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Fungal Infections L
Fungal Infections L
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Outline
• Candidiasis
• Aspergillus
• Cryptococcosis
Candidiasis
General Characteristics
1. Candida species are oval, budding yeasts known for their
formation of hyphae and long pseudohyphae.They normally
colonize humans, and it is the overgrowth of these organisms that
results in the clinical pathology of candidiasis.
b. Mouth, oropharynx—“thrush”
This causes thick, white, scrapable plaques that adhere to the oral mucosa
usually painless unexplained oral thrush should raise suspicion of HIV
infection
c. Cutaneous candidiasis
This causes erythematous, eroded patches with “satellite lesions”. It is more
common in obese diabetic patients; it appears in skin folds (e.g.,
axilla, groin, underneath breasts) and in macerated skin areas
Candidiasis
d. GI tract (e.g., esophagus)
Candida esophagitis may cause significant odynophagia
It may also be asymptomatic
Treatment
1. Remove indwelling catheters or central lines.
2. Acceptable treatments for oropharyngeal candidiasis.
a. Clotrimazole troches (dissolve in the mouth) five times per day.
b. Nystatin mouthwash (“swish and swallow”) three to five times per day;
only for oral candidiasis.
c. Oral ketoconazole or fluconazole for esophagitis.
3. Vaginal candidiasis—miconazole or clotrimazole cream.
4. Cutaneous candidiasis—oral nystatin powder, keeping skin dry.
5. For systemic candidiasis, use amphotericin B or fluconazole. New,
Candidiasis
Oral thrush
Aspergillus
General Characteristics
1. Aspergillus spp. spores are found everywhere in the
environment. Typically, disease occurs when spores are
inhaled into the lung.
2. Pulmonary aspergilloma.
a. Pulmonary aspergilloma is caused by inhalation of spores into
the lung. Patients with a history of sarcoidosis, histoplasmosis, TB,
and bronchiectasis are at risk.
b. It presents with chronic cough; hemoptysis may be present as
well.
c. It may resolve spontaneously or invade locally.
Aspergillus
3. Invasive aspergillosis.
a. This occurs when hyphae invade the lung vasculature,
resulting in thrombosis and infarction.
b. Hosts are typically at-risk patients with acute leukemia,
transplant recipients, and patients with advanced AIDS.
c. It usually presents with acute onset of fever, cough,
respiratory distress, and diffuse, bilateral pulmonary
infiltrates.
d. It is transmitted via hematogenous dissemination, and
may invade the sinuses, orbits, and brain.
Aspergillus
Diagnosis
1. CXR reveals a dense pulmonary consolidation and
sometimes a fungus ball.
2. Definitive diagnosis of invasive aspergillosis is by tissue
biopsy, but diagnosis is presumed when Aspergillus is
isolated from the sputum of a severely
immunocompromised/neutropenic patient with clinical
symptoms.
3. Blood cultures are usually not helpful because they are
rarely positive.
Aspergillus
Treatment
1. For allergic bronchopulmonary aspergillosis, patients should
avoid exposure to Aspergillus; corticosteroids may be
beneficial.