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Intro to fungi (i) (Intro (cell wall (antigenic, contains chitin for…

- - - - 1 drop ink + 1 drop CSF when fungal meningitis suspected
      - obsolete now
  - - - part of normal flora in mouth, intestine + lower GUT
      - can cause opportunistic superficial + systemic disease
    - - partly yeasts
      - partly elongated cells with pseudohyphae
  - - - histoplasma
      - sporothrix
      - blastomyces dermatidis in N America - causes RTIs + skin infections
      - coccidiosis immitis in USA + Mexico - causes RTIs + systemic infections
      - paracoccidiodes brasiliensis in S + central America - causes skin + mucosal granolumas
  - - - results in hypoxia
    - - BAL - methanamine silver/Grocott stain, PCR
      - CXR/CT-thorax: ground glass infiltrates
- - - - sinusitis or broncho-pul
      - in preexisting cavity (e.g. from TB/asthma/CF)
      - eosinophilia (high IgE)
      - Dx
        
        high serum IgE titre
        
        fleeting CXR changes
      - bronchospasm, obstruction, wheeze, cough, dyspnoea, fever
      - Tx: steroids +/- itraconazole
    - - in lung damaged from TB/CF/COPD
      - can by asymptomatic or chronic cough +/- haemoptysis
      - Dx
        
        sputum +ve 66% of time
        
        Ig +ve 70% of time
        
        CXR/CT: fluid-filled cavity
      - Tx: surgical resection (no role for antifungals)
- - - - itraconazole
      - if pul/disseminated use amphotericin B