Term
| What agents are used to treat fungal infections? |
|
Definition
- Amphotericin B - Conventional (Most AE including kidney, hypokalemia and hypomagnesemia), liposomal, and lipid complex
- Azoles - Fluconazole/Diflucan, Itraconazole/Sporanox, Voriconazole/Vfend, Posaconazole/Noxafil
- Echocandins - the fungins
- Flucytosine/Ancobon |
|
|
Term
| What species of candida is resistant to fluconazole? |
|
Definition
Candida krusei
**glabrata has variable resistance |
|
|
Term
| What are other types of Candida species? |
|
Definition
- Candida albicans
- Candida glabrata - variable resistance
- Candida parapsilosis
- Candida tropicalis
- Candida krusei - resistant to fluconazole |
|
|
Term
| What increases risk of Candidemia? |
|
Definition
- Broad spectrum antibiotics
- Catheters and TPN
- Neutropenia
- Implants
- Immunosuppresants |
|
|
Term
| How is Candidemia diagnosed? |
|
Definition
Persistent infection despite antibiotics
Risk factors
+ yeast blood culture - NEVER a contaminant. Slow growing |
|
|
Term
| What are the 2 types of azole resistance? |
|
Definition
- Primary/intrinsic - prior to exposure to drug. Candida krusei is always resistant
- Secondary/acquired - Mutation due to selective pressure. If albicans becomes resistant. |
|
|
Term
| How is non-neutropenic candidemia treated? |
|
Definition
- 1st line: Fluconazole OR an echocandin (may use if rate of non-albicans is high)
- 2nd line: Lipid amphotericin B or Voriconazole/Vfend
**If there is a catheter, remove it.
Tx x2 weeks from 1st negative culture |
|
|
Term
| How is neutropenic candidemia treated? |
|
Definition
1st line: Echocandin or Lipid amphoB
2nd line: Azoles (Fluconazole or Voriconazole) |
|
|
Term
| What literature studies have been done on fungal infections? |
|
Definition
- Anidulafungin noninferior to fluconazole in candidemia
- Vfend SUPERIOR to amphoB in aspergillosis |
|
|
Term
| What is the major complication of candidiasis? |
|
Definition
| Endophthalmitis – evaluate by an opthomologist to rule out |
|
|
Term
| What are risk factors for an aspergillus infection? |
|
Definition
**Immunosuppression!!
Caused by transplant, HIV, immunodeficiency, neutropenia |
|
|
Term
| How is aspergillosis diagnosed? |
|
Definition
- Signs/symptoms
- culture and biopsy
- Risk factors
- Serology |
|
|
Term
| What is the drug of choice for aspergillosis? |
|
Definition
Voriconazole/Vfend for 6-12 weeks
**Alternatives: AmphoB, fungin, posaconazole |
|
|
Term
| What are the major risk factors for cryptococcus? |
|
Definition
- HIV - CD4 < 50
- Immunosuppression - CKD, DM, a malignancy, transplant |
|
|
Term
| How does cryptococcus present? |
|
Definition
- Non-immunosuppressed - a pulmonary infection. Cough, rales, SoB
- HIV/AIDs - Meningitis: fever, HA. Atypicial. Less common: neck stiffness, seizures
**Diagnosis by lumbar puncture - incr pressure, positive indian ink and antigen. A positive blood culture is rare. |
|
|
Term
| What is the cryptococcal induction phase? |
|
Definition
| CONVENTIONAL amphoB + Flucytosine x 14 days |
|
|
Term
| What is the cryptococcal consolidation phase? |
|
Definition
After 2 weeks and clinical improvement seen:
- Fluconazole 400 mg daily x8 weeks |
|
|
Term
| What is the cryptococcal suppression phase? |
|
Definition
- Fluconazole 200 mg daily x 12 MONTHS!
Can be lifelong in HIV patients if CD4 < 100 |
|
|
Term
| What is the pathophys for dimorphic fungi infections? |
|
Definition
| - Inhalation of conidia/spores --> incubation --> acute infection --> chronic infection --> extrapulmonary infection |
|
|
Term
|
Definition
- Acute - asymptomatic
- Chronic - Opportunistic in pts w/ structural defects like emphysema. Seen with aspergillosis. |
|
|
Term
|
Definition
- Acute - Can present like ARDS or CAP
- Chronic - similar to TB
- Extrapulmonary in 20-45% of cases |
|
|
Term
| How are histoplasmosis and blastomycosis treated? |
|
Definition
- Mild/moderate - Itraconazole 200mg TID x3days, then 200mg BID. Liquid preferred
- Severe/disseminated - Lipid amphoB for 1-2 weeks, then itraconazole regimen
**Histoplasmosis for 6-12 weeks, 12 months if disseminated. Blastomycosis for 6-12 months |
|
|
Term
|
Definition
- Acute - similar to CAP. may have pulmonary sequelae
- Disseminated - Filipino/African more at risk. Immunosuppressed. |
|
|
Term
| How is coccidiomycosis treated? |
|
Definition
- Any azole in high doses
- AmphoB for rapidly progressing disease. Causes hypo-K/Mg. Monitor Scr. Needs premeds
- Itraconazole - suspension preferred. Avoid PPIs and 3A4 |
|
|
