Systemic mycoses

Question 1

What are some of the categories of systemic mycoses?

Answer 1

• Cryptococcosis
• Aspergillosis
• Systemic candidiasis
• Mucormycosis/Phycomycosis
• Pneumocystis jiroveci
• Dimorphic fungi (restricted geographical locations, rare in Singapore)

Question 2

What fungi causes Cryptococcosis?

Answer 2

C. neoformans (compromised patients)
C. gattii (normal immune system)

Question 3

How is Cryptococcosis transmitted?

Answer 3

Breathe in from soil and trees

Question 4

What does Cryptococcosis cause?

Answer 4

CNS (meningitis, cryptococcoma) lungs (pneumonia, pleural effusion, cryptococcoma), skin, systemic (fever), prostate, bloodstream

Question 5

How to diagnose Cryptococcosis?

Answer 5

1. Antigen test (serum, CSF, urine)
2. Culture (CSF, blood, urine, tissue)
3. Microscopy india ink (CSF)
   - specific but not very sensitive test to show capsules

Question 6

What fungi causes Aspergillosis?

Answer 6

Aspergillus species (filamentous fungus)

Question 7

What does Aspergillosis cause?

Answer 7

• Allergic (bronchopulmonary Aspergillosis - Type I)
• Fungus ball in lung (forms in cavity)
• Invasive Aspergillosis (immunocompromised, neutropenia)

Question 8

Who is at risk for Aspergillosis?

Answer 8

immunodeficiency, diseased lungs, patients on steroids, chemotherapy treatment resulting in severe neutropenia, stem cell and solid organ transplantation, AIDS

Question 9

How does Aspergillosis transmit?

Answer 9

Airbone

They are ubiquitous! Esp. construction sites

Question 10

What is used to treat invasive Aspergillosis?

Answer 10

Empirical amphotericin (hard to diagnose)

Question 11

Systemic candidiasis is an ___ of superficial candidiasis

Answer 11

extension

Question 12

Who is at risk of systemic candidiasis?

Answer 12

Antibiotics, immunocompromised, surgery, intravascular line, preterm neonates

Question 13

What is the most common source of infection of systemic candidiasis?

Answer 13

Central line may be source of infection

Question 14

What are the Candida vascular infections?

Answer 14

1. Cardiac
   * Purulent pericarditis
   * Myocarditis
2. Endocarditis
3. Urinary tract
   * Candiduria
   * Upper tract (kidneys)
   * Haematogenous or ascending infection
   - Fungus balls, perinephric abscess, papillary necrosis

Question 15

In who does Mucormycosis occur in?

Answer 15

Immunocompromised patients (not in normal people!)

Question 16

What is the mortality rate of Mucormycosis?

Answer 16

30-70% (to 90% if disseminated)

Question 17

How to successfully treat Mucormycosis?

Answer 17

Timely diagnosis, early initiation of antifungal drugs, aggressive surgical debridement of necrotic and devitalised tissue, correction of predisposing factors

Question 18

What are the factors predisposing to systemic fungal infection?

Answer 18

• antibiotics
• intravenous drug abuse (IVDA)
• hyperalimentation (artificial nutrients, typically IV)
• polyethylene catheters
• neutropenia
• neutrophil defects

Question 19

What is the most common systemic fungi? Where are they found?

Answer 19

Candida
Normal commensal of humans, female genital tract, soil