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Infect & Immune 2 MW, NJH & AB > NH L1 Invasive Fungal Infections > Flashcards

NH L1 Invasive Fungal Infections Flashcards

1
Q

‘Mycosis’

A

fungal infection

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2
Q

‘Invasive’

A

as opposed to localised

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3
Q

‘Disseminated’

A

spread from the initial localised source

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4
Q

‘Fungaemia’

A

fungus in the blood

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5
Q

‘Systemic’

A

of a system, usually the blood

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6
Q

‘Septic shock’

A

circulatory system cannot supply the demands of the body

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7
Q

What happens during septic shock?

A

Inflammatory mediators compromise the integrity of blood vessels - leakage of intravascular fluids - low BP - hypoperfusion of organs - death

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8
Q

Are fungi prokaryotes or eukaryotes?

A

eukaryotes

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9
Q

Where can we look for evidence about fungus?

A

Inasive fungal infections coooperative group,

Infectrions diseases society of america etc.

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10
Q

Who gets fungal infections (7)

A 
neutropenic patients (bone marrow transplant/chemotherapy)
ITU patients
IV catherters
HIV/AIDS
Transplant (anti-rejection drugs)
Impaired immune function
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11
Q

Main causative organisms (4)

A

Candida
Aspergillus
Cryptococcus
Histoplasma capsulatum

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12
Q

Candida is what sort of fungus?

A

A yeast

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13
Q

T/F Candida is normal flora

A

T

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14
Q

Diagnosis of candida via….

A

culture

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15
Q

Important to know when diagnosing candida: (3)

A

Previous azole therapy
Species
Susceptibility

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16
Q

Types of candida infection (4)

A

catheter related
acute disseminated
chronic disseminated
deep organ

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17
Q

Sources of candida infection (2)

A

GI tract

central venous catheter

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18
Q

Complications of candida infection (2)

A
  • Dissemination, acute/chronic/deep organ
  • Fungal endocarditis
  • Endophthalmitis (eyes)
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19
Q

Aspergillus is what type of fungus?

A

A mould

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20
Q

Aspergillus tends to cause infections where? in whom?

A

In the lungs

immunocompromised or lung transplant pts

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21
Q

How do we detect aspergillus? (2)

A

Blood culture are hard to obtain

Imagin or antibody detection?

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22
Q

What is aspergillosis

A

-invasive aspergillus (typically of lung origin)
OR
-AMPA (allergic bronchopulmonary aspergillosis

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23
Q

What is aspergilloma

A

A fungal ball - growth in a pre-existing cavity e.g. TB patient

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24
Q

What are the complications of aspergillosis?

A

RAGING PNEUMONIA
dissemination to the CNS
localised invitation to heart/vessels

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25
Q

Why do we surgery on people with aspergillosis?

A

Restriction of locally invasive legions

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26
Q

Cryptococcus is what sort of fungus?

A

Yeast

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27
Q

Most common species cryptococcus is….

A

cryptococcus neoformans

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28
Q

Types of infection from cryptococcus (2)

A

Pulmonary

Invasive CNS disease

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29
Q

How is particularly prone to cryptococcus infection?

A

HIV/AID patients

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30
Q

Histoplasma is what sort of ting?

A

An environmental pathogen

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31
Q

Histoplasmosis is usually where?

A

Pulmonary - but disseminates elsewhere

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32
Q

Who does histoplamsa usually affect?

A

HI/AIDS pattients

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33
Q

Types of infection (4) (catagories)

A

Invasive
Disseminated
Fungemia
Distant site of infection (endocarditis)

34
Q

Diagnosis is difficult but can be via….. (5)

A 
Diagnosis is difficult - (systemic/neurological/respiratory symptoms?).
Cultures
Microscopy
Imaging
Other clever tools
35
Q

Type o’ culture (4)

A

blood
respiratory
biopsy
material

36
Q

Other clever tools includes (4)

A

Mannan/anti-mannan
Beta-D-glucan
Galactomannan
Other serology (to detect antigens)

37
Q

Diagnostic certainty levels

A

Proven - fungal cause known
Probable - 1x host, clinical and mycological
Possible

Definitions of these levels of certainty vary from one organism to the next - between types/site of infection

