MYCOLOGY KEY CHARACTERISTICS Candida auris · 15/150 can cause disease - emerging pathogen · Multi drug resistant called 'Japanese Fungus' - 200 people died · First isolated in Japan 2009 · Found in skin, urogenital tract and respiratory tract, resulting in invasive infections · Cells smaller than C. Albicans · 66% mortality rate . Mostly immunocompromised individuals get it and due to rareness, its not looked for · Common symptoms = fever and chills which don't improve after antibiotic treatment for suspected bacterial infection - broad symptoms therefore hard to pinpoint diagnosis · Only lab tests can diagnose · Highly transmissible between patients and from contaminated environments - highlights the importance of patient control Ringworm · 'Dermatophytosis' or 'tinea' - feed off skin/hair debris . First discovered in 1841 by David Gruby . Chester Emmons published study of several species in 1934 · WWII = lots of people came back with it therefore US government launched intensive study of fungal diseases - created a bank of species · How can you catch it? · Person to person · Touching items contaminated with infected person · From domestic / farm animals · Soil (rare) Aspergillus Fumigatus · 16/200+ dangerous to humans · Found in soil / other organic matter · Respiratory tract / sinus infections usually · Develops if you have pre-existing lung condition / weakened immune system · 20-55 degrees · Not contagious - can't be passed person to person . 5 main clinical syndromes all caused by entry through the respiratory tract · Allergic bronchonpulmonary aspergillosis (ABPA) = hypersensitivity reaction to colonisation of airways/sinuses/lungs · Severe Asthma With Fungal Sensitisation (SAFS) = severe asthma (despite standard treatment) · Aspergilloma = presence of a mycetoma (fungal ball) of aspergilli in pre-existing pulmonary cavity (e.g. TB) · Invasive Aspergillosis = disseminated infection affecting immunocompromised, often starting in lungs but may spread to other organs / tissues / blood · Chronic Necrotising Pulmonary Aspergillosis (CNPA) = subacute pulmonary infection affecting those with moderate immunosuppression usually with a pre-existing lung disease, causing cavitating pulmonary infiltration · Pathiophysioology · Immunocompetent individual = macrophages and neutrophils usually defend against inhaled fungus · Toxic metabolites attack neutrophils and macrophages - e.g. steroids · Underlying immunosuppression affects neutrophil numbers and function INCIDENCE AND EPIDEMIOLOGY IN CANDIDA AURIS · First case in UK = 2013 - rates have been rising since · End of July 2017 = affected more than 200 patients in England
· Ofte misdiagnosed · Approximately 1/4 of reported C. Auris detections are clinical infections, including 27 candidaemias · Every isolate from UK has demonstrated reduced susceptibility to flucanozole KEY SYMPTOMS FROM FUNGAL INFECTION Ringworm · Presentation · Tinea Capitis = scalp ringworm - causes infected area to scale and temporary hair loss · Tinea Corporis = arm and leg ringworm - ring like patch with elevated scaling border and a central clearing · Tinea Pedis = athletes foot - white macerated area and dermatophytes can cause a more dry scaling process · Tinea Cruris