Kays Fungal Infection Flashcards
(81 cards)
1
Q
Oropharyngeal candidiasis is
A
an Infection of the oral mucosa with Candida species
2
Q
Esophageal candidiasis is
A
an Infection of the esophagus with Candida species
3
Q
Candida are normal flora in the GI tract and what is the most common candida in the GI tract
A
C. albicans
4
Q
Most common opportunistic infection in HIV patients
A
OPC
5
Q
What is the primary line of host defenses against superficial Candida infections is
A
cell mediated immunity
6
Q
Risk Factors for OPC and EC
A
- steroid use
- dentures
- xerostomia due to drugs , chemo, and radiotherap
- smoking
- disruption of oral mucosa
- drugs
- neonates or elderly
- HIV infection/AIDS
- Diabetes
- Malignancies
- Nutritional deficiencies
7
Q
Clinical presentation of OPC
A
- cottage cheese appearing plaques
- painful mouth, burning tongue, metallic taste
8
Q
Clinical Presentation of EC
A
- painful and difficulty swallowing
- fever, few white/ beige plaques
9
Q
Topical treatment for mild OPC
A
- treat for 7-14 days
- clotrimazole 10mg troche 5xday
- Nystatin 5mL swish and swallow
- Miconazole 50mg buccal tablet
10
Q
Systemic treatment for refractory OPC patients who can’t tolerate or respond to mild therapy
A
- FLuconazole Daily
- Itraconazole solution Daily
- Posaconazole daily for 14 days
11
Q
Treatment for Fluconazole-Refractory OPC
A
treat from 14-28 days
- itraconazole daily
- posaconazole suspension for 28 days
- Amphotericin B deoxycholate
- Voriconazole
- Caspofungin
- Micafungin
- Anidulafungin
- Amphotericin B deoxycholate
12
Q
Treatment of Esophageal Candidiasis
A
treatment 14-21 days
- fluconazole
- itraconazole
- echinocandin
- voriconazole
- posaconazile
- amphotericin B
- Fluconazole refractory treat for 21-28 days
- higher dose itraconazole
- caspofungin
- micafungin
- anidulafungin
13
Q
Vulvovaginal candidiasis is
A
- an infection in women with or without symptoms who have positive vaginal cultures
14
Q
Complicated versus uncomplicated vulvovaginal candidiasis
A
uncomplicated - sporadic infection susceptible to all anti fungal therapy
complicated - recurrent VVC severe disease; non-candida albicans infection
15
Q
Candida albicans and its role in VVC
A
- responsible for the overwhelming majority of VVC
- C. glabrata is increasing in frequency
- terminated candida associated with tissue invasion
16
Q
VVC Risk factors
A
- contraceptives
- antibiotic use
- increased incidence in post-menopausal women taking HRT
17
Q
VVC Symptoms
A
- intense culcular itching, burning on urination
- curl cheese like discharge
- test for vaginal pH
18
Q
VVC Treatment
A
- Over the counter topical agents for uncomplicated VVC are butoconazole, clotrimazole, miconazole, tioconazole.
- prescription Uncomplicated VVC Nystatin and Terconazole, fluconazole, ibrecafangerp
19
Q
Complicated VVC Treatment
A
treatment duration 10-14 days and use the same drugs
- topical agents are safe throughout pregnancy, oral agents contraindicated.
20
Q
Recurrent VVC Treatment
A
Two stage treatment with Topical or oral azole 10-14 days followed by fluconazole once a week for 6 months
21
Q
Antifungal Resistance VVC
A
- Boric acid 600mg capsule, intravaginally daily, then 1 capsule twice a week
- FLucytosine cream 1000mg
22
Q
Dermatophytoses is a superficial mycotic infection of
A
the skin
23
Q
Typical organisms involved in Mycotic infections of ski, hair, and nails
A
TRICHOPHYTON, EPIDERMOPHYTON, MICROSPORUM
24
Q
Risk factors for mycotic infections
A
prolonged exposures to sweaty clothes, failure to bathe regularly,skin folds
25
Tinea pedis
athletes foot
| - topical treatment for 2-4 weeks is adequate in mild infections
26
Tinea manuum
- involves the palmar surfaces
27
Tinea cruris
jock itch topical therapy for mild infections
28
tine corporis
- infection of skin and trunk and extremities
29
tinea capitis
- involves scalp and hair
- usually affects children
- usually treated with oral therapy Terbinafin
30
tine barbae
infection of hair follicles on beards and mustache
31
tinea versicolor
- hyper or hypopigmented scaly patches on trink and extremities
- common for adults in tropical environments
- topical therapy usually enough
32
```
Topical agents that can be used for:
Tinea Pedis
Tinea mannum
Tinea cruris
Tinea corporis
```
- Butenafine
- Sertaconazole
- Ciclopirox
- Clotrimazole
- Econazole
- Haloprogin
- Ketoconazole cream
- Miconazole
- Oxiconazole
- Sulconazole
- Terbinafine
33
```
Oral agents that can be used for more severe infections of:
Tinea Pedis
Tinea mannum
Tinea cruris
Tinea corporis
```
- FLuconazole
- Itraconazole
- Terbinafine
34
Tinea capitis topical treatment
Shampo in conjunction with Terbinafine for 4-8 weeks
