Exam 6 - Invasive Fungal Infections Flashcards
Which type of fungal pathogen is a frequent nosocomial infectious pathogen?
Candida
Name the two types of microbial resistance.
1) Primary - prior to exposure
2) Secondary - after exposure
Name the 5 primary pathogens of systemic infections.
1) Histoplasma
2) Blastomycosis
3) Coccidioides
4) Sporotrichosis
5) Crytpococcus
Name the 5 opportunistic pathogens in systemic infections.
1) Candida
2) Aspergillus
3) Mucor (Zygomycetes)
4) Fusarium
5) Trichosporon
What is the name of the nonspecific diagnostic test for any fungal pathogen?
B, D-glucan (Fungitel)
What type of test is the B, D-glucan (Fungitel) diagnostic test?
A nonspecific test for any fungal pathogen
What is the name of the diagnostic test that is specific for Aspergillus spp?
Galactomannan test
What type of diagnostic test is the Galactomannan test?
One that is specific for Aspergillus spp.
Which two types of pathogens have urinary antigen tests?
Cryptococcal
Histoplasma
The following are risk factors for which pathogen:
- Indwelling catheter/IV line
- Surgery
- Broad-spectrum antibiotics
- TPN therapy
- IV drug users
- Immunocompromised pts
- -Neutropenic, Immunosuppressed, HIV/AIDS?
Systemic candidiasis
A ____ ____ provides a definitive diagnosis of systemic candidiasis.
A BLOOD CULTURE provides a definitive diagnosis of systemic candidiasis.
In both immunocompromised and immunocompetent adults, what is the initial/empiric treatment for Systemic Candida?
Echinocandin - i.e., Micafungin
In the treatment of systemic candida, if the species is albicans what is the next step?
To convert to an AZOLE - i.e., Fluconazole
How long do you treat a systemic candida infection for?
14 days after the FIRST negative blood culture
Where is Aspergillosis found?
Soil, plant debris, air
Who is at risk for Aspergillosis infections?
Immunocompromised pts
- Stem cell transplant
- Solid organ transplant
- Immunodeficient pts
- Bone marrow cancers
- Steroid use
What 3 ways can Aspergillosis present?
1) Allergic bronchopulmonary aspergillosis
2) Aspergilloma
3) Invasive Aspergillosis (IA)
How are Aspergillosis infections diagnosed? (4)
1) Tissue/specimen cultures
2) Chest x-rays, CT scans
3) Bronchial alveolar lavage
4) Galactomannan assay
What is the name of the diagnostic test that tells you if the fungi is Aspergillosis spp.?
Galactomannan test
What is FIRST LINE TREATMENT for Invasive Aspergillosis?
VORICONAZOLE
-IV, then PO x 6-12 weeks
How long is Voriconazole used in Invasive Aspergillosis?
IV, then PO x 6-12 weeks
Name 2 alternatives to treating Invasive Aspergillosis.
1) AmphoB (lipid)
2) Isavuconazole
Name the 4 salvage treatments in treating Invasive Aspergilosis.
1) Caspofungin
2) Micafungin
3) Posaconazole
4) Itraconazole
Name the 2 options for FIRST LINE TREATMENT of allergic bronchopulmonary Aspergillosis.
1) Itraconazole
2) Voriconazole
with steroid
Name the 3 options of FIRST LINE TREATMENT for Aspergilloma.
1) Surgery, then ….
2) Itraconazole OR
3) Voriconazole
Who is primarily impacted by Histoplamosis?
Immunocompromised pts
What are the S/S associated with Histoplasmosis?
- Fever
- Cough
- Fatigue
- Chills
- HA
- Chest pain
- Body aches within 3-17 days after inhaling fungal spores
T/F: For some pts, histoplasmosis is self-limiting.
TRUE - Immunocompetent pts
Name two types of pts that need treatment for Histoplasmosis.
1) Chronic histoplasmosis in the lungs
2) Disseminated histoplasmosis (immunosuppressed pts)
What is the treatment for severe or moderately severe Histoplasmosis treatment?
Lipid Amphotericin B for 1-2 weeks, followed by Itraconazole for 12 weeks
-May also need a steroid for 1-2 weeks for the lungs
What is the treatment for Disseminated Histoplasmosis?
Lipid Amphotericin B for 1-2 weeks, followed by Itraconazole FOR 12 MONTHS
How is CNS histoplasmosis treated?
Lipid Amphotericin B for 4-6 weeks, followed by Itraconazole for 12 months
Name the 3 concerning SE associated with Amphotericin B.
1) Nephrotoxicity
2) Hypokalemia
3) Hypomagnesia
What causes hypokalemia and hypomagnesia in using Amphotericin B?
Distal tubular acidosis
What is the mechanism of nephrotoxicity in Amphotericin B?
Proximal tubular damage
Where can Coccidioidomycosis be found?
Soil and dirt
How do pts obtain a Coccidioidomycosis infection?
Inhaling arthroconidium
What do pts complain of with a Coccidioidomycosis infection?
Respiratory illness
Name the primary treatment in Coccidioidomycosis infections.
FLUCONAZOLE
Who is at risk for Coccidioidomycosis infections?
Pt with winter homes in AZ, southern CA
T/F: For immunocompetent pts, a blastomycosis infection can be self-limiting.
TRUE
What is the treatment for Blastomycosis infections?
Lipid Amphotericin B for 1-2 weeks until improvement, then LD Itraconazole followed by maintenance for 6-12 months
T/F: Cryptococcus neoformans is rare in immunocompetent pts.
TRUE
What two organ systems does Cryptococcus neoformans affect?
Lungs
CