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Infection Systems > Lecture 13: Fungal Infections > Flashcards

Lecture 13: Fungal Infections Flashcards

1
Q

what are the two main types of fungal skin infections?

A

candidasis:
- yeast like infection
- uniform commensal of mouth/GI tract
- opportunistic infection

tinea:
- superficial skin infections caused by dermatophytes

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2
Q

candida risk factors

A
  • moist areas
  • skin folds
  • obesity
  • diabetes
  • neonates
  • pregnancy
  • poor hygeine
  • occupation in wet environments
  • recent broad spectrum antibiotic
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3
Q

symptoms of genital candidiasis (vaginal thrush)

A
  • itch
  • soreness and burning discomfort
  • dysuria
  • vulval oedema, fissures and excoriations
  • cottage cheese/white curd discharge
  • bright red rash
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4
Q

genital candidiasis (vaginal thrush) risk factors

A
  • just before and during menstruation
  • obesity
  • diabetes
  • iron deficiency anaemia
  • immunodeficiency
  • recent course of broad spectrum antibiotic
  • high dose combined OCP/oestrogen based HRT
  • pregnancy
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5
Q

genital candidiasis (vaginal thrush) diagnosis

A
  • clinical
  • vaginal swab
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6
Q

genital candidiasis (vaginal thrush) management

A
  • clotrimazole: topical antifungal pessary or cream
  • oral treatment: fluconazole
  • supportive measures: loose clothing, avoiding soap or bubble baths to wash
  • no evidence for probiotics or treating sexual partner
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7
Q

Oral Candidiasis (Oral Thrush) risk factors

A
  • extremes of age
  • immunocompromised
  • inhaled or oral corticosteroids
  • broad-spectrum antibiotics
  • diabetes
  • dental prosthesis
  • smoking
  • poor oral hygiene
  • llocal trauma
  • nutritional deficiency
  • impaired salivary function
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8
Q

Oral Candidiasis (Oral Thrush) symptoms

A
  • white or yellow plaques in mouth
  • mild burning
  • erythema
  • altered taste
  • ‘furry tongue’
  • if chronic can cause dysphagia
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9
Q

Oral Candidiasis (Oral Thrush) management

A
  • topical anti-fungal: nystatin, miconazole gel
  • if extensive: oral fluconazole
  • smoking cessation
  • good oral hygiene
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10
Q

what is the 4th most common bloodstream infection in adults?

A

invasive candidiasis

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11
Q

tinea infection mode of transmission?

a superficial skin infections caused by dermatophytes

A
  • direct spread from infected individual or animal
  • indirect contact with objects/materials which carry infection e.g. bedding, clothin
  • rare contact with soil
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12
Q

tinea diagnosis

A

clinical:
- scaly itchy skin
- single or multiple flat/slight raised annular patches
- typical central clearing
- assymetrical distribution

if uncertain: skin scrapings or skin swab if pustular/macerated

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12
Q

tinea risk factors

A
  • hot humid environments
  • obesity
  • tight fitting clothing
  • immunocompromised
  • hyperhidrosis (excess sweating)
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13
Q

tinea treatment

A
  • topical anti-fungal cream: terbinafine 1% cream, clotrimazole 1% or miconazole 1%
  • if extensive and positive culture or strong clinical suspicion: oral terbinafine first sline or itraconazole if not tolerates: require 4 weeks of treatment.
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14
Q

fungal nail infection treatment

A
  • topical nail lacquer: amorolifine 5%, treat for 6 months fingernails and 9-12 months toenails
  • oral terbinafine: 6-12 weeks fingernails and 3-6 months for toenails, need to monitor LFTs
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15
Q

aspergillus is a type of mould found in:

A
  • soil, compost and other organic matter
  • dust and bedding
  • damp buildings
  • air conditioning systems and uncovered attic water tanks
16
Q

how is aspergillus transmitted?

A

inhalation by spores

17
Q

aspergillosis symptoms

A
  • cough
  • SOB
  • wheeze
  • pyrexia
  • general malaise
  • headache
18
Q

list the types of aspergillosis

A
  • allergic bronchopulmonary aspergillosis
  • chronic pulmonary aspergillosis
  • aspergilloma
  • invasive pulmonary aspergillosis
19
Q

when should you suspect allergic bronchopulmonary aspergillosis?

A
  • patients clinical condition deteriorating e.g. in asthma or CF
  • failure to respond to normal treatment
  • longstanding cough > 3 weeks
20
Q

complication of allergic bronchopulmonary aspergillosis?

A

pulmonary fibrosis

21
Q

diagnosis of allergic bronchopulmonary aspergillosis

A
  • bloods: eosinophilia
  • sputum culture
  • positive skin test for aspergillosis
  • positive serology for aspergillus spp
  • CXR/CT scan
22
Q

allergic bronchopulmonary aspergillosis management

A
  • oral long term high dose prednisolone
  • anti-fungal treatment of itraconazole also of benefit
23
Q

what is the presentation of chronic pulmonary aspergillosis?

A
  • > 3 months
  • exacerbations not responding to antibiotics
  • decline in lung function
  • increased respiratory symptoms: cough, decreased exercise tolerance and SOB
24
Q

chronic pulmonary aspergillosis diagnosis

A
  • primary care: sputum culture and refer for CXR
  • referral to secondary care for diagnosis and treatment
25
Q

chronic pulmonary aspergillosis management

A

guided by secondary care with oral anti-fungals

26
Q

what is an aspergilloma?

A

a fungal mass - grows in lung cavities

27
Q

who is at risk of an aspergilloma?

A

TB
sarcoidosis
bronchiectasis
after pulmonary infection
bronchial cyst or bullae

28
Q

aspergilloma presentation

A
  • haemoptysis
  • cough and fever less frequently
  • asymptomatic: identified on CXR
29
Q

aspergilloma management

A

surgical resection and long-term antifungal

30
Q

what patients are at risk of Acute Invasive Pulmonary Aspergilliosis?

A
  • neutropenic patients
  • post-transplant (stem cell highest risk)
  • patients with defects in phagocytes
31
Q

Acute Invasive Pulmonary Aspergilliosis presentation

A
  • any organ can be involved
  • cough
  • fever
  • haemoptysis
  • pleuritic chest pain
  • nasal congestion and pain: sinusitis develops
  • persistent febrile neutropenia despite broad spectrum antibiotics
32
Q

Acute Invasive Pulmonary Aspergilliosis management

A

IV anti-fungals

Infection Systems (13 decks)

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