Tieman - Invasive Fungal Infections Flashcards
(20 cards)
Candidiasis signs and symptoms
-Fever
-Tachycardia
-Tachypnea
-Chills
-Hypotension
Candidiasis risk factors
-Broad-spectrum antibacterial agents
-Use of central venous and urinary catheters
-Dialysis
-Neutropenia (ANC less than 500)
-Immunosuppression
-Surgery (especially intra-abdominal)
-Intrabdominal perforation
Candidemia treatment
-Echinocandin
-Fluconazole once you know species (based on local susceptibilities)
-Get susceptibility testing done on all blood stream and clinically relevant isolates
-Narrow to oral therapy
-Remove the line (candida likes to stick to prosthetic material)
-Repeat blood cultures every 48h
-Treat for 14 days after first negative blood culture
When can you narrow candidemia treatment to oral?
-Once susceptibilities are achieved
-Patient is clinically stable
-Negative repeat blood cultures
-Been on therapy for 48h
Alternative candidemia therapy
-Amphotericin B
-Voriconazole
Candidemia treatment for neutropenic patients
-Echinocandin
-Lipid formulation of amphotericin B
-If not critically ill and no prior azole therapy then can give fluconazole or voriconazole
Histoplasmosis clinical presentation
-Weight loss
-Night sweats
-Fever
-Seizure
-Mental status changes
Treatment of mild-moderate acute pulmonary histoplasmosis
Itraconazole 200mg TID for 3 days, then 200 mg QD or BID for 6-12 weeks
Treatment of severe acute pulmonary histoplasmosis
Lipid amphotericin B 3-5 mg/kg/day for 1-2 weeks, then itraconazole 200 mg TID for 3 days followed by 200 mg BID for total of 12 weeks
Treatment of mild-moderate disseminated histoplasmosis
Itraconazole 200mg TID for 3 days, then 200 mg QD or BID for at least 12 months
Treatment of severe disseminated histoplasmosis
Lipid amphotericin B 3-5 mg/kg/day for 1-2 weeks, then itraconazole 200 mg TID for 3 days followed by 200 mg BID for at least 12 months
When to treat coccidioidomycosis
-Most patients with symptomatic primary pulmonary disease recover without therapy
-Treat patients with large inocula, severe infection, or concurrent risk factors
Treatment of primary respiratory coccidioidomycosis infection
Fluconazole 400-800 mg PO/IV daily for 3-6 months
Treatment of symptomatic chronic cavitary coccidioidomycosis pneumonia
Fluconazole 400-800 mg PO/IV daily for 12 months
What is the most causative pathogen for cryptococcosis?
Cryptococcus neoformans found in soil and pigeon droppings
Cryptococcosis clinical presentation
-Pulmonary: cough, rales, SOB
-Meningitis: headache, fever, NV, mental status changes, nuchal rigidity
How to diagnose cryptococcosis
Lumbar puncture and look at fluid
How to treat cryptococcal meningitis
-Induction: amphotericin B + flucytosine
-Consolidation: fluconazole
-Maintenance: fluconazole
Treatment of invasive pulmonary aspergillosis
-Voriconazole 6 mg/kg IV for 1 day then 4 mg/kg IV q12h
-Continue treatment for a minimum of 6-12 weeks
Prophylaxis treatment for aspergillosis
Posaconazole
