Dr. Walraven Flashcards
(29 cards)
Which fungi are yeasts
- Candida
- Cryptococcus
Which fungi are molds
- Coccidioidomycosis
- Histoplasmosis
- Aspergillus
- Mucormycosis
Candida Epidemiology
- Most common cause of fungal infection
- Usually healthcare associated
- Mortality rate 40-50%
Physical exam findings with Candida
- Skin lesions
- Muscle soreness
Candida risk factors
- Catheters
- Broad spectrum abx
- Dialysis
- Parenteral nutrition
- Corticosteroids
Candida Treatment Guidelines
-Echinocandins are first line therapy (2 week duration)
(Micafungin, Caspofungin, etc)
-Alternatives
1) Fluconazole-if not critically ill
2) AmB- if suspected azole or echinocandin resistance
Management of Candidemia
- Remove catheters if possible
- Dilated opthalmological exam
- Repeat blood cultures
Aspergillosis Epidemiology
- Ubiquitous mold
- Found all over the world
- Exposure via inhalation
Aspergillosis Disease Spectrum
- Immunocompetent host = Allergic reaction (ABPA)
- Immune impairment = chronic necrotizing pulmonary aspergillosis (Fungal ball)
- Immune compromised = Acute invasive infection (lower RTI, dissemination to other tissues)
Aspergillosis risk factors
- Prolonged neutropenia
- Stem cell or organ transplant recipient
- HIV/AIDS
- Chronic granulomatous disease
Aspergillosis radiographic findings
- Halo sign (early stages)
- Air crescent sign (late phase)
Aspergillosis Treatment Guidelines
- Voriconazole is first line treatment
- Alternatives
1) Liposomal AmB
2) Isavuconazole - Echinocandins are NOTTTT recommended
Histoplasmosis Epidemiology
- Dimorphic fungi
- Endemic to Ohio, Mississippi river valleys
- Grows in bird/bat droppings
- Found in abandoned buildings and caves
Chest radiograph findings in Histoplasmosis
-Extensive upper lobe cavitary
Treatment guidelines for Histoplasmosis
- Chronic mild to moderate infection
1) Itraconazole (for non-sever infection)
2) AmB or Fluconazole can be used as alternatives - Moderate to severe/ CNS disease
1) Lipid AmB followed by Itraconazole
Coccidioidomycosis Epidemiology
-Endemic to the south west (CA, AZ, NM, TX, NV, UT)
5 main clinical manifestations in Coccidioidomycosis
- Acute pneumonia
- Chronic progressive pneumonia
- Pulmonary nodules/ cavities
- Extra-pulmonary disease
- Meningitis
Coccidioidomycosis clinical presentation
-Signs/symptoms are indistinguishable for CAP
(headache, fatigue, chest pain)
-More common in A.A, filipino, pregnant women
Treatment guidelines for Coccidioidomycosis
- Fluconazole 400mg po qd
- Alternatives
1) Itraconazole
2) AmB (lipid or dex form) - Do NOT treat asymptomatic patients
Cryptococcus epidemiology
- Fungi
- Endemic to the west coast (CA, WA, OR, up into Canada too)
Cryptococcus clinical manifestations
- Blunted immune response
- Pulmonary infection
- Cryptococcal meningitis
- Can infect ANY organ in the body
Treatment Guidelines for Cryptococcus
- Mild to moderate disease
1) Fluconazole - Severe/ Cryptococcal meningitis
1) AmB PLUS 5-FC x 2 wks - maintenance fluconazole x 6 months
Mucormycosis risk factors
- Major trauma
- Burn
- Diabetes
- Stem cell/ organ transplant
- Immunosuppression
Clinical presentation of Mucormycoses
- Infarction and necrosis of host tissue
- Usually begins at nasal turbinates
- 90% mortality rate
