DS: Opportunistic Infection Flashcards
(25 cards)
Infectious complications following hematopoeitic stem cell transplantation (HCT)
Immunosuppressive effects of common medications
Initial inpatient management of fever in NF cancer patient
Indications for addition of expanded GP coverage in NF cancer patient
Comparison of azole antifungal
Drug interaction with azole antifungal
Major Consideration = DDI
Qt prolongation also an issue (Except for isavuconazonium sulfate)
NCCN Guidelines for antifungal ppx in cancer patients
IDSA Guidelines for antifungal ppx in cancer patients
Ppx against Candida is recommended in patient at substantial risk (e.g. allogenic HCT recipient, patient receiving intensive induction chemotherapy for acute leukemia
Ppx against Aspergillus is recommended in selected patients receiving intensive chemotherapy for acute leukemia
Antifungal ppx is not recommended in low risk patient
Prophylaxis for Pneumocystis jirovecii in Cancer patient
Antiviral ppx in cancer patients
Antiviral ppx nin solid organ transplant recipients
Forscarnet vs. Ganciclovir for treatment of CMV reactivation in HCT recipients
Foscarnet and ganciclovir are similarly effective in the treatment of early CMV reactivation in HCT recipients
Ganciclovir associated with more frequent myelosupression
Foscarnet associated with more frequent renal toxicity and electrolyte abnormalities than ganciclovir
Choice will be depending on patient risk and tolerance:
Foscarnet may be preferred if patient has myelosuppression or at high risk for myelosuppressive adverse event
Ganciclovir may be preferred if patient has renal/electrolyte abnormality
CMV Treatment in Allogeneic HCT Recipients
CMV Treatment in solid organ transplant recipients
Treatment of antiviral resistant CMV
Treatment of antviral resistant CMV - refractory treatment
Maribavir - It cannot be coadminister with (val)gannciclovir
Invasive Fungal Infection - Host Criteria
Clinical Criteria for IFI (invasive fungal infection)
Invasive Aspergillosis - Diagnosis
Aspergillus is a ubiquitous mold found in the environment → most common invasive mold infection in immunocompromised patients
Indirect serum test:
1. Gallactoommannan → component of aspergillus cell wall released into systemic circulation in angioinvasive disease
Serrum and/or bronchoalveolar lavage galactomannan recommended as diagnostic marker for IA
Cross reactivity with Fusarium, Scedosporium, other less common molds
- (1 → 3) beta-D-glucan - component of cell wall in many fungi
Although not specific for Aspergillus
High rate of false positivity due to cross reactivity with yeast (including candida)
Treatment of invasive pulmonary aspergillosis - IDSA
Is there a role for front-line combination therapy for invasive pulmonary aspergillosis
Per IDSA: suggest consideration for an echinocandin with voriconazole for primary therapy in the setting of severe disesae especially in patient with hematologic malignancy and those with profound and persistent neutropenia
Target trough of azole antifungal
Upper limit with voriconazole is due to hallucinations/visual effects and hepatobiliary concerns
Voriconazole level above 1 mcg/ml has been shown to lead to improved outcome
No max trough associated with toxicity with respect to posaconazole
Isavuconazonium Sulfate and posaconazole for invasive aspergillus
Conclusion: Cresemba and posaconazole are non inferior and roughly equivalent to voriconazole in patient with invasive Aspergillus
Both favorable adverse event profile, better tolerated than voriconazole
Still not the first line option - less clinical experience, cost consideration and lack of awareness and timing of guidelines release.
Invasive Mucormycosis
