Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical 2 - Antibiotics > 11 - Invasive Fungal Infections > Flashcards

11 - Invasive Fungal Infections Flashcards

1
Q

List the type of infections associated with candida

A
  • Mucosal candidiasis such as oropharyngeal, esophageal, vulvovaginitis
  • Candidemia, 4th most common cause of blood stream infection
  • Invasive candidiasis (i.e. acute disseminated) involves visceral sites/organ
  • Hepatosplenic candidiasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common species of Candida

A

Candida albicans (>50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

______ prophylaxis/pre-emptive use, increases occurrence of non-albicans

A

Fluconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

______ = emerging HCA pathogen with MDR (multi drug resistance)

A

C. auris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the risk factors for developing a candidal infection ?

A
  • ICU > 4 days, septic shock, liver transplant, peritoneal dialysis-related peritonitis
  • severe pancreatitis, GI surgery particularly if associated with leak
  • immunocompromised especially due to hematologic malignancy, chemotherapy, transplant, immunosuppression, corticosteroids
  • central venous catheter
  • broad spectrum antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the basis for diagnosing candidiasis

A
  • Culture
  • Microscopic visualization (yeasts are bigger so you can see them under a microscope)
  • Histopathology critical for deep-seated infections and particularly mold infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the clinical signs and symptoms of candidiasis

A
  • Endophthalmitis involving choroid and retina, with fluffy yellow-white lesions +/- vitrifies or retinal hemorrhages; dilated funduscopic exam indicated in all cases of candidemia
  • Skin lesions with pustules on erythematous base; scrape sample or punch biopsy for histopathology and culture
  • Hepatosplenic micro-abscesses, present with persistent fever, RQ pain, increased ALP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the prognosis of Candidemia ?

A

30-40% mortality, increase 3x with delay in therapy >12-24 hours (lower for C. parapsilosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Outline the anti fungal therapy for treating candidemia in NON-neutropenic patients

A

Prompt anti fungal therapy, remove/replace catheter if that is the source

Treat with:
Echinocandin (class of AB)
-Anidulafungin
-Caspofungin
-Micafungin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do you treat Candida with for a non-crticially ill, non-invasive and without risk factors for Fluconazole-R ?

A

Fluconazole

  • 800 mg (12mg/kg) po/iv LOAD
  • 400mg (6mg/kg) q24h
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is an alternative (either for intolerance, resistance or pregnancy) for treating candidal infections ?

A

Amphotericin B

  • deoxycholate
  • liposomal preparation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When would you consider PO-step down therapy from IV therapy (Echinocandin or AmphoB) to Fluconazole

A

After 5-7 days if symptoms resolved and clinically stable, Fluconazole-S isolate and negative repeat blood culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the duration of treatment for NON-neutropenic patients ?

A

2 weeks after negative repeat blood culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Outline the anti fungal therapy for treating candidemia in neutropenic patients.

A

Prompt anti fungal therapy, more likely GI than CVC source, consider granulocyte colony-stimulating factors/granulocyte infusions if persistent infection and prolonged neutropenia

-Treat with Echinocandin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Non-neutropenic patient - most likely from a ____ source

A

CVC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Neutropenic patient - most likely from a ___ source

A

GI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Alternative for intolerance, resistance or pregnancy ?

A

AmphoB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What can we add for additional fungal/mold coverage ?

A

Voriconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Duration of treatment for a candidal infection for neutropenic patients

A

2 weeks after negative repeat blood culture, symptoms resolved and neutropenia resolved (ANC > 500)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the 2nd most common Candida ?

A

C. glabrata

21
Q

What is the treatment for C. glabrata ?

A
  • Dose-dependent anti fungal activity
  • Increasing Flucon-R (>10%)
  • Emerging Echino-R

-Try Echinocandin first (HD)

  • *C. glabrata is 100% susceptible to fluconazole but at a HIGH DOSE (800mg q24h)
  • *100% susceptible dependent on high dose
22
Q

Alternatives for treating C. glabrata ?

A
  • AmphoB (HD)
  • Fluconazole (HD 800 mg q24h)
  • Voriconizole (200-300 mg q12h)
23
Q

What is the 3rd most common Candida ?

