fungal infections Flashcards
severity range of fungal infections
common mild superficial infections to severe invasive life threatening infections
burden of fungal infections
difficult to determine - many mild infections go undiagnosed and are self-managed
> 1bln affect
11.5mln life threatening infections
1.5mln deaths p/a
what type of infections are fungal infections
opportunistic
patients w/ impaired immune systems
who gets fungal infections
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
GP perspective of fungal infections
body
nails
mucous membrane e.g. thrush
invasive fungal infections - rare in GP
2 main types of fungal skin infections in UK
candidiasis - yeast like infection, uniform commensal of mouth/GI tract, opportunistic
tinea - superficial skin infection caused by dermatophytes
is candida part of the normal skin flora
no
range of infections caused by candida
asymptomatic until disruption - lowered immune system, disruption to mucosal barrier
non-life threatening mucotaneous infections to severe disseminated disease
risk factors for candida infection
moist area skin folds obesity DM neonates pregnancy poor hygiene occupation in wet environments recent broad spectrum antibiotic
what is interigo
skin fold infection
commonly groin, under breasts and axillae
nappy rash - also suspect in older pts w/ incontinence pads
genital candidiasis symptoms
itch soreness and burning discomfort dysuria vulval oedema, fissures, excoriations cottage cheese/white curd discharge bright red rash
risk factors for genital candidiasis
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
diagnosis of genital candidiasis
clinical
vaginal swab
management of genital candidiasis
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
what is non-specific balanitis
inflammation of glans penis
non-specific balanitis cause
bacterial or candida infection
management of non-specific balanitis
if candida - topical clotrimazole
good hygiene
risk factors for oral candidiasis
extremes of age immunocompromised broad spectrum abx ICS/ oral corticosteroids DM dental prosthesis smoking poor oral hygiene local trauma nutritional deficiency impaired salivary function
Symptoms of oral candidiasis
white/yellow plaques in mouth mild burning erythema altered taste, unusual taste in mouth furry tongue chronic --> dysphagia
management of oral candidiasis
topical anti-fungal - nystatin, miconazole gel
extensive - oral fluconazoel
smoking cessation and good oral hygiene
systemic candida infections - who gets them
immunocompromised - HIV, malignancy, chemotherapy
other risks - recent abdo surgery, renal failure, low birth weight infants, neutropaenia, DM
what is candidaemia
candida infection which has spread to the bloodstream
where does systemic candida infection affect
can affect any body part
presentation can vary
indications of systemic candida infection
typically fever and chills doesn’t respond to abx
where can systemic candida infection occur
bone infectious pulmonary abscess endophthalmitis liver abscess infectious splenic abscess peritonitis biofilm formation kidneys and bladder
how does invasive candidiasis occur
gut commensal
infections mostly endogenous of origin
how common is invasive candidiasis
4th most common bloodstream infection in adults - 30/100 000 admissions premature neonates (<1000g) - 150/100 000 admissions
mortality rate of invasive candidiasis
40%
if concern in 1y care - admit to hospital
diagnosis and treatment of invasive candidiasis
blood cultures
IV/oral antifungals
causes of tinea infections
direct spread from infected individual or animal
indirect contact w/ objects/materials which carry infection - bedding, clothing
rarely - contact w/ soil
risk factors for tinea infection
hot, humid environments obesity tight fitting clothing immunocompromised hyperhidrosis (XS sweating)
diagnosis of tinea
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
5 locations of tinea infection
tinea cruis - groin (jock's itch) tinea unguium - fungal nails tinea corporis - ringworm tina pedis - athlete's foot tinea captis - scalp and hair
management of tinea infection
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
anti-fungals for tinea infections
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)
diagnosis of fungal nail infections
nail clippings
management options for fungal nail infections
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)
what is aspergillus
type of mould
where is aspergillus found
soil, compost, other organic matter
dust and bedding
damp buildings
air conditioning tanks and uncovered attic water tanks
transmission of aspergillus
inhalation by spores
who gets aspergillus infection
rare in healthy individuals
at risk if underlying health conditions - CF, COPD, TB, sarcoidosis or immunocompromised
what causes aspergilliosis
aspergillus
symptoms of aspergilliosis
cough SOB wheeze pyrexia general malaise headache
types of aspergilliosis
allergic bronchopulmonary aspergilliosis
chronic pulmonary aspergilliosis
aspergilloma
invasive pulmonary aspergilliosis
who gets allergic bronchopulmonary aspergilliosis
commonest in asthma and CF
due to allergic response to aspergillus mould
when to suspect allergic bronchopulmonary aspergilliosis
pts clinical condition deteriorating e.g. in asthma or CF
failure to respond to normal treatment
longstanding cough >3wks
presentation of allergic bronchopulmonary aspergilliosis
longstanding cough >3wks
complications of allergic bronchopulmonary aspergilliosis
can lead to pulmonary fibrosis
diagnosis of allergic bronchopulmonary aspergilliosis
bloods - eosinophilia sputum culture \+ve skin test for aspergilliosis \+ve serology for aspergillus spp CXR/CT
management of allergic bronchopulmonary aspergilliosis
oral long term high dose prednisolone
anti-fungal treatment (itraconazole) also of benefit
duration of chronic pulmonary aspergilliosis
> 3mths
who gets chronic pulmonary aspergilliosis
pts w/ underlying lung conditions
presentation of chronic pulmonary aspergilliosis
high morbidity
exacerbations not responding to abx
decline in lung function
increased resp symptoms - cough, decreased exercise tolerance, SOB
diagnosis of chronic pulmonary aspergilliosis
1y care - sputum culture, refer for CXR
referral to 2y care for diagnosis and management
management of chronic pulmonary aspergilliosis
guided by 2y care w/ oral anti-fungals
what is aspergilloma
fungal mass
grows in lung cavities
colonises in a healed lung scar of abscess from a previous disease
who is at risk from aspergilloma
TB sarcoidosis bronchiectasis after pulmonary infection bronchial cyst or bullae
presentation of aspergilloma
haemoptysis - commonest presentation
cough and fever is less frequent
asymptomatic - identified on CXR
appearance of aspergilloma on CXR
mass w/ pulmonary cavity
management of aspergilloma
refer to 2y care following CXR
CT
management may be surgical resection and long term anti-fungal
high mortality rate - 50%
IV anti-fungals
who is at risk from acute invasive pulmonary aspergilliosis
neutropenia post transplant (stem cell highest risk) pts w/ defects in phagocytes
presentation of acute invasive pulmonary aspergilliosis
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
spread of acute invasive pulmonary aspergilliosis
can spread haematogenously
kidneys, brain, thyroid, GI tract, eyes skin
therefore clinical presentation can vary
