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DTM&H > Tropical Fungal Diseases > Flashcards

Tropical Fungal Diseases Flashcards

1
Q

What is Mycetoma?

A

An infection that can be either fungal or bacterial, which causes a slow insidious destruction of skin, soft tissue and bones and nodular masses with sinus and ‘grain’ formation

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2
Q

What is the epidemiology of Mycetoma?

A

Europe, Asia, Africa, Latin America

**MEXICO AND SUDAN

Associated with areas of long dry season

Associated with thorny bushes –> people who spend their time working outside are most at risk

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3
Q

What causes Mycetoma?

A

BACTERIA –> actinomyocytes, like nocardia spp.

FUNGAL –> Madurella spp.

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4
Q

How does Mycetoma present?

A

A painless slow growing nodule, usually on the foot, which eventually spreads along the skin and soft tissue and causes the formation of sinuses

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5
Q

What are the complications of Mycetoma?

A
  1. Disseminated infection –> amputation, death etc.

**Very insidious onset which means people are very slow to present with it

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6
Q

How is mycetoma diagnosed?

A

FNA and microscopy
PCR
Clinical diagnosis
Relevant imaging looking for bony destruction

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7
Q

How is mycetoma managed?

A
  1. Bacterial –> Co-trimoxazole + Streptomycin
  2. Fungal –> Ketoconazole 400mg OD for 1-2 years
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8
Q

What is a major side effect of long-term anti-fungal use?

A

Hepatic toxicity

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9
Q

What is Sporotrichosis?

A

A fungal sub-cut infection which frequently infects and spreads along lymph nodes

Found in SA

Associated with HIV

Rx with Antifungals

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10
Q

What is histoplasmosis?

A

Fungal infection primarily assocaited with HIV, which behaves very similarly to TB

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11
Q

What is the epidemiology of Histoplasmosis?

A

North America, South America, Africa

French Guiana (exam!) –> leading cause of HIV deaths

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12
Q

What is the main risk factor for developing histoplasmosis?

A

HIV +ve

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13
Q

What is the causative organism of histoplasmosis?

A

Histoplasma Capsulatum

2 varieties: African and Classical

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14
Q

How does Histoplasmosis present?

A

95% Asymptomatic

Acute infection: Fever, cough, malaise, lymphadopathy

Progressively worsens –> unrelenting pneumonia, weight loss, night sweats, hepatomegaly

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15
Q

How is histoplasmosis diagnosed?

A
  1. CXR
  2. Aspirate (Bone Marrow or Liver) –> microscpoy and culture
  3. Antigen testing
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16
Q

What might you see on a histoplasmosis x-ray?

A

Cavitating areas
Apical Lesions
Miliary Pattern

(i.e. TB es el mismo)

17
Q

What is your main DDx of histoplasmosis?

A

TB

18
Q

How do you manage Histoplasmosis?

A
  1. Liposomal Amphotericin B is recommended in disseminated illness

Itraconazole if non-severe disease (i.e. no end organ involvement, such as O2 requirement, renal impairment, hepatic failure)

19
Q

What is paracoccidiomycosis?

A

Paracoccidioidomycosis is a granulomatous systemic infection caused by the fungus Paracoccidioides.

This fungus lives in parts of Central and South America.

Most often affects men who work outdoors in rural areas.

20
Q

What is Talaromycosis?

A

An invasive fungal disease which predominantly occurs in Asia and affects HIV +ve people

21
Q

How does Talaromycosis present?

A

Diffuse papular skin lesions with necrotic centre

22
Q

How do you treat Talaromycosis?

A

Amphotericin B or L-AMB

23
Q

NOT A QUESTION JUST AN IMPORTANT FACT:

Basically with the fungal infections - chuck them into your DDx whenever you have an HIV +ve patient with some weird systemic disease and rash

Testing is through Antigen testing usually

Management is usually long term

Differentiate these by their location more than anything (because for example, talaromycosis, histomplasmosis and paracoccidiomycosis present almost the same, but have different global epidemiology)

A
24
Q

What are the side effects of Amphotericin B?

A

Highly toxic

Renal toxicity
Anaemia
Rigors

Needs to be given IV - challenging for long courses of medication

25
Q

What is the biology of Cryptococcus?

A

Encapsulated yeast-like fungus

Cryptococcus neoformans spp.

26
Q

How is cryptococcus spread?

A

Aerosolised droplets

27
Q

What is the epidemioliogy of Cryptococcus?

A

Commonest cause of meningitis in Zimbabwae and Malawi

Assocaited with HIV with CD4 <100

28
Q

What is the main risk factor for developing Cryptococcus?

A

HIV with CD4 <100 (OI!)

29
Q

Who should you screen for Cryptococcus?

A

All HIV patients with CD4 <100 should be screened with serum CrAg…

If Positive: LP and repeat
If negative: Prophylactic Fluconazole therapy until CD4 count improves

30
Q

How does Cryptococcus present?

A

CNS Disease –> Meningitis

Respiratory Disease –> TB like pneumonia

31
Q

How do you diagnose Cryptococcus

A

HIV test in all patients
LP –> CSF, Opening pressure
- Culture
- India ink stain
CrAg** (ideally CSF but can do serum too!)

32
Q

How would you expect the CSF to be in Cryptococcus

A

HIGH opening pressure
High lymphocytes
Low glucose
High protein

33
Q

What are the complications of Cryptococcal meningitis?

A

Very high ICP –> can be cause of death (and does not respond to roids or mannitol)

Untreated Cryptococcus = death

34
Q

How do you manage Cryptococcus?

A

NEWEST GUIDANCE (2022 from WHO; Lecture outdated)

Liposomal Amp B 10mg/kg STAT
+ 14/7 Flucytosine
+ 14/7 Fluconazole 1200mg

+ additional 8/52 of fluconazole 800mg

ART

35
Q

When should you start ART in Cryptococcal meningitis?

A

if not already established, wait 4-6 weeks after initiating Rx for Crypto because, like TB, it can cause IRIS

36
Q

What is chromoblastomycosis?

A

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissue, most commonly of hands, feet and lower legs.

It is typically caused by traumatic percutaneous inoculation of the genera Fonsecaea, Phialophora and Cladophialophora which are found in plant debris or forest detritus.

Infection occurs worldwide but is most common in rural tropical and subtropical areas e.g. SEA

Male agricultural workers are most commonly affected.

37
Q

How does Chromoblastomycosis present?

A

Painless lesions develop slowly over years from the site of inoculation as verrucous nodules or plaques, gradually spreading centripetally by lymphatic or cutaneous dissemination.

Typical complications are ulcerations, bacterial superinfection and chronic lymphoedema, which may be confused with elephantiasis in regions co-endemic with lymphatic filariasis.

38
Q

How is Chromoblastomycosis diagnosed?

A

Microscopy: detection of pathognomonic sclerotic cells in skin scrapings (‘Medlar bodies’, fumagoid or muriform cells)

39
Q

How is chromoblastomycosis managed?

A

Itraconazole +/- trbinafine +/- Abx for concurrent bacterial infection

DTM&H (29 decks)

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