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Y2 infection > fungal infections > Flashcards

fungal infections Flashcards

1
Q

severity range of fungal infections

A

common mild superficial infections to severe invasive life threatening infections

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2
Q

burden of fungal infections

A

difficult to determine - many mild infections go undiagnosed and are self-managed

> 1bln affect
11.5mln life threatening infections
1.5mln deaths p/a

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3
Q

what type of infections are fungal infections

A

opportunistic

patients w/ impaired immune systems

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4
Q

who gets fungal infections

A

impaired immune system - 1y immunodeficiency, HIV/AIDS, malignancy and transplants, premature neonates

chronic lung diseases - aspergillosis and moulds - asthma, COPD, CF, sarcoidosis

pts in ICU - esp artificial ventilation

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5
Q

GP perspective of fungal infections

A

body
nails
mucous membrane e.g. thrush
invasive fungal infections - rare in GP

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6
Q

2 main types of fungal skin infections in UK

A

candidiasis - yeast like infection, uniform commensal of mouth/GI tract, opportunistic

tinea - superficial skin infection caused by dermatophytes

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7
Q

is candida part of the normal skin flora

A

no

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8
Q

range of infections caused by candida

A

asymptomatic until disruption - lowered immune system, disruption to mucosal barrier

non-life threatening mucotaneous infections to severe disseminated disease

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9
Q

risk factors for candida infection

A 
moist area
skin folds 
obesity 
DM
neonates
pregnancy 
poor hygiene 
occupation in wet environments
recent broad spectrum antibiotic
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10
Q

what is interigo

A

skin fold infection

commonly groin, under breasts and axillae

nappy rash - also suspect in older pts w/ incontinence pads

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11
Q

genital candidiasis symptoms

A 
itch 
soreness and burning discomfort
dysuria 
vulval oedema, fissures, excoriations 
cottage cheese/white curd discharge
bright red rash
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12
Q

risk factors for genital candidiasis

A 
just before and during menstruation 
obesity 
DM
iron deficiency anaemia 
immunodeficiency 
recent course of broad spectrum antibiotic 
high dose combined OCP/ oestrogen base HRT 
pregnancy
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13
Q

diagnosis of genital candidiasis

A

clinical

vaginal swab

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14
Q

management of genital candidiasis

A

most commonly clotrimazole - topical anti-fungal pessary or cream
oral fluconazole
supportive measures - loose clothing, avoiding soap or bubble baths to wash

no evidence for pro-biotics or treating sexual partner

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15
Q

what is non-specific balanitis

A

inflammation of glans penis

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16
Q

non-specific balanitis cause

A

bacterial or candida infection

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17
Q

management of non-specific balanitis

A

if candida - topical clotrimazole

good hygiene

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18
Q

risk factors for oral candidiasis

A 
extremes of age 
immunocompromised
broad spectrum abx
ICS/ oral corticosteroids 
DM 
dental prosthesis 
smoking 
poor oral hygiene 
local trauma 
nutritional deficiency
impaired salivary function
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19
Q

Symptoms of oral candidiasis

A 
white/yellow plaques in mouth 
mild burning 
erythema 
altered taste, unusual taste in mouth 
furry tongue 
chronic --> dysphagia
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20
Q

management of oral candidiasis

A

topical anti-fungal - nystatin, miconazole gel

extensive - oral fluconazoel

smoking cessation and good oral hygiene

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21
Q

systemic candida infections - who gets them

A

immunocompromised - HIV, malignancy, chemotherapy

other risks - recent abdo surgery, renal failure, low birth weight infants, neutropaenia, DM

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22
Q

what is candidaemia

A

candida infection which has spread to the bloodstream

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23
Q

where does systemic candida infection affect

A

can affect any body part

presentation can vary

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24
Q

indications of systemic candida infection

A

typically fever and chills doesn’t respond to abx

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25
Q

where can systemic candida infection occur

A 
bone 
infectious pulmonary abscess
endophthalmitis 
liver abscess
infectious splenic abscess
peritonitis 
biofilm formation
kidneys and bladder
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26
Q

how does invasive candidiasis occur

A

gut commensal

infections mostly endogenous of origin

27
Q

how common is invasive candidiasis

A 
4th most common bloodstream infection in adults - 30/100 000 admissions
premature neonates (<1000g) - 150/100 000 admissions
28
Q

mortality rate of invasive candidiasis

A

40%

if concern in 1y care - admit to hospital

29
Q

diagnosis and treatment of invasive candidiasis

A

blood cultures

IV/oral antifungals

30
Q

causes of tinea infections

A

direct spread from infected individual or animal
indirect contact w/ objects/materials which carry infection - bedding, clothing

rarely - contact w/ soil

31
Q

risk factors for tinea infection

A 
hot, humid environments
obesity 
tight fitting clothing 
immunocompromised
hyperhidrosis (XS sweating)
32
Q

diagnosis of tinea

A

clinical - scaly itchy skin

examination - single/multiple flat/slightly raised anular patches, typical central clearing, asymmetrical distribution

investigations not normally required in 1y care

if uncertain - skin scrapings or skin swab if pustular/macerated

33
Q

5 locations of tinea infection

A 
tinea cruis - groin (jock's itch)
tinea unguium - fungal nails 
tinea corporis - ringworm
tina pedis - athlete's foot 
tinea captis - scalp and hair
34
Q

management of tinea infection

A

supportive - loose clothing, good hygiene, don’t share towels, wash clothes and bed linen frequently
patient info leaflets
topical anti-fungal cream or oral medications
dermatology review if extensive or persistent infection

