ID-Fungal Infections Flashcards
(43 cards)
Risk factors for candidemia?
Neutropenia, malignancies, organ transplantation, broad-spectrum antimicrobial agents, intravascular catheters, hemodialysis, parenteral nutrition, major abdominal surgery
How is systemic candidiasis usually diagnosed?
By a positive blood culture or a positive culture from a normally sterile site
When disseminated candidiasis is suspected what consults should you get?
Ophthalmology! You get these white exudate splotches on the retina
What are common focal infections in systemic candidiasis?
UTIs, peritonitis, bone and joint infections, CNS infections
For disseminated candidiasis which anti fungal do you start ASAP?
An echinocandin: anidulafungin, caspofungin, micafungin
What candida infections at specific sites do you not treat with an echinocandin?
Do not treat meningitis, UTI, endopthalmitis because echinocandins have poor organ penetration!
What do you do for C. glabrata?
You have to do susceptibility testing to see if it is susceptible to an -azole
What antifungal is recommended for C. parapsilosis?
An azole!
Because it is not susceptible to an echinocandin
Treatment duration for uncomplicated candidemia?
14 days after first negative cultures
Treatment duration of candidiasis focal organ infection?
For several weeks to months… based on resolution of signs and symptoms
When is treatment of asymptomatic candiduria indicated?
ONLY treat in neutropenic patients and those undergoing urological procedures
With positive blood culture for candida what can’t you forget?
to remove central lines!!!
Risk factors for invasive or disseminated aspergillosis?
profound and prolonged neutropenia and immunosuppression associated with chemo or organ transplantation… now being reported in ppl who are critically ill in the ICU and are exposed to glucocorticoids
Radiographic signs of aspergillus infection?
wedge shaped densities that look like infarcts, target lesion with a necrotic center surrounded by a ring of hemorrhage (halo sign)
What is the best way to diagnose disseminated aspergillus disease?
Galactomannan antigen assay, blood cultures are rarely positive
What is the most common way that mucormycosis presents?
Rhinocerebral infection with headache, epistaxis, ocular findings (proptosis periorbital edema, decreased vision)
How can cryptococcal infection be diagnosed?
suggestive histopathology or by the detection of cryptococcal antigen in the serum or CSF
Diagnosis is confirmed by culture
What is the most sensitive and specific assay for the diagnosis of cryptococcal meningitis?
Latex agglutination assay for cryptococcal antigen
How good is the serum assay for cryptococcal infection?
Not as good, it’s sensitivity is lower so a negative test cannot be used to exclude meningitis
CSF profile of cryptococcal meningitis?
Lymphocyte pleocytosis
High opening pressure
Treatment of cryptococcal infection in AIDS patients
Maintenance therapy required until they have responded to antiretroviral therapy (CD 4 count greater than 100 for more than 3 months) and have been receiving antifungal therapy for at least a years
Treatment of cryptococcal infection in those without AIDS
maintenance therapy for 6-12 months
What happens if a patient has received appropriate antifungal therapy and other measures to reduce elevated ICP have failed? In crypto infection…
give frequent lumbar punctures and removal of CSF or placement of a VP shunt is required
What happens to organ transplant patients with cryptococcus on high dose immunosuppressive therapy?
They may require life-long antifungal therapy
