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Candida (Chronic disseminated candidasis (Quite uncommon, Path: candida in…
Candida
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Oropharyngeal
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RF: ImmunoC (e.g., HIV, CD4 <200), antimicrobial tx, chemo, radiation head/neck
Tx: topical with clotrimazole, miconazole
oral azole
Oesophagitis
Odynophagia, retrosternal
RF: HIV, CD4 <100, haematological malignancy (e.g. AML, ALL etc), inhaled corticosteroids
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Invasive infection
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RF: haematological malignancy, transplant (SOT and BMT), chemotherapy, severely ill in ICU
typically due to line (e.g. entral, indwelling)
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Aspergillosis
Diagnosis
CT thorax: nodules, consolidation, peri-bronchial infiltrates, cavitation, Halo sign, air-crescent sign
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Respiratory culture (BAL > sputum), Galactomannan (antigen) in blood and BAL
Note: not confirmative - general picture
Management
Voriconazole - 1st line
Amphotericin B or Echinocandins (caspofungin, anuidulafungin) (alternatives)
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Prevention (nosocomial): cleaning + physical barriers (spore-free environment), HEPA filters)
Overview
Types:
A. fumigatus (mc)
A. flavus, A. terreus (lc)
Risk factors
prolonged neutropenia (> 14 days) e.g., AML, Transplant (BMT, SOT), HIV (rare <1%), Diabetes mellitus, high dose steroids
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Pathogenesis
Primary site is lung (macrophages, neutrophils) causing widespread destructive growth in lung tissue
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Dissemination to other sites (liver, spleen, kidney, CNS)
Clinical features
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Resp tract: cough, dyspnoea, chest pain
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Pneumocystis jiroveci (aka PJP, PCP)
Overview
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Disease only in ImmunoC:
HIV (CD4 count), malignancy (esp ALL), transplant, immunosuppressive drugs, steroids
Clinical features
Pneumonia: fever, dry cough, progressive dyspnoea, hypoxia, resp failure
Diagnosis
CXR: Bilateral interstitial infiltrates, but may be normal
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BAL: Grocott (silver) stain, direct fluorescent antibody staining, PCR
Management
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Prevention: Prophylaxis in at-risk groups, segregation from other immunoC patients
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Murcomycosis
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Overview
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RF: Immunocompromised, DM, IVDU
Pathogenesis
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may involve rhinocerebral disease (with brain abcesses), pulmonary, GIT, cutaneous