Echinocandin: - anidula, capso, micafungin POOR organ penetration to UTI, meninges, endophthalmitis

Infectious diseases Flashcards by Sophie Shorten

Standard TB therapy

2 months daily: 
isoniazid 
rifampicin 
pyrazinamide
ethambutol

4 months daily or 3x week:
Isoniazid
Rifampicin

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Isoniazid side effects

Rash
Hepatits
Peripheral neuropathy
Lupus like syndrome

Pyridoxine may help prevent peripheral neuropathy
adjust for kidney
safe in pregnancy + BF

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Rifampicin side effects

Rash
Hepatits
GI
colours body fluids orange (rifampicin/orangutan)
Drug interactions ** protease inhibitors and NNRTIs**

not safe in pregnancy

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Pyrazinamide

Hepatitis ***
rash, GI 
hyperuracaemia &amp; gout 
hyperglycaemia 
renal adjustment

only works in acidic environment - good for the caseating bit
shortens the 9 month course to 6 months

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Ethambutol

optic neuritis
rash
regular testing of VA and colour
adjust for kidney

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Treatment of latent TB

12 week DOT isoniazid + rifampicin
9 months isoniazid alone (HIV on ART)
pregnancy + HIV or recent exposure (otherwise defer)
4 months rifampicin (isoniazid resistant)

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TB meningitis

9-12 month course

+ steroids

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MDR TB

isoniazid
rifampicin
fluoroquinalone
amikacin

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BCG

used in endemic countries to prevent disseminated meningitis in children
does not prevent primary infection or reactivation

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Risk factors for non-TB Mycobacterial infection

low CD4
IL-12
IFN-y
STAT1
lung disease - COPD/bronchiectasis

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Mycobacterium avium complex

pulmonary disease
middle age older adult male smokers COPD
nonsmoking postmenopausal women with pectus-excavatum, MV prolapse, scoliosis and joint abnormalities
nodular bronchiectatic disease
most common cause of NTBM lymphadenitis
disseminated disease CD4<50
clarithromycin or azith, ethamb, rifampicin

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Mycobacterium kanasii

mimics pulmonary TB
risk factors: COPD, cancer, HIV, EtOH, immunosuppression
isoniazid, ethamb, rifamp

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Systemic candiadiasis

catheter
neutropenia
malignancies
organ transplantation 
broad spectrum antis
immunosuppression 
chemo
haemodialysis 
TPN
major abdo surgery

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Candidaemia

Echinocandin:

anidula, capso, micafungin
POOR organ penetration to UTI, meninges, endophthalmitis*

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Candiduria

fluconazole

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Candida glabrata

resistant to azoles

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Candida kruseii

resistant to fluconazole

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Candida parapsilosis

usually always catheter related
resistant to echinocandins
use fluconazole

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ABPA

hypersensitivity reaction that occurs with colonisation of the larger airways with aspergillus

RFs: CF/COPD

Asthma like sx, fleeting pulmonary infiltrates, peripheral eosinophilia, elevated IgE, serum aspergillus antibodies

Rx: Steroids + irta/voriconazole

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Aspergilloma

surgical management

antifungals for symptomatic, non-surgical candidates

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Invasive or disseminated aspergillosis

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RFs: transplant, neutropenia, steroids+++ICU

invades pulmonary vasculature
CNS, heart, GI, skin

Blood cultures frequently negative, Dx Bx
Galactomannan antigen assay detects serum antibodies to cell wall antigens

Rx Voriconazole
amphotericin B, echinbocandins, posaconazole

Mucormycosis

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Rhizopus, Mucor spp
Pts with uncontrolled DKA
Desferoxamine for iron overload
Severe burns or trauma

rhinocerebral
rapidly fatal

epixtaxis
occular findings -> proptosis, periorbital oedema, decr VA
black eschar in th enose or palate
broad irregular ribon like hypae with right angle branching