38
Q

Diagnostic indicators: host factors (5)

A 
Neutropenia
Fever unresponsive to broad spec antibiotics
Use of immunosuppressants
HIV/AIDs
recent prolonged use of corticosteroids
39
Q

Clinical diagnostic indicators: respiratory

A

lesions
air crescent sign
cavity

40
Q

Clinical diagnostic indicators: CNS

A

legions, meningeal enhancement

41
Q

Clinical diagnostic indicators: disseminated

A

target lesions liver/spleen

42
Q

MYCO diagnostic indicators (4)

A

Galactomannan
Beta-D-glucan
MC&C (sputum, NBL)

43
Q

Key characteristics of an antifungal

A

specificity i.e. drug kills fungus not us.

44
Q

problems with treating fungi?

A

they are eukaryotic, harder to treat the differences between them and us

45
Q

4 classifications of antifungals

A

Azoles
Echinocandins
Polyenes
Nucleoside analogues

46
Q

How do Azoles work?

A

Inhibition of ergosterol biosynthesis in the cell membrane

47
Q

Polyenes work by….

A

Ergosterol disruption in the cell membrane

48
Q

Echinocandins work by…

A

Inhibition of the beta-1.3-glucan synthesis in the cell wall

49
Q

2 types of azoles

A

Imidazoles

Triazoles (such as fluconazole, itraconazole)

50
Q

Triazoles work by

A

decreased ergosterol production through inhibitions of fungal CYP p450

51
Q

Triazoles are static or cidal

A

static

52
Q

triazoles are orally active?

A

y

53
Q

s/e of triazoles

A

hepatic derangement

QT prolongation

54
Q

Interactions with triazoles?

A

yes, many through CYP P450

55
Q

Cheap and cheerful triazole?

A

Fluconazole

56
Q

Fluconazole is active against most….

A

candida

57
Q

Itraconazole is administered by…

A

liquid - needs acidic stomach and taste horrible

58
Q

s/e

A

hepatotoxicity

59
Q

itraconazole or fluconazole is better for prophylaxis of invasive fungal infections

A

Intraconzole

60
Q

Itraconazole has interactions?

A

yes (via CYP)

61
Q

Itraconazole is contraindicated with what class?

A

Statins

62
Q

Voriconazole is effective against…. (2)

A

candida and aspergillus

63
Q

Voriconazole is cool because…

A

it has superior CNS penetration

64
Q

Voriconazole s/e

A

taste disturbances

65
Q

Voriconazole tends to be restricted to…

A

CNS infections

or where patient factors dictate

66
Q

Amphotericin works by

A

binding to ergosterol creating pores, increasing permeability

67
Q

Amphotericin interacts with

A

most stuff, including other nephrotoxic

68
Q

Amphotericin is broad or narrow spectrum

A

broad

69
Q

Amphotericin is cidal or static

A

cidal

70
Q

Amphotericin is administered via

A

IV - with a crash trolley ready

or liquid amphotericin now used first line

71
Q

s.e of Amphotericin

A 
renal tox
electrolyte disturbances
infusion reactions
cardiotox
hepatotox
72
Q

Amphotericin delivered orally gives significant reduction in….

A

renal toxicity

73
Q

Amphotericin has a tricky preparation as ….

A

low micron fibres

74
Q

Echinocandins include (2)

A

Caspofungin (broad license, okay in renal impairment)

Anidulafungin (invasive endocarditis - okay in hepatic and renal failure)

75
Q

Flucytosine is a nucleoside analogue,

synergistic with

A

amphotericin (resistance is a problem if used alone)

76
Q

Flucytosine works by

A

converting 5-FU intracellularly, and suppressing bone marrow

77
Q

What treatment to use?

A 
Evidence base
Empirical vs confirmed
Pt group
Activity (susceptibility and CNS penetration)
Toxicity
Interactions (chemotherapy drugs)
Cost
78
Q

For most simple infections use…

A

fluconazole (where no previous azole therapy)

79
Q

For most serious infections use

A

lipid formulations of amphotericin or echinocandin

80
Q

For CNS infections consider using

A

vorconazole

Infect & Immune 2 MW, NJH & AB (12 decks)

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