35
Tinea barbae topical treatment
- Ketoconazole
| - Selenium Sulfide
36
Tinea barbae oral treatment
Itraconazole
37
Tinea versicolor topical treatment
- Clotrimazole
- Econazole
- Haloprogin
- Ketoconazole
- Miconazole
- Oxiconazole cream
- Sulconazole
38
Tinea versicolor oral treatment
- Fluconazole
| - Itraconazole
39
onchyomycosis treatment
- Terbinafine
- Itraconazole
- Fluconazole
40
Terbinafine AE
- Potent inhibitor of CYP2D6,
- rare and severe hepatotoxicity avoid in liver disease
- may decrease lymphocyte count
41
Histoplamosis potpurri
- Ohio and Mississippi River Valley
- Caused by Histoplasma capsulatum
- organism is phagocytized by macrophages but not killers, macrophages migrate to other areas
42
Histoplasmosis and granulomas
- granulomas form to wall off organism and causes necrotic degredation of tissue
- granulomas become encapsulated and calcified over several years with viable organisms still trapped. can become reinfected if immune system wanes
43
Histoplasmosis presentation
- variable degree of immune suppression
- low inoculum can result in mild pulmonary infection
- high innoculum can result in flu-like sympoms and become hypoxic
44
Disseminated histoplasmosis
- seen in immunocompromised or high innoculum where the body cannot form granulomas
- go through asymptomatic periods and then have periods of weakness and fatigue
45
Histoplasmosis Diagnosis
- standard is serological testing
46
Acute Histoplasmosis Treatment in immunocompetent hosts
- Mild/moderate disease
Itraconazole 6-12 weeks (also posaconazole or fluconazole_
- Moderately Severe Disease
Lipid Amphotericin B for 12 weeks, (may use deoxycholate if low nephrotoxic risk), and methylprednisolone
47
Disseminated Histoplasmosis treatnment in an immunocompromised host
- Less severe disease
Itraconazole for 12 weeks (posaconazole, voriconazole, or fluconazole are ok substitutes)
- Moderately severe disease
Lipid amphotericin B for 1-2 weeks, then Itraconazole for 12 months
48
Blastomyces dermatitides potpurri
- endemic to south eastern south centeral and midwest united states
- infection occurs after inhalaion of the conidia, this draws neutrophils to the lungs and then disseminates it through the body and forms granulomas
49
Acute pulmonary blastomycosis symptoms
- fever chills and productive cough in immunocompetent host
50
Chronic pulmonary blastomycosis symptoms
- fever, malaise, weight loss, night sweats, chest pain, and productive cough
51
Treatment of pulmonary blastomycosis in immunocopetent patients
- mild-moderate disease
itraconazole for 6 months
- moderately severe-severe disease
lipid amphotericin B for 1-2 weeks then itraconazole for 6-12 months
52
Disseminated or extrapulmonary Blastomycosis in immunocompetent patients
- CNS disease
induction lipid amphotericin B 4-6 weeks followed by oral azole for at least 12 months (fluconazole, voriconazolem or itraconazole)
- Moderately severe and mild to moderate disease treat the same as pulmonary disease
53
Blastomycocis treatment in immunocompromised host
- Acute disease
Lipid amphotericin B for 1-2 weeks until improvement and then suppressive therapy for at least 12 months
Itraconazole for at least 12 months
- suppressive therapy might be considered for lifelong patients that we cannot reverse immunocuppression
54
coccidiodomycosis potpurrie
- endemic in southwestern and western united states
- causative pathogen is coccidiodes immits
- initial infection almost always involves lungs
55
Primary coccidiodomycosis facts
- valley fever
- symptoms are fever, cough, headache, sore throat and arthralguas and myalgias, diffuse macropapular rash appears in a few days, pneumonia can be seen later with a blood streaked cough
56
coccidiodomycosis clinical presentation
- persistent pulmonary coccidiodomycosis
disease last more than 6 weeks and is complicated by scarring and spiting blood
- disseminated coccidiodomycosis
seen in skin, lymph nodes, bone, CNS infections we can see headache weakness, neck stiffness, and low grade fever
57
coccidiodomycosis treatment
- primary respiratory infection
fluconazole and itraconazole for 3-6 months
- symptomatic chronic cavitary pneumonia
fluconazole and itraconazole
- diffuse pneumonia with bilateral or miliary infiltrates
58
disseminated coccidiodomycosis treatment
- nonmeningeal disease
itraconazole or fluconazole, or amphotericin B
- meningeal disease
choice treatment is fluconazole for lifelong suppresivetherapy, other options include itraconazole or intrathecal amphotericin B
59
Cryptococcus potpurri
- Cryptococcus neoformans found more in immunocompromised hosts
- Cryptococcus gattii more in immunocompetent hosts.
