17 Lab Investigation (cont.) Bronchoscope with BAL findings: brown color, thick, mud-like fluid at RUL bronchusBALgram stain : mixed organismAFB : not foundModified AFB : not foundAFB culture : no growthAnaerobic culture : no growthCulture for fungus : Aspergillus fumigatus
33 Mycology Culture of mould from aspirate, BAL or sputum PCR in BAL, CSF or bloodMycologyMould seen in sinus aspirateFungal elements seen in sterile body fluidsAspergillus antigen in BAL, CSFor bloodInvasive Fungal Infections Cooperative Group
34 Host factors Host factor >3 weeks corticosteroids Neutropenia >4 days unexplained fever despite broad spectrum antibiotics<36°C or >38°C and:prior mycosisAIDSimmunosuppressives>10 days neutropeniaGraft versus host diseaseInvasive Fungal Infections Cooperative Group
36 Diagnostic testsDichotomously branched and septate hyphae identified by KOH or Gomori methenamine-silver nitrate stainDefinitive diagnosis is BAL or tissue biopsy cultureRapid antigen test and PCR also helpCT are more specific than CXR
41 Candins Potent broad spectrum activity Fungicidal Novel mechanism of activityLow potential for developing resistanceWell tolerated in humans
42 Caspofungin Member of a new class of antifungals, the echinocandins Inhibitors of glucan synthesis in the fungal cell wallCell wall target absent from mammalian cellsSpectrum of activity includes Aspergillus and Candida spp.Unique mechanism of action results in a lack of cross-resistance with azoles and polyenes
43 Caspofungin spectrum of activity Spectrum of activity includes Candida albicans, non-albicans Candida spp., and Aspergillus spp.Caspofungin is fungicidal for Candida spp.Caspofungin demonstrates clear activity against Aspergillus spp.In vitro, no cross-resistance to Candida spp. with intrinsic or acquired resistance to fluconazole, amphotericin B, or flucytosineNo activity against Cryptococcus neoformansActivity against other fungi less well defined
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