Invasive fungal infections Flashcards
What is septic shock?
Sepsis induced hypotension persisting despite adequate fluid resiscitation
Who gets serious fingal infections?
Neutropenic patients. ITU patients. Central IV catheters. HIV/AIDS. Organ transplant Long course corticosteroids
What gives guiding evidence on fungal infections?
European oragnisation for resaerch and treatment of invasice fungal infections.
IDSA
ESCMID
BCSH
What are the main causative organisms of fungal infections?
Candida
Aspergillus
Cryptococcus
Histoplasma
What is candida?
A yeast
What is aspergilus?
A mould
What does aspergillus tend to cause?
Pulmonary infection
What is aspergilloma?
Fungal ball
What are the complications of invasive pulmonary aspergillpsis?
Raging pneumonia
Dissemination to CNS
Local invasion into heart/vessels
What is cryptococcus?
A yeast
What types of infection does cryptococcus cause?
Pulmonary
Invasive CNS disease
What types of infection to histoplasma cause?
Pulmonary disease
Further dissemination
Name some diagnostic indicators (host) of fungal infection
Neutropenia Fever unresponsive to broad spec Abx Use of immunosuppressants HIV/AIDS Recent prolonged corticosteroids
Name some indirect fungal tests
Galactomannan antigen detected in sample.
Beta-D-glucan detected in serum
Name some triazole antifungals
Fluconazole
Itraconazole
Posaconazole
Voriconazole
What is the mechanism of action of triazoles?
Decreased ergosterol production through inhibition of fungal CYP450 enzymes
What are the side effects of triazole antifungals?
Hepatic derangemnt
QT prolongation
What is fluconazole active against?
Most candida
Voriconazole has good or bad CNS penetration?
Good
What is the mechanism of action of amphoterocin?
Binds ergosterol in fungal cell mrmbrane, creates pores, increasing permeability
Is amphotericin broad or narrow spectrum?
Broad
What are the side effects of amphotericin?
Renal toxicity Electrolyte disturbances Infusion reactions Cardiotoxicity Hepatotoxicity
What antifungal do you need to have a crash trolley ready for when administering?
Amphotericin
What is the mechanism of action of flucytosine?
Converted to 5-FU intracelularuly.
Bone marrow suppression.
What antifungal should be used for most simple infections where candida confirmed?
Fluconazole
What antifungal should be used for serious infections?
Lipid-formulation amphoterocin or echinicandin
What antifungal should be used for CNS infections?
Voriconazole