- found in soil and pigeon droppings
- cell mediated immunity plays important role in this
60
Cryptococcus Clinical Presentation
```
- pulmonary
cough, rales, SOB
- Meningitis
Non-Aids: photophobia, neck stiffness
HIV/AIDS: Fever, malaise, headache
```
61
Cryptococcal meningitis treatment
- non-HIV, non-transplant host
induction: L amphotericin deoxycholate + flucytosine for 4 weeks, may use lipid amphotericin B, extend amphotericin to minimum of 6 weeks if neurologic conditions worsen or if there is no flucytosine given. consider 2 week duration for induction if low risk for failure
consolidation: fluconazole for 8 weeks
Maintenance: fluconazole for 6-12 months
- HIV infected agents
Induction: liposomal amphotericin B + flucytosine for a minimum of 4 weeks,
Consolidation: fluconazole 8 weeks
Maintenance: minimum of at least 1 year of azole therapy. consider stopping after a year if CD4 count is greater than or equal to 100 cells and undetectable viral load for 3 months
62
Cryptococcal meningitis for HIV infected patients alternative regimens
- amphotericin deoxycholate or lipid amphotericin B for 4-6 weeks
- amphotericin B plus fluconazole for 2 weeks then fluconazole for 8 weeks
- fluconazole + flucytosine for 6 weeks
- fluconazole for 10-12 weeks
63
Cryptococcal meningitis treatment for organ transplant recipients
- Induction: Liposomal amphotericin B + flucytosine for at least 2 weeks
Consolidation: FLuconazole for 8 weeks
Maintenacne fluconazole for 6-12 months
64
Candidiasis potpurri
- C. albicans is the most common cause of invasive fungal infections
- PMNs play a major role in patients host defense
65
Candidiasis and candidemia presentation
- acute onset of fever, tachycardia, chills and hypotension
66
Candidemia Treatment in nonneutropenic adults
- Eichinocandins recommended as initial therapy (may transition later to fluconazole if susecptible)
- FLuconazole daily for patients who are unlikely to have fluconazole-resistant Candida species
- azole susceptibility testing recommended for all clinically relevant isolates
- alternative therapy is Lipid amphotericin B, or voriconazole, remove catheters if possible. treat for 14 days after negative blood culture
67
Candidemia treatment in neutropenic adults
- eichinocandin recommended as initial therapy
- lipid formulation of amphotericin B
- if not critically ill and no prior azalea exposure use fluconazole or voriconazole
68
pathogen specific treatments candidemia in neutropenic adults
C. glabrata - echinocandin
C. parapsilosis - fluconazole or lipid amphotericin B
C. krusei - eichinocandin, lipid amphotericin B or voriconazole preferred
- treat for 14 days after documented clearance of candida from blood, resolution of symptoms and neutropenia. remove IV catheters
69
Chronic Disseminated candidiasis treatment
- lipid amphotericin B or an eichinocandin for several weeks, followed by fluconazole
- continue therapy until documentation fo lesion resolution on repeat
70
Empiric Treatment of suspected invasive candidiasis in nonneutropenic adults in ICU
- eichinocanfin preferred
- alternative regimens fluconazole in patients who are not colonized with an azalea resistant Candida species
- recommended treatment duration is 2 weeks
71
Empiric treatment of suspected invasive candidiasis in neutropenic adults in the ICU
- lipid amphotericin B
- echinocadin
- voriconazole
- alternative agents
fluconazole, itraconazole
- azalea should not be used in patients who have received azalea for prophylaxis
72
prophylaxis of invasive candidiasis in the ICU treatment
- fluconazole in patients in ICUs greater than 5% 0f invasive candidiasis
- echinocandin is an alternative
- daily bathing with chlorhexidine
73
intraabdomnial candidiasis treatment
- consider empiric anti fungal therapy for patients with clinical evidence of an intra-abdominal infection, treatment the same as candidiasis in nonneutropenic adults
74
growth of candida species from respiratory secretions, does it require anti fungal therapy
no it doesn't
75
symptomatic treatment of candida UTIs
- for fluconazole susceptible candida cystitis, fluconazole for 2 weeks
- for fluconazole resistant candida species amphotericin B deoxycholate for 1-7 days. amphotericin bladder irrigation. flu cytosine 7-10 days.
- remove or replace indwelling catheters
76
aspergillus potpurri
- causative pathogens are, A. fumigatus, A. flavus, A. niger, A. terries and generally acquired by conidia
- impaired host defenses are required for development of invasive disease. prolonged neutropenia is the most important predisposing factor
77
aspergillosis clinical presentation
- commonly presents in the lungs
- survival beyond 2 or 3 weeks is uncommon, chest pain
- hyphae invade walls of bronchi and surrounding parenchyma resulting in necrotization
78
aspergillus diagnosis
- based on septate hyphae
79
treatment of aspergillosis in invasive pulmonary aspergillosis
- voriconazole
- lipid amphotericin, isavuconazole plus echinocandin in select patients
- echinocandin primary therapy not recommended
- therapy recommended for 6-12 weeks
80
invasive pulmonary aspergillosis salvage therapy treatment options
- amphotericin B, Caspofungin, Micafungin, Posaconazole, or itraconazole
81
prophylaxis of aspergillosis
- posaconazole primary
| - alternative agents are voriconazole, itraconazole, micafungin. aerosilized amphotericin B
