- 𝛽 Glucan + perete celular chitina
- unicelular/ micelii
Colonizare pulmonara
- Aspergilius
- Cnadida
- Penicillium
- Clavispora
- Pneumocistis
Fungile reprezinta 0.1% din microbiomul intestinal
- Ascomycota
- Bazidiomycota
MUCORALES
- ubicuitari
- hife
- afinitate crescuta pentru fier (PTR1)
- Imunocompromisi - cancer, imunoterapie, malnutritie, administrarea de voriconazol, GVHD, MV
- DZ cu glicemii necontrolate
- Neutropenie severa
- COVID 19 nonsever + glucocorticoid
- Chelator fier
- trauma
- Black Skin
ASPERGILIUS
- trasnmitere - inhalare spori
- saprofit, oportunist
- forme:
- ABPA - Aspergiloza Bronhopulmonara Alergica
- CNPA - Pneumonie Cronica Necrotizanta cu Aspergilius
- Aspergilom
- Aspergiloza invaziva
- IAPA - Influenza Associated Invasive Apergillosis
- CAPA - Covid 19 Associated Pulmonary Apergillosis
- CPA - Chronic Pulmonary Aspergillosis
- Neutropenic → angio invasive
- Non-neutropenic → airway invasive
Colonizare → Invazie tisulara → Angioinvazie
Factori de risc:
- neutropenie (leucemii) → profilazie Posaconazol
- pneumoniii virale severe (covid)
- leziuni structurale pulmonare
- imunosupresoare (transplant)
Factori de risc CAPA
- supresie cale Interferon
- fact clinici: Tocilizumab + Dexa
* Klebsiella inhiba formarea de hife si biofilm de catre Aspergillius
Aspergiloza invaziva - IPA (Invasive Pulmonary Aspergollosis) / TBA (tracheobronchial aspergillosis)
- biomarker: galactomanan (BAL > ser) / amplificare ADN
- imagistic : halo/crescent sign Rx
- 1 semn/simptom compatibil
- febra > 3 zile sub antibioterapie corecta
- reaparitie febra > 48 ore de la oprirea acesteia sub antibioterapie neintrerupta
- durere pleuretica
- dispnee
- hemoptizii
- 1 criteriu clinic
- ulceratii traheo-bronsice
- noduli
- infiltrate pulmonare
- abcese
- 1 criteriu ce tine de gazda
- gripa
- covid
- BPOC moderat/sever
- HIV CD4 < 200
- cancer
- 1 criteriu micologic
- galactomanan BAL > 1.0 ODI
- galactomana ser > 0.5 ODI
- culturi pozitive cu Aspergillius
CANDIDA SPP
- comensala
Candida
- Albicans
- Glabrata
- Thropicalis
- Parapsilosis
- Krusei
- Kefyr
- Auris
- Candemie:
- neutropenie
- hemodializa
- cvc
- chirugie abdominala
Candemie = Candida izolata din hemocultura crecoltata central/periferic (FUNDICU - vena periferica)
* Candemie → tratament timp de 14 zile dupa negatire culturi
- biomarker: 1,3 𝛽Dglucagon (BDG)
ALTI FUNGI
Pneumocystis Jiravecii Pneumonia