fungal infections

Question 1

candida

Answer 1

• Up to 60% of healthy people are asymptomatic carriers of Candida spp. (as a GI commensal)
• Symptomatic oral infection is unusual in healthy adults but occurs in 5% of newborns and in up to 84-100% of those with HIV.
most common cause of invasive fungal infections in hospital patients

Question 2

risk factors

Answer 2

broad spectrum antibiotics
central venous catheters or parenteral nutrition
immunocompromise
cushing
DM
renal replacement
GI surgery

Question 3

mucocutaneous candidiasis

Answer 3

o Specific risk factors:
♣ Pregnancy or high-oestrogen contraceptive pill.
♣ Iron deficiency.
♣ Underlying skin disease - e.g. psoriasis, dermatitis.
♣ Local factors - heat, moisture, skin maceration, topical corticosteroids, poor dental hygiene or oral irritation.

Question 4

Invasive candidiasis

Answer 4

infections mostly endogenous
4th most common blood stream infection
mortality 40%
spread kidney

Question 5

treatment

Answer 5

IV fluconazole in nonneutropenic

neutropenic- echinocandin or lipid formulation of amphotericin

echinocandin in severe illness recent azole exposure

Question 6

aspergillus and aspergillosis

Answer 6

fumigatus or niger
classifications:
acute invasive pulmonary aspergillosis
-neutropenic
-phagocyte defects
Chronic pulmonary
 aspergillosis
- underlyinh chronic lung condition
allergic aspergillosis
♣	Allergic bronchopulmonary aspergillosis (ABPA) in CF and asthma
♣	Extrinsic allergic (broncho)alveolitis
♣	Asthma or CF with fungal sensitisation

Question 7

acute invasive pulmonary aspergillosis

Answer 7

rapid hyphal growth
thrombosis and haemorrhage
angio invasive and dissemination
-persistent febrile neutropenia despite broad spectrum antibio
mortality 50-90%

Question 8

treatment

Answer 8

• Treatment:
o Voriconazole / Isavuconazole i.v. and oral formulation
o Liposomal Amphotericine B only i.v.

Question 9

pulmonary aspergilloma

Answer 9

• A fungal mass that usually grows in lung cavities
o Tuberculosis (11% of patients)
o Sarcoidosis
o Bronchiectasis
o Bronchial cysts and bullae
o After pulmonary infections
• Management:
o Surgical resection should be considered for all patients with pulmonary aspergilloma who have acceptable pulmonary reserve.
Long-term oral itraconazole may be successful in up to 60% of patients.

Question 10

cryptococcus and cryptococcosis

Answer 10

transmission: inhalation, found on bark of varitey of trees, bird faeces and organic mater
meningitis in HIV,after latent infection
diagnosis-indian ink CSF (very sensitive)
o Amphotericine B + flucytosine (followed by fluconazole)
LP pressure high