Fungus

Question 1

Treatment for oral/oesophageal candidiasis

Answer 1

Nystatin
Fluconazole
Amphotericin

Question 2

Subtypes of Cryptococcus

Answer 2

Gattii - in areas with eucalyptus
Neoformans

Question 3

Management if cryptococcal disease

Answer 3

Induction - single high dose Liposomal amphotericin B + Flucytosine and fluconazole for 2 weeks (as per Ambition trial - NEJM paper)
Consolidation - 8 weeks moderate dose fluconazole
Maintenance - fluconazole low dose 12 months + until immune reconstitution

Avoid steroids - even in CNS disease.
Cryptococcal meningitis causes a gelatinous CSF that does not respond to steroids.

Question 4

Cryptococcal diagnostics

Answer 4

CrAg
India ink stain on microscopy

Question 5

Description of histoplasmosis

Answer 5

Dimorphic - changes from mould to yeast
Is an environmental mould
associated with bats

Question 6

Presentation of histoplasmosis

Answer 6

Mimic of TB
Lung infiltrates, lymphadenopathy, Hepatosplenomegaly, cytopenias, bone lesions

Question 7

Treatment for histoplasmosis

Answer 7

Liposomal amphotericin + Itraconazole → Itraconazole maintenance

Question 8

Treatment for aspergillus

Answer 8

Mx - Voriconazole (Not fluconazole or ketoconazole! - resistant), Amphotericin, Echinocandins.

Question 9

What is a mycetoma?

Answer 9

firm painless swelling
Usually on lower limb
Usually soil organisms

• can be from a fungus or a mimic from actinomycosis

Question 10

What is sporotrichosis

Answer 10

Rose handlers disease
more common in HIV

Question 11

Symptoms of cryptococcal disease

Answer 11

Lesions - Lungs, CNS, Skin, prostate, eye
Can mimic TB
Commonly can cause 6th nerve palsy