antibs

Question 9

Chronic pulmonary aspirgillosis

Answer 9

Patients w underlying chronic lung conditions
More than 3 months
Lung function decline
Pulmonary exacerbations not responding to antibs
Incr resp symptoms
Positive sputum cultures for aspergillus

Question 10

Allergic aspergillosis

Answer 10

Allergic broncopulmonary aspergillosis in CF and asthma
Asthma or CF with fungal senstitisations
Acute or subacute deterioration of lung function and resp symptoms
Abnormal chest imaging
Elevated IgE
Positive aspergillus IgG

Question 11

Pulmonary aspergilloma

Answer 11

Fungal mass growing in lung cavities

Can be linked to TB, sarcoidosis, bronchiectasis or post infective

Question 12

Diagnose pulmonary aspergillosis non neutropenic

Answer 12

Culture sputum
Bronchoalveolar lavage
Biopsy
Aspergillus specific IgE and IgG in chronic/allergic

Question 13

Diagnose pulmonary aspergillosis neutropenic

Answer 13

High resolution CT chest- halo sign
Molecular markers in blood- galactomannan and PCR-aspergillus
BAL and biopsies

Question 14

Cryptococcus and cryptococcosis

Answer 14

Transmission by inhalation
Can be found on bark of some trees, bird faeces and organic matter
Pulm infection from asymp to pneumonia
Dissemination to brain- meningoecephalitis in HIV/AIDs patients
high mortality in africa (20%)

Question 15

Cryptococcus and cryptococcosis presents

Answer 15

Presents w headache, confusion, altered behaviour, visual disturbances, coma (inc ICP)

Question 16

Daignosis crytptococcal disease

Answer 16

CSF fluid- indian ink preparation, culture, high protein and low glucose, cryptoccus antigen
Blood culture and cyptoccus antigen

Question 17

Antifungal treatment

Answer 17

Amphotericin B fromulation
Azoles
Echinocandins
Flucytosine

Question 18

Amphotericin B

Answer 18

Broad spectrum

Question 19

Echocandins and fluconazole

Answer 19

Invasive candidasis

Question 20

Voriconazole and isavuconazole

Answer 20

Acute invasive aspergillosis

Question 21

Itraconzole and posaconzole

Answer 21

Antifunga; prophylaxis

Question 22

AmB and flucytosine followed by fluconazole paintances

Answer 22

Cryptococcal meningitis