Presentation on theme: "Fungal Infections Slackers Facts by Mike Ori. Disclaimer The information represents my understanding only so errors and omissions are probably rampant."— Presentation transcript:
Fungal Infections Slackers Facts by Mike Ori
Disclaimer The information represents my understanding only so errors and omissions are probably rampant. It has not been vetted or reviewed by faculty. The source is our class notes. The document can mostly be used forward and backward. I tried to mark questionable stuff with (?). If you want it to look pretty, steal some crayons and go to town. Finally… If you’re a gunner, buck up and do your own work.
What is a tinea
A superficial fungal infection defined by its anatomical location
List common tinea locations and names
NameLocation CapitisHead BarbaeBeard/face FacieiFace CorpusBody (ringworm) CrurisInguinal (Jock itch, usually not scrotum/penis) PedisFoot (Athletes foot) ManuumHands – expect pedis to be present too UnguiumNails/nail bed (onychomycosis)
Etiologic agent: Itchy scrotum
Vaginal candidiasis predisposing factors
Diabetes Antibiotic use Pregnancy HIV
What is a woods lamp and why is it used
It is a UV lamp that causes some fungal infections to fluoresce and hence serves as a diagnostic tool.
What is the slide mount prep for fungal infections
Etiologic agent: Angular chelitis
Etiologic agent: Erythematous depapillation in midline of lingua
Etiologic agent: pseudomembranous plaques in mouth
Topicals - Nystatin rinse (swish and swallow), OTC azoles Systemics – Triazoles or amphotericin B
Opaque, yellow, thickened, chalky nails with debris accumulation
Usually long term systemic anti-fungals like fluconazole, itraconazole, terbinafine.
Destruction of the lung parenchyma with invasion into the vasculature (angio invasive)
Invasive pulmonary aspergillosis epidemiology
Prolonged neutropenia as in cancer tx
Commensal organism on many grains that causes keratitis in contact lens users. Infection occurs by direct inoculation and may spread systemically in immunocompromised hosts.
Fusariosis risk factors
Prolonged neutropenia or immune suppression due to allograft transplants
Bioterror potential of Fusariosis
Mycotoxins have been weaponized
Dimorphic fungus with clinical disease similar to Fusariosis.
Scedosporiosis risk factors
Prolonged neutropenia, immune suppression due to allograft transplants, diabetes.
Zygomycosis chracterization. AKA: Mucormycosis
Nasal sinus infection extending into the brain or orbit as a result of Mucorales species.
Immune compromised hosts with acidemia as occurs in diabetes. Also occurs in poor nutrition, burns, and neutropenia.
Aggressive surgical debridement
Identify Etiology: A patient complains of dry cough, dyspnea, and fevers. CXR shows diffuse bilateral interstitial infiltrate. ABG shows hypoxemia and hypocarbia. HX includes treatment for rheumatoid arthritis.
Is it likely the PT above is HIV +?
While PJP is most commonly associated with HIV, it can occur in situations of depressed cellular immunity independent of HIV status.
What is the tx for PJP?
TMP-SMX both for TX and prophylaxis.
What is the likely illness of an HIV + with a CD4 < 100 individual that cleans chicken coops?
Cryptococcus neoformans meningitis
Cryptococcal DX tests
India ink stains showing encapsulated yeast. Serology
Amphotericin B followed by fluconazole
A 30 year old female presents to your clinic with complaining of a yeast infection that “won’t go away”. She has tried OTC treatment. She has not been sexually active for the last 4 years. She is has never used IV drugs. What tests would you recommend?
HIV test. Recurrent or intractable yeast infections can be a sign of HIV. Remember HIV can take years to develop. (Not sure if you would culture the infection)
A patient in the ICU suffered a traumatic laceration to their bowel. They are receiving TPN and antibiotics. They are currently tachycardic, hypotensive, and febrile. Three blood cultures drawn 4 hours apart are negative for bacteremia. What is the likely agent.
Lab tests identify Candida krusei. What possible agent would you administer to resolve the fungemia.
Triazoles amphotericin B echinocandins
You administer triazoles but the patient does not improve. Why?
Candida krusei is increasingly resistant to triazoles through a Ca++ dependent efflux pump.