Fungal Infections

Question 1

Number of fungal infections of humans per year

Answer 1

1.5 billion fungal infections of humans

> 3 million life-threatening infections per year

Question 2

Mortality rates of invasive fungal infection

Answer 2

> 50%

Question 3

Number of cases of blindness caused by fungal infections each year

Answer 3

> 400,000 per year

Question 4

Number of exacerbations of asthma and allergies (and other chronic lung disease) caused by fungal pathogens each year

Answer 4

> 20 million

Question 5

Global mortality figures for invasive fungal infections, TB and malaria

Answer 5

Invasive fungal infections - 1,350,000
TB - 1,400,000
Malaria - 1,240,000

Question 6

Common fungal pathogens

Answer 6

Aspergillus species
Candida species
Cryptococcus species

Question 7

What patients are typically affected by fungal infections?

Answer 7

Impaired immune systems e.g. 
HIV
AIDS
Premature neonates
Malignancies 
Transplants

Question 8

Why do fungal infections affect patients in an ICU setting?

Answer 8

Due to use of broad spectrum antibiotics and the need to use intravascular catheters i.e. normal mucosal barriers being compromised

Also due to multi-system disease

Question 9

What should be considered in a serious fungal infection of an otherwise health individual?

Answer 9

Underlying undiagnosed immunodeficiency

Question 10

Predisposing factors for mucocutaneous candidiasis

Answer 10

Can affect both healthy and immunocompromised individuals
Inhalation steroids
Antibiotic treatments

Question 11

Patients generally affected by mucocutaneous candidiasis

Answer 11

Neonates < 3 months
Primary immunodeficiency
Elderly

Question 12

What is the fourth most common blood stream infection?

Answer 12

Invasive candidiasis

Question 13

When would an anti fungal be given for a blood stream infection?

Answer 13

Presentation of fungal BSI is the same as bacterial BSI, so anti fungal would be given at failure to improve on antibiotic

Question 14

Mortality of invasive candidiasis

Answer 14

up to 40%

Question 15

Risk factors for invasive candidiasis

Answer 15

Use of broad spectrum antibiotics
Intravascular catheters
Total parenteral nutrition

Question 16

Transmission of aspergillus and aspergillosis

Answer 16

Transmission by sporulation, airborne, inhalation

Question 17

Patients affected by acute invasive pulmonary aspergillosis

Answer 17

Neutropenic patients
Defects in phagocytes
Acquired, congenital or acute diseases with high mortality rates

Question 18

Patients affected by chronic pulmonary aspergillosis (> 3 months)

Answer 18

Patients with underlying chronic lung conditions e.g. asthma, COPD

Question 19

What is the difference between acute and chronic pulmonary aspergillosis?

Answer 19

Acute is more severe, chronic is milder but will lead to progressive decline in lung function

Question 20

Forms of allergic aspergillosis

Answer 20

Allergic bronchopulmonary aspergillosis
Extrinsic allergic bronchoalveolitis
Asthma or CF with fungal sensation

Question 21

Why is allergic aspergillosis a challenge to treat clinically?

Answer 21

Have to balance between steroids for the allergy and anti-fungals for the infection

Question 22

Patients affected by acute invasive pulmonary aspergillosis

Answer 22

Neutropenic hosts e.g. acute leukaemia, HSCT, post-bone marrow transplant

Question 23

Pathophysiology of acute invasive pulmonary aspergillosis

Answer 23

Rapid and extensive hyphal growth
Thrombosis and haemorrhage
Angio-invasion and dissemination

Question 24

Presentation of acute invasive pulmonary aspergillosis

Answer 24

Absent or non-specific clinical signs and symptoms

Persistent febrile neutropenia despite broad spectrum antibiotics

Question 25

Mortality rates of acute invasive pulmonary aspergillosis

Answer 25

50-90% due to the inability to reverse the causative/predisposing immune deficiency

Question 26

Patients affected by pulmonary aspergilloma

Answer 26

``` TB Sarcoidosis Bronchiectasis Bronchial cysts and bullae After pulmonary infections ```

Question 27

What is pulmonary aspergilloma?

Answer 27

A fungal mass, usually grows in lung cavities

Question 28

Transmission of cryptococcus and cryptococcosis

Answer 28

Inhalation | Found on bark of trees, in bird faeces and in organic matter

Question 29

What patients are susceptible to cryptococcal meningitis?

Answer 29

HIV/AIDS patients

Question 30

When might subacute meningoencephalitis occur?

Answer 30

After latent cryptococcal infection

Question 31

Mortality of cryptococcosis in the US and in Africa

Answer 31

25% in US | 70% in Africa

Question 32

Diagnosis of cryptococcal infection

Answer 32

India-ink CSF

Question 33

Anti-fungal treatment for invasive aspergillosis

Answer 33

Voriconazole or isavuconazole IV or oral formulation Liposomal amphotericin B IV only (second line)

Question 34

Anti-fungal treatment for invasive candidiasis

Answer 34

Echinocandins IV only Fluconazole IV or oral formulation (second line)

Question 35

Anti-fungal treatment for cryptococcal meningitis

Answer 35

Amphotericin B and Flucytosine followed by fluconazole

Question 36

Resistance of candida auras to fluconazole, echinocandin, amphotericin and multi-drug

Answer 36

Fluconazole - 90% resistant Echinocandin - 30-40% resistant Amphotericin - 5-15% resistant 50% multi-drug resistant