A

C. krusei

24
Q

Describe C. krusei

A
  • considered intrinsically fluconazole-R

- relatively high AmphoB MICs

25
Q

How do you treat C. krusei ?

A

Echinocandin

  • Anidulafungin
  • Caspofungin
  • Micafungin
26
Q

What are alternatives for treating C. krusei ?

A
  • Voriconazole (if susceptible)

- AmphoB (HD)

27
Q

Side effect of AmphoB ?

A

nephrotoxicity

28
Q

What are special considerations in treating invasive candidiasis (like things that involve the eye) ?

A

Prompt, aggressive and prolonged anti fungal therapy guided by patient characteristics, clinical status, site of infection and treatment response

**Echinocandins do not penetrate the eye, therefore fluconazole is drug of choice.

29
Q

What is the role of empirical anti fungal therapy for candidiasis?

A

-Initiate therapy, prior to definitive diagnosis for suspected infection based on preliminary microbiology or histopathology for persistent fever despite broad-spectrum antibiotics in high-risk patient (critically ill ICU, neutropenic fever, immunocompromised, total parenteral nutrition, recent GI surgery, candida colonization)

30
Q

What 2 agents can be used as empirical anti fungal therapy for candidiasis ?

A
  • Echinocandin

- Fluconazole

31
Q

What is an alternative for empirical antifungal therapy for candidiasis ?

A

AmphoB

-covers mold

32
Q

What is each triazole approved for:

Fluconazole

A

-oropharyngeal, esophageal and invasive candidiasis; PROPHYLAXIS

33
Q

What is each triazole approved for:

Itraconazole

A

-oropharyngeal, esophageal candidiasis

34
Q

What is each triazole approved for:

Voriconazole

A

-esophageal and invasive candidiasis

35
Q

What is each triazole approved for:

Posaconazole

A

oropharyngeal candidiasis; PROPHYLAXIS

36
Q

What is aspergillosis?

A

-spore-forming mold, environmental exposure; most commonly A fumigatus or A. flavus

37
Q

Aspergillosis:

Significantly ________ patients including hematologic malignancy, transplants (BMT, SOT), prolonged neutropenia

A

immunocompromised

38
Q

Describe the treatment of invasive pulmonary aspergillosis

A

prompt anti fungal therapy, source control, consider GCSF/granulocyte infusions

39
Q

What is the 1st line for treating invasive pulmonary aspergillosis?

A

Voriconazole with limited data for initial 2 week combination therapy with Echinocandin [AmphoB] for prolonged duration > 6-12 weeks)

40
Q

When should we check Voriconazole levels at steady state ?

A

4-7 days

41
Q

What can be used as secondary prophylaxis for treating invasive pulmonary aspergillosis ?

A
  • Voriconazole
  • Posaconazole
  • *during subsequent immunosuppresion
42
Q

What are some alternatives for secondary prophylaxis for treating invasive pulmonary aspergillosis?

A
  • Itraconazole (unreliable bioavailability)
  • Caspofungin
  • Micafungin
43
Q

What is blastomycosis?

A

-spore-forming mold, environmental exposure (inhalation) surrounding Ohio and Mississippi River, endemic in Manitoba, Ontario (LOTW)

44
Q

What can blastomycosis cause?

A

Acute or chronic pulmonary infection (25-40% involve skin, osteoarticular, genitourinary or CNS), disseminated infection presenting 3-6 months post-exposure.

45
Q

What is the treatment for moderate-severe blastomycosis ?

A

-AmphoB x 1-2 weeks, max 2 grams
THEN
-Itraconazole 200 mg po q12h x 6-12 months

46
Q

What is the treatment for mild-moderate blastomycosis ?

A

Itraconazole 200mg po q12h x 6-12 months

47
Q

Limited data for ______ as alternative to intraconazole

A

voriconazole

48
Q

Describe mucormycosis

A
  • spore-forming mold, environment exposure
  • rhino-orbital-cerebral or pulmonary mucomycosis
  • surgical treatment in conjunction with AmphoB [Posaconazole]

Clinical 2 - Antibiotics (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions