OVERVIEW
- Best empiric treatment for life-threatening fungal infection is amphotericin B (all fungi are susceptible)
- fungal infection is termed mycosis
TYPES OF INFECTIONS
- superficial, cutaneous and subcutaneous infections (e.g. oral thrush)
- endemic mycosis (e.g. histoplasmosis, blastomycosis, coccidioidomycosis, sporotrichosis)
- opportunistic infections (most important in ICU)
EXAMPLES OF PATHOGENIC FUNGI
Yeast
- Candida spp
- Cryptococcus spp
- Pneumocystis spp (“a yeast-like fungus”)
Molds
- Aspergillus
- Zygomycetes (Mucor, Rhizopus)
- Other (Scedosporium, Fusarium)
YEAST
Candida
- C. albicans: fluconazole
- voriconazole
- flucytosine
- echinocandins: caspofungin, micafungin, anidulafungin (first line for invasive candidemia)
Cryptococcus
- triazoles: fluconazole, itraconazole
- flucytosine
Pneumocystis
- co-trimoxazole 10mg/kg of sulfamethoxazole
- pentamidine isethionate
- dapsone
MOLDS
Rhizopus (causes mucormycosis)
- amphotericin B
- (surgery!)
Aspergillus
- itraconazole
- voriconazole
- echinocandins: caspofungin, micafungin, anidulafungin
References and Links
LITFL
- CCC — Aspergillosis
- CCC — Candidiasis
- CCC — Cryptococcosis
- CCC — Pneumocystis Jiroveci
- CCC — Rhinocerebral Mucormycosis
Journal articles
- Enoch DA, Ludlam HA, Brown NM. Invasive fungal infections: a review of epidemiology and management options. J Med Microbiol. 2006 Jul;55(Pt 7):809-18. PMID: 16772406.
- Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD; Infectious Diseases Society of America. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Mar 1;48(5):503-35. PMID 19191635.
- Van Thiel DH, George M, Moore CM. Fungal infections: their diagnosis and treatment in transplant recipients. Int J Hepatol. 2012;2012:106923. PMC3433127.
FOAM and web resources
- ICN Podcast — 69. Janin on Fungal Infections (2012)
- Maryland CC Project — Fungal Invasion of the ICU: A catastrophe waiting to happen (2014)
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of LITFL.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
On Twitter, he is @precordialthump.
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