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OPPORTUNISTIC FUNGAL INFECTIONS. Smilja Kalenic, MD, PhD Clinical Hospital Centre Zagreb, Croatia. LEARNING AND PERFORMANCE OBJECTIVES to learn about the most frequent opportunistic fungi and to understand main risk factors for developing infection

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opportunistic fungal infections

OPPORTUNISTIC FUNGAL INFECTIONS

Smilja Kalenic, MD, PhD

Clinical Hospital Centre Zagreb, Croatia

slide2

LEARNING AND PERFORMANCE OBJECTIVES

  • to learn about the most frequent opportunistic fungi and to understand main risk factors for developing infection
  • to be able to predict the most probable agent of invasive fungal infection in a particular compromised patient state and to be able to act preventively
fungi
FUNGI
  • EUCARIOTIC ORGANISMS
  • TWO BASIC FORMS:

- YEASTS

- MOLDS

mycoses
MYCOSES

1. SUPERFICIAL

2. CUTANEOUS

3. SUBCUTANEOUS

mycoses5
MYCOSES

4. ENDEMIC (PRIMARY, SYSTEMIC):

Histoplasma capsulatum, Coccidioides immitis, Blastomyces dermatitidis, Paracoccidioides brasiliensis

mycoses6
MYCOSES

5.OPPORTUNISTIC

endogenous

- Candida (different species)

- Pneumocystis carinii (?)

mycoses7
MYCOSES

5.OPPORTUNISTIC

exogenous

- Cryptococcus neoformans

- Aspergillus (different species)

- Zygomycetes

- MANY OTHER FUNGI

candida albicans and other candida species
Candida albicans and other Candida species
  • Harmless inhabitants of the skin and mucous membranes of all humans
  • Normal immune system keeps candida on body surfaces
main defense mechanisms against candida i
MAIN DEFENSE MECHANISMS AGAINST CANDIDA I.
  • skin and mucous membranes integrity
  • presence of normal bacterial flora
main defense mechanisms against candida ii
MAIN DEFENSE MECHANISMS AGAINST CANDIDA II.
  • phagocytosis
  • killing, mostly in polymorphonuclear cells, less in macrophages
  • T-cells (CD4)
the most important risk factors
THE MOST IMPORTANT RISK FACTORS

1. Neutropenia

2. Diabetes mellitus

3. AIDS

4. SCID

5. Myeloperoxidase defects

6. Broad-spectrum antibiotics

slide12

THE MOST IMPORTANT RISK FACTORS

7. Indwelling catethers

8. Major surgery

9. Organ transplantation

10. Neonates

11. Severity of any illness

12. Intravenous drug addicts

clinical forms of candidiasis
CLINICAL FORMS OF CANDIDIASIS

1. Cutaneous and mucosal

candidiasis

clinical forms of candidiasis14
CLINICAL FORMS OF CANDIDIASIS

2. Invasive (systemic, disseminated, hematogenous) candidiasis

invasive candidiasis
INVASIVE CANDIDIASIS
  • Usually begins with candidemia (but in only about 50% of cases candidemia can be proven)
  • If phagocytic system is normal, invasive infection stops here
invasive candidiasis16
INVASIVE CANDIDIASIS
  • If phagocytic system is compromised, infection spreads to many organs and causes focal infection in these organs
  • mortality of candidemia is 30-40%
diagnosis of invasive candidiasis
DIAGNOSIS OF INVASIVE CANDIDIASIS
  • Gram stain and isolation from blood, CSF or peritoneal fluid
  • isolation and/or pathology positive of organ involved
  • other tests are of lower significance for the diagnosis
epidemiology
EPIDEMIOLOGY

Although candidiasis is endogenous in most cases, cross infections are described, especially in intensive care unit patients.

slide19

Pneumocystis carinii

  • Present in lungs of many mammals, including humans, in persistent but harmless infection
slide20

Pneumocystis carinii

  • Main defense mechanism is T-cell mediated
  • causes interstitial pneumonitis in compromised patients
  • treatment and prevention: cotrimoxasole or pentamidine
cryptococcus neoformans
Cryptococcus neoformans
  • Occurs worldwide in soil and in bird droppings
  • Prominent feature: thick polysaccharide capsule, which causes evasion from phagocytosis
main defense mechanisms and pathogenesis
MAIN DEFENSE MECHANISMS AND PATHOGENESIS
  • T-cells responsible for defense
  • Cryptococcus reaches humans by inhalation of aerosolized yeast cells
chronic meningitis in aids patients
CHRONIC MENINGITIS IN AIDS-PATIENTS
  • The most important clinical syndrome
  • treatment: amphotericin B+/-flucytosine
  • recurrence prevention: fluconazole
epidemiology of cryptococcosis
EPIDEMIOLOGY OF CRYPTOCOCCOSIS

Infection is always exogenous, is not transmitted from human to human

aspergillus species
Aspergillus species
  • Aspergilli are worldwide occurring saprophytes, living in soil and on plants; they have small conidia that form aerosols
slide26

Main defense mechanism is

  • phagocytosis
  • Main risk factors are
  • hematological malignancy,
  • bone marrow transplantation
  • and corticosteroid therapy
slide27

The most frequent syndromes

are: - aspergilloma

- invasive aspergillosis

(high mortality rate)

Treatment: amphotericin B,

itraconazole, flucytosine

and surgery

Prevention: avoid exposure

to conidia (new buildings in the hospital!)

zygomycetes
ZYGOMYCETES
  • Zygomycetes are ubiquitous saprophytes
  • main host defense is phagocytosis
  • main risk factors are diabetes, hematological malignancies, corticosteroid therapy
slide29

Major clinical syndrome is:

Rhinocerebral mucormycosis

(infection of nasal passages,

sinuses, eyes, cranial bones

and brain)

Treatment: surgery and

amphotericin B

Prognosis: very poor

opportunistic fungal infections are
OPPORTUNISTIC FUNGAL INFECTIONS ARE:
  • difficult to diagnose
  • difficult to treat
  • difficult to prevent
  • more and more frequent
  • a great challenge for a future work in all fields