35
Q

anti-fungals for tinea infections

A

topical - terbinafine 1% cream, clotrimazole 1% or miconazole 1%

if extensive and +ve culture or strong clinical suspicion - oral terbinafine 1st line or itraconazole if not tolerated (require 4wks of treatment)

36
Q

diagnosis of fungal nail infections

A

nail clippings

37
Q

management options for fungal nail infections

A

conservative - not harmful if left untreated
keep nails trimmed short and well fitting shoes
cotton absorbent socks
topical nail lacquer - amorolifine 5% for 6mths fingernails and 9-12mths toenails

oral terbinafine - 6-12wks fingernails and 3-6mths for toenails - need to monitor LFTs (can cause hepatitis so measure baseline before commencing and then throughout)

38
Q

what is aspergillus

A

type of mould

39
Q

where is aspergillus found

A

soil, compost, other organic matter
dust and bedding
damp buildings
air conditioning tanks and uncovered attic water tanks

40
Q

transmission of aspergillus

A

inhalation by spores

41
Q

who gets aspergillus infection

A

rare in healthy individuals

at risk if underlying health conditions - CF, COPD, TB, sarcoidosis or immunocompromised

42
Q

what causes aspergilliosis

A

aspergillus

43
Q

symptoms of aspergilliosis

A 
cough 
SOB
wheeze
pyrexia 
general malaise
headache
44
Q

types of aspergilliosis

A

allergic bronchopulmonary aspergilliosis
chronic pulmonary aspergilliosis
aspergilloma
invasive pulmonary aspergilliosis

45
Q

who gets allergic bronchopulmonary aspergilliosis

A

commonest in asthma and CF

due to allergic response to aspergillus mould

46
Q

when to suspect allergic bronchopulmonary aspergilliosis

A

pts clinical condition deteriorating e.g. in asthma or CF
failure to respond to normal treatment
longstanding cough >3wks

47
Q

presentation of allergic bronchopulmonary aspergilliosis

A

longstanding cough >3wks

48
Q

complications of allergic bronchopulmonary aspergilliosis

A

can lead to pulmonary fibrosis

49
Q

diagnosis of allergic bronchopulmonary aspergilliosis

A 
bloods - eosinophilia 
sputum culture 
\+ve skin test for aspergilliosis 
\+ve serology for aspergillus spp
CXR/CT
50
Q

management of allergic bronchopulmonary aspergilliosis

A

oral long term high dose prednisolone

anti-fungal treatment (itraconazole) also of benefit

51
Q

duration of chronic pulmonary aspergilliosis

A

> 3mths

52
Q

who gets chronic pulmonary aspergilliosis

A

pts w/ underlying lung conditions

53
Q

presentation of chronic pulmonary aspergilliosis

A

high morbidity

exacerbations not responding to abx
decline in lung function
increased resp symptoms - cough, decreased exercise tolerance, SOB

54
Q

diagnosis of chronic pulmonary aspergilliosis

A

1y care - sputum culture, refer for CXR

referral to 2y care for diagnosis and management

55
Q

management of chronic pulmonary aspergilliosis

A

guided by 2y care w/ oral anti-fungals

56
Q

what is aspergilloma

A

fungal mass
grows in lung cavities
colonises in a healed lung scar of abscess from a previous disease

57
Q

who is at risk from aspergilloma

A 
TB 
sarcoidosis 
bronchiectasis 
after pulmonary infection 
bronchial cyst or bullae
58
Q

presentation of aspergilloma

A

haemoptysis - commonest presentation
cough and fever is less frequent
asymptomatic - identified on CXR

59
Q

appearance of aspergilloma on CXR

A

mass w/ pulmonary cavity

60
Q

management of aspergilloma

A

refer to 2y care following CXR
CT
management may be surgical resection and long term anti-fungal

high mortality rate - 50%

IV anti-fungals

61
Q

who is at risk from acute invasive pulmonary aspergilliosis

A 
neutropenia 
post transplant (stem cell highest risk) 
pts w/ defects in phagocytes
62
Q

presentation of acute invasive pulmonary aspergilliosis

A 
any organ can be involved 
cough, SOB 
fever 
haemoptysis 
pleuritic chest pain 
nasal congestion and pain - sinusitis develops

can present as persistent febrile neutropaenia despite broad spectrum abx

63
Q

spread of acute invasive pulmonary aspergilliosis

A

can spread haematogenously

kidneys, brain, thyroid, GI tract, eyes skin

therefore clinical presentation can vary

Y2 infection (15 decks)

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