Fungal Infections Flashcards by Rodolfo Choussal

Candidemia TOC

Echinocandin

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Invasive aspergillosis TOC

Voriconazole

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Allergic bronchopulmonary aspergillosis TOC

Itraconazole or voriconazole

+ glucocorticoids

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Aspergilloma (fungus ball) TOC

Itraconazole, voriconazole, posaconazole

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Mucormycosis TOC

Liposomal amphotericin B, high-dose amphotericin B deoxycholate; posaconazole

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Cryptococcal meningitis TOC

CSF findings . . .

Induction period: amphotericin B and flucytosine

Consolidation period: oral fluconazole

Maintenance period: oral fluconazole

Organ transplant may require life-long antifungal therapy.

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Nonmeningeal cryptococcosis TOC

Fluconazole

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Cutaneous/pulmonary/extrapulmonary Blastomycosis TOC

Lipid formulation of amphotericin B followed by itraconazole (check blood levels)

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CNS Blastomycosis TOC

Lipid formulation of amphotericin B followed by fluconazole

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Mild to moderate acute pulmonary Histoplasmosis TOC

Itraconazole

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Moderately severe to severe pulmonary Histoplasmosis TOC

Lipid formulation of amphotericin B followed by itraconazole

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Acute progressive disseminated Histoplasmosis TOC

Lipid formulation of amphotericin B followed by itraconazole

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Pulmonary (patient at low risk) Coccidioidomycosis TOC

No treatment indicated

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Primary pulmonary (patient at high risk) Coccidioidomycosis TOC

Itraconazole, fluconazole

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Severe coccidioidal pneumonia or disseminated disease TOC

Conventional or lipid formulation of amphotericin B until improved, then itraconazole or fluconazole

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Coccidioidal meningitis TOC

Fluconazole

should be lifelong

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Cutaneous sporotrichosis TOC

Itraconazole

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Can a negative culture exclude the diagnosis systemic candidiasis ?

N O !

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How can candida present on skin?

As painless skin papules or pustules on an erythematous base

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When NOT to use echinocandins

Not for those with Candida meningitis, UTI, or endophthalmitis because of poor organ penetration.

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TOC for Candida parapsilosis

Fluconazole;

because C. parapsilosis may have reduced susceptibility to echinocandins.

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Treatment duration for uncomplicated candidemia

14 days after clearance of the organism from the bloodstream and resolution of symptoms.

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When to treat ASYMPTOMATIC candiduria

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Only in neutropenic patients and those undergoing urologic procedures.

Neutropenic patients with asymptomatic candiduria should be treated similarly to those with candidemia.

Common sites for Aspergillus infection . . .

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Lung being the principal site of clinical infection, followed by the paranasal sinuses.

Manifestations of pulmonary Aspergillosis . . .

Colonization, allergic bronchopulmonary aspergillosis, aspergilloma (fungus ball), or invasive aspergillosis.

Cardinal features of Allergic bronchopulmonary aspergillosis

asthma-like symptoms, fleeting pulmonary infiltrates on imaging, peripheral eosinophilia, elevated serum IgE levels, serum Aspergillus-precipitating antibodies, and cutaneous reactivity to Aspergillus antigens

When can you see an "halo sign" ?

Invasive pulmonary Aspergillosis and mucormycosis

What can impair sensitivity of β-D-glucan assay ?

Antifungal drugs and Zosyn

"Particular" risk factor for Mucormycosis ?

hematologic malignancies, organ transplantation, diabetes /ketoacidosis deferoxamine for iron-overload Outbreaks have also been reported during natural disasters.

Pathognomonic finding of rhinocerebral mucormycosis ?

presence of a black eschar on nose or palate

Mucormycosis histology . . .

broad, irregular, and ribbon-like aseptate hyphae with right-angle branching.

Predominant Crypto species in the United States?? In California?

All US: C. neoformans California: C. gattii

Most common site of disseminated cryptococcosis

CNS subacute or chronic meningoencephalitis.

What to do when cryptococcosis is found outside of the CNS

Lumbar puncture !!! Skin lesions imply disseminated disease.

Check crypto Ag (serum or CSF)

sensitivity of the serum assay is lower in patients without HIV infection Confirm w/ culture

Blastomyces dermatitidis is endemic to . MOIST EARTH NEAR RIVER, BEAVER DAMS.

Ohio and Mississippi river valleys, Great Lakes, and the St. Lawrence River

MoCo site of infection for Blastomycosis ?

Primarily lungs. Second most frequent is SKIN (painless chronic ulcer/lesion), followed by the bones, joints, and prostate.

What test should all patients with disseminated blastomycosis get

Bone scan to detect occult osteoarticular infection

What serves as nidus for infection/relapse in Blastomycosis ?

Prostate, thus get UCx

Histoplasma capsulatum is the MoCo mycosis in the US and is found in . . .

the Ohio and Mississippi river valleys.

Histoplasmosis presentation . . .

Asymptomatic, Pulmonary Histoplasmosis (miliary lung lesions) Disseminated disease (subacute fever, pancytopenia, hypoadrenalism, mucosal lesions- gingival ulcers)

May be seen in Histoplasmosis on peripheral blood smear

Small yeast forms within neutrophils Check urine Ag

Coccidioides immitis and Coccidioides posadasii are endemic to . . . Both serious lab hazards

Desert areas of the southwestern US, including Arizona, New Mexico, Texas, and the central valley of California; Also parts of Central and South America

What is Valley fever ?

Valley fever is a subacute Coccidioidomycosis infection with respiratory symptoms, fever, and erythema nodosum.

What is “desert rheumatism,” ?

Arthralgia of multiple joints seen in Coccidioidomycosis

Risk factors for disseminated Coccidioidomycosis . . .

Immunosuppression, AIDS, or pregnancy skin, bones (including vertebrae), joints, and the meninges.

Where is Sporothrix schenckii found ?

Soil, moss, and other vegetation | landscaping, gardening.

Sporotrichosis lesions

A papule appears days to weeks after inoculation and ulcerates. Similar lesions "spread" along lymphatics Skin, pulmonary, osteoarticular infection

Exserohilum rostratum

Outbreak of meningitis and other infections due to contaminated lots of methylprednisolone Treated with voriconazole

endemic mycoses = dimorphic fungi • USA

 Histoplasmosis  Coccidioidomycosis  Blastomycosis

endemic mycoses = dimorphic fungi • Overseas

 Talaromycosis marneffei (Penicilliosis marneffei)  Paracoccidioidomycosis (South American blastomycosis)

Histoplasmosis exposure risk factor

Dust from rich earth (digging, raking) or bat guano (caving).

Coccidiodomycosis HY points

thin walled cavity may persist chronic meningitis- Serum and CSF serology useful. Eosinophilia in CSF. COCCI SPHERULE BIG, NO BUDDING Rx: fluconazole. Nonmeningeal: itraconazole

Paracoccidioides brasiliensis, HY points

Multiply budding yeast, slow growing mold. skin and mucosal membranes Asymptomatic infiltrates on chest xray. -Serodiagnosis in endemic areas. Biopsy.

TALAROMYCOSIS |  Talaromyces marneffei (Penicilosis)

 divides by binary fission, no budding  Thailand, South China  Bamboo rats  AIDS, normal children  Skin lesions (looks like crypto [moluscum like]), lymph nodes, liver, spleen, bone  Methenamine silver stain of skin or other tissue. Blood culture+  Treatment: ampho B then itraconazole.

Other names for MUCORMYCOSIS Hyphae invade blood vessels (like Aspergillus)

Cunninghamella, Apophysomyces, Saksenaea

Fungal Infections Flashcards

(56 cards)