Cryptococcosis

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commonly meningioenphepahalitis
when skin (molluscum) , prostate, bone lesions are found, typically disseminated disease (perform LP)
histo, antigen in CSF
latex agglutinatination more sensitive in HIV pts

high OP
lymphocytic pleocytosis
low glucose

steroids + antifungals
frequent LPs or VP shunt

maintenance therapy for 6-12 months
HIV: 12 months + CD4>100 for >3months

Cryptococcal meningitis

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Amphotericin B + flucytosine / fluconazole
oral fluconazole maintenance

steroids

Histoplasmosis

asymptomatic acute and chronic pulmonary disease granulomatous mediastinal disease + fibrosing mediatinitis, broncholithiasis, pulmonary nodules (histoplasmomas) acute progressive disease: hepatosplenomegally and pancytopenia small yeasts can bee seen within neutrophils on film

Sporotrichosis

skin gardening papule develops weeks after inoculation and ulcerates track along lymphatics

WHich oral abx achieve good CSF penetration?

Chloramphenicol, rifampicin, trimethoprim+sulfamethoxazole metronidazole achieve good CSF penetration when taken orally

Encephaliitis

alteration in mental status for 24hours or more fever, focal neurological deficit, seizure, CSF pleocytosis, abnormal EEG or neuroimmaging all patients should undergo neuroimaging

Toxoplasma encephalitis

HIV infection and in other immunocompromised patients, cerebral infection with Toxoplasma gondii usually presents with multiple ring-enhancing brain lesions on magnetic resonance imaging (MRI). sulfadiazine

which malaria has chloroquine resistance?

Falciparum | Vivax

PJP prophylaxis

CD4 <200 ``` glucocorticoids >20mg daily for >month + other immunosuppression ALL CLL: alemtuzumab Idelisamib ``` temozolomide & radiotherapy Solid organ - 12months, lifelong lung HCT - cytarabine/fludarabine high dose steroids Bactrim DS MFW

Toxoplasmosis

CD4 <100 & positive serology Bactrim DS

MAC

CD4 <50 Azith 1200mg weekly

latent TB

Isoniazid for 9 months

cobicistat & doutegravir

inhibit tubular secretion of creatinine

tenofovir

Hep B and HIV

Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs)

``` Abacavir Tenofivir Lamivudine Emtricitabine Zidovudine ```

NNRTIs

``` '-vir-' class effect: nausea, rash SJS, abnormal liver function efavirenz - psych sx etravirine - hyperlipidaemia, DRESS nevirapine - LFTs, ```

Protease inhibitors

-navir"

Prizaquintel

schistosomiasis, clonorchiasis, opisthorchiasis, tapeworm infections, cysticercosis, hydatid disease, and other fluke infections

Tinidazole

Amoebic liver abscesses

echinocandins

glucan synthesis inhibitors | fungolytic to yeasts and fungostatic to filamentous fungi

Carbapenums generally do not cover-

MRSA VRE Enterococcus faecium

azoles

inhibit ergosterol synthesis triazoles imidazoles

polyenes

amphotericin B | bind ergosterol

fluconazole

excellent yeast cover | no mould cover

itraconazole

extended cover, but inconsistent bioavailability limits use in critically ill pts

Voriconazole

first-line agent for the treatment of invasive aspergillosis, but its bioavailability is unpredictable and genetically determined, it is associated with unique side effects, and it lacks activity against the Mucorales, the agents of mucormycosis

posaconazole and isavuconazole

broadest spectrum of activity

ketoconazole

imidazoles largely been replaced by the triazoles because of superior pharmacokinetics, improved safety profiles, and higher efficacy for the treatment of systemic mycoses

Mechanism of action of amphotericin B

disruption of fungal cell wall synthesis because of its ability to bind to sterols, primarily ergosterol, which leads to the formation of pores that allow leakage of cellular components

Infectious diseases Flashcards

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