ICUIdea

 – 𝛽 Glucan + perete celular chitina

– unicelular/ micelii

Colonizare pulmonara:

• Aspergilius
• Candida
• 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

– Sinuzita severa → abces cerebral

– Sediu pulmonar, gastrointestinal, cutanat

– Caractersitic: Black Skin

Colonizare → invazie tisulara → angioinvazie → +++ tromboza →  necroza + diseminare

ASPERGILIUS

– transmitere – 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
  • Covid 19 Associated Traheobronchittis
• CPA – Chronic Pulmonary Aspergillosis
• Neutropenic → angio invasive
• Non-neutropenic → airway invasive

Colonizare → Invazie tisulara → Angioinvazie

Factori de risc:

• neutropenie (leucemii) →  profilazie Posaconazol
• pneumonii virale severe (covid)
• leziuni structurale pulmonare
• imunosupresoare (transplant)

Factori de risc CAPA

• supresie cale Interferon
• factori 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

galactomanan BAL > 1.0 ODI

galactomana ser > 0.5 ODI

culturi pozitive cu Aspergillius

CANDIDA SPP

– comensala

Specii de 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 negativare culturi

– biomarker: 1,3 𝛽Dglucagon (BDG)

ALTI FUNGI

Pneumocystis Jiravecii Pneumonia