Clinical_Mycology_10

Clinical_Mycology_10 - Mycology from the perspective of the...

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Mycology from the perspective  of the Clinician John R. Wingard, MD University of Florida Gainesville, FL
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Fungi are all around us We touch them, we swallow them, we breathe  them There are more than 1.5 million fungal species in  nature Yet only about 100 cause human disease Most cause superficial infections, some cause  allergic reactions Few cause invasive infections Fungal Fast Facts
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Why so few invasive  infections? A. Dumb luck B. Most fungi are wimps C.Some bugs are meaner than  others D.Some people are meaner than  others E. A little of all of these
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Host/Pathogen Balance: Normal Circumstances Host  Factors Anatomical   barriers Adaptive  immunity Innate  defenses Virulence Fungal  Burden Fungal  Factors Protection Infection Why so few Invasive Infections?
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Fungi as Primary Pathogens in  Healthy Individuals
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Conditions that disrupt immune  defenses Neutropenia Immunosuppression Fungi as Opportunists
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What are the major fungi I need  to worry about? A.Coccidiomycosis B.Histoplasmosis C.Candida D.Aspergillus E.Cryptococcus F.Zygomycetes
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Mortality Due to Invasive  Mycoses Pathogen Overall Mortality Candida spp 40% Aspergillus spp 62% Other Invasive moulds ( Fusarium spp., Zygomycetes) ~80% Scedosporium spp. 100% *Adults hospitalized in the US;  Hospitalized patients with IA;  HSCT recipients. 1. Pappas PG, et al.  Clin Infect Dis . 2003;37:634-643;  2. Wisplinghoff H, et al.  Clin Infect Dis.  2004;39:309-317; 3. Perfect J, et al.  Clin Infect Dis . 2001;33:1824-1833;  4. Marr KA, et al.  Clin Infect Dis . 2002;34:909-917. 
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Risk for Invasive Candidiasis  Risk for Invasive Candidiasis  Is a Continuum Is a Continuum High-risk patients Surgery Leukopenia Burns Premature  infants Exposures ICU > days CVCs Antibiotics TPN If candidemia develops ~40% die ~60% survive CVCs=central venous catheters; TPN=total parenteral nutrition. Rex JH, et al.  Adv Intern Med . 1998;43:321-369; Pappas PG, et al.  Clin Infect Dis . 2003;37:634-643. 
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Case 1 Patient with Acute Leukemia 36 yo woman with AML in CR1 given HDAC to  Discharged on ciprofloxacin, no fluconazole Day 15 admitted for sepsis;  blood cultures grew  ESBL  E. coli  (sensitive only to imipenem,  meropenem, gentamycin) She received imipenem + vancomycin Fever persists CT scan done 7 days later
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Bacterial abscesses
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Clinical_Mycology_10 - Mycology from the perspective of the...

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