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DTMH Block 3 > Candidiasis > Flashcards

Candidiasis Flashcards

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1
Q

What are the virulence factors of candidiasis?

A

GIT commensals - hospitalised patient’s skin and mucosa
Opportunistic - immunosuppression
Biofilm formers (lines, devices)

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2
Q

What is the 4th cause of BSI in hospitalised patients?

A

Candidiasis, 50% of which are ICU patients

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3
Q

What is the definition of invasive candidiasis?

A

Isolation of candida from a sterile site
1. Candidemia
2. Deep seated

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4
Q

What is the number 1 cause of systemic fungal infections?

A

Candida

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5
Q

What is the in hospital mortality of invasive candidiasis?

A

50%
Outcomes are worse if treatment is delayed

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6
Q

What are the intra-abdominal types of invasive candidiasis?

A
  1. Peritonitis
  2. Abscess (post-surgery)
  3. Cholecystitis
  4. Choleangitis
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7
Q

What does the diagnosis of invasive candidiasis require?

A

Isolation from sterile site
AND
Clinical evidence

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8
Q

If diagnosing an invasive candidiasis, what is the maximum length of time of the drain from which the fluid is taken allowed to be?

A

<24h

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9
Q

Can you use swabs to diagnose invasive candidiasis?

A

No

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10
Q

What are disease related breaches in barrier defence?

A

Burns
Mucositis
GI perforation
Pancreatitis
Anastomotic leak

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11
Q

What are intervention related breeches in barrier defence?

A

IV lines
TPN
GI surgery
Urological intervention

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12
Q

How can candida colonise the body?

A

Antibiotic use
Environmental acquisition

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13
Q

To which organs does candidemia often disseminate to haematongeously?

A

Endocarditis
Endopthalmitis
Renal
Brain
Hepatosplenic

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14
Q

Which host factor co-morbidities increase the risk of candida infection?

A

Cancer (haem>solid organ)
Diabetes
Transplant (BM>solid organ)
Liver failure
Renal failure

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15
Q

Which host factor drugs increase the risk of candida infection?

A

Corticosteroids
Chemotherapy
Anti-rejection
Biologics

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16
Q

Which host factor genes increase the risk of candida infection?

A

SNPs at loci
- CD58
- LCE4A-C1orf68
- TAGAP

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17
Q

What is the gold standard of candida diagnosis?

A

Culture

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18
Q

What is the sensitivity and specificity of BDG?

A

60-80%

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19
Q

What is the NPV and PPV of BDG?

A

NPV - high (use to exclude)
PPV - low (anti-fungal overuse)

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20
Q

Which circumstances can cause a false positive BDG

A

Hemodialysis
Immunoglobulin infusion
Albumin
Surgical gauze

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21
Q

What improves the performance of BDG?

A

Serial samples
Cut off >250

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22
Q

What is the benefit of BDG combined with other biomarkers?

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A

Inconclusive benefit

23
Q

What is the Candida Colonisation Index?

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A

Ratio of the number of non-blood sites colonised with candida spp/total number of sites

24
Q

What are adjuncts to diagnosis invasive candidiasis?

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A
  1. Candida Colonisation Index
  2. Candida Score
  3. Ostrosky-Zeichner Clinical Prediction Rule
25
What is the Candida Score?
TPN (1) Surgery (1) Severe sepsis (2) Multifocal candida colonisation (1) >2.5 is positive
26
What is the Ostrosky-Zeichner Clinical Prediction Rule?
Mechanical ventilation >48h AND systemic ABs AND CVP PLUS 1 of any - major surgery - pancreatitis - immunosuppressive agents - TPN - dialysis
27
Which strategy is used when patient has risk factors for candidiasis?
Prophylactic strategy
28
Which strategy is used when patient has clinical features of fungal sepsis?
Empiric strategy
29
Which strategy is used when patient has fungal biomarkers?
Pre-emptive strategy
30
Which strategy is used when patient has positive fungal culture, PCR or histology?
Targeted strategy
31
Which sites do echinocandins not penetrate?
CNS Urine
32
What is the preferred initial therapy for all candida species?
Echinocandins
33
Which candida species can fluconazole be considered as an alternative therapy?
C. albicans C. tropicalis C. parapsilosis
34
Which candida species can amphotericin B be considered as an alternative therapy?
C. glabrata C. krusei C. auris
35
What is the preferred agent for candida krusei?
Voriconazole
36
Which drugs interact with triazoles?
CYP450 inhibitors
37
Which anti-fungal treatments need TDM?
Voriconazole Flucytosine
38
What is the target site of terbinafine?
Squalene -> squalene epoxide
39
What is the target site of azoles?
Lanosterol -> ergosterol
40
What is the target site of amphotericin B?
Cell membrane
41
What is the target site of nystatin?
Cell membrane
42
What is the target site of echinocandins?
Beta-glucan synthase
43
What is the target site of flucytosine?
Fungal RNA
44
How do you monitor for candidiasis resolution?
Clearance cultures Clinical Radiological
45
What are poor prognostic factors for invasive candidiasis?
GI source Lack of source control Short BC TTP Delayed treatment Lack of ID consult Severe sepsis Severe comorbidities
46
Which candida species are intrinsically resistance to the azaleas?
C. kruseii C. guillermondi C. glabrata
47
Which candida species has acquired resistance to echinocandins?
C. glabrata
48
What are the most common mechanisms of acquired resistance?
Target alteration (aspergillus) Drug efflux regulation (glabrata)
49
Which gene mutation is seen in azole resistant aspergillus?
ERG11
50
What are the drivers of anti fungal resistance?
Widespread human use Agricultural crop spraying
51
Which gene mutation is seen in echinocandin resistance?
FKS 1/2
52
What is the most common cause of candidemia in SA?
C. parapsilosis
53
How many candida species are on the WHO fungal priority pathogens list?
4/11 1. C.auris 2. C. albicans 3. C. parapsilosis 4. C. tropicalis
54

DTMH Block 3 (18 decks)

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