Lecture 13: Fungal Infections Flashcards
what are the two main types of fungal skin infections?
candidasis:
- yeast like infection
- uniform commensal of mouth/GI tract
- opportunistic infection
tinea:
- superficial skin infections caused by dermatophytes
candida risk factors
- moist areas
- skin folds
- obesity
- diabetes
- neonates
- pregnancy
- poor hygeine
- occupation in wet environments
- recent broad spectrum antibiotic
symptoms of genital candidiasis (vaginal thrush)
- itch
- soreness and burning discomfort
- dysuria
- vulval oedema, fissures and excoriations
- cottage cheese/white curd discharge
- bright red rash
genital candidiasis (vaginal thrush) risk factors
- just before and during menstruation
- obesity
- diabetes
- iron deficiency anaemia
- immunodeficiency
- recent course of broad spectrum antibiotic
- high dose combined OCP/oestrogen based HRT
- pregnancy
genital candidiasis (vaginal thrush) diagnosis
- clinical
- vaginal swab
genital candidiasis (vaginal thrush) management
- clotrimazole: topical antifungal pessary or cream
- oral treatment: fluconazole
- supportive measures: loose clothing, avoiding soap or bubble baths to wash
- no evidence for probiotics or treating sexual partner
Oral Candidiasis (Oral Thrush) risk factors
- extremes of age
- immunocompromised
- inhaled or oral corticosteroids
- broad-spectrum antibiotics
- diabetes
- dental prosthesis
- smoking
- poor oral hygiene
- llocal trauma
- nutritional deficiency
- impaired salivary function
Oral Candidiasis (Oral Thrush) symptoms
- white or yellow plaques in mouth
- mild burning
- erythema
- altered taste
- ‘furry tongue’
- if chronic can cause dysphagia
Oral Candidiasis (Oral Thrush) management
- topical anti-fungal: nystatin, miconazole gel
- if extensive: oral fluconazole
- smoking cessation
- good oral hygiene
what is the 4th most common bloodstream infection in adults?
invasive candidiasis
tinea infection mode of transmission?
a superficial skin infections caused by dermatophytes
- direct spread from infected individual or animal
- indirect contact with objects/materials which carry infection e.g. bedding, clothin
- rare contact with soil
tinea diagnosis
clinical:
- scaly itchy skin
- single or multiple flat/slight raised annular patches
- typical central clearing
- assymetrical distribution
if uncertain: skin scrapings or skin swab if pustular/macerated
tinea risk factors
- hot humid environments
- obesity
- tight fitting clothing
- immunocompromised
- hyperhidrosis (excess sweating)
tinea treatment
- topical anti-fungal cream: terbinafine 1% cream, clotrimazole 1% or miconazole 1%
- if extensive and positive culture or strong clinical suspicion: oral terbinafine first sline or itraconazole if not tolerates: require 4 weeks of treatment.
fungal nail infection treatment
- topical nail lacquer: amorolifine 5%, treat for 6 months fingernails and 9-12 months toenails
- oral terbinafine: 6-12 weeks fingernails and 3-6 months for toenails, need to monitor LFTs
aspergillus is a type of mould found in:
- soil, compost and other organic matter
- dust and bedding
- damp buildings
- air conditioning systems and uncovered attic water tanks
how is aspergillus transmitted?
inhalation by spores
aspergillosis symptoms
- cough
- SOB
- wheeze
- pyrexia
- general malaise
- headache
list the types of aspergillosis
- allergic bronchopulmonary aspergillosis
- chronic pulmonary aspergillosis
- aspergilloma
- invasive pulmonary aspergillosis
when should you suspect allergic bronchopulmonary aspergillosis?
- patients clinical condition deteriorating e.g. in asthma or CF
- failure to respond to normal treatment
- longstanding cough > 3 weeks
complication of allergic bronchopulmonary aspergillosis?
pulmonary fibrosis
diagnosis of allergic bronchopulmonary aspergillosis
- bloods: eosinophilia
- sputum culture
- positive skin test for aspergillosis
- positive serology for aspergillus spp
- CXR/CT scan
allergic bronchopulmonary aspergillosis management
- oral long term high dose prednisolone
- anti-fungal treatment of itraconazole also of benefit
what is the presentation of chronic pulmonary aspergillosis?
- > 3 months
- exacerbations not responding to antibiotics
- decline in lung function
- increased respiratory symptoms: cough, decreased exercise tolerance and SOB
chronic pulmonary aspergillosis diagnosis
- primary care: sputum culture and refer for CXR
- referral to secondary care for diagnosis and treatment
chronic pulmonary aspergillosis management
guided by secondary care with oral anti-fungals
what is an aspergilloma?
a fungal mass - grows in lung cavities
who is at risk of an aspergilloma?
TB
sarcoidosis
bronchiectasis
after pulmonary infection
bronchial cyst or bullae
aspergilloma presentation
- haemoptysis
- cough and fever less frequently
- asymptomatic: identified on CXR
aspergilloma management
surgical resection and long-term antifungal
what patients are at risk of Acute Invasive Pulmonary Aspergilliosis?
- neutropenic patients
- post-transplant (stem cell highest risk)
- patients with defects in phagocytes
Acute Invasive Pulmonary Aspergilliosis presentation
- any organ can be involved
- cough
- fever
- haemoptysis
- pleuritic chest pain
- nasal congestion and pain: sinusitis develops
- persistent febrile neutropenia despite broad spectrum antibiotics
Acute Invasive Pulmonary Aspergilliosis management
IV anti-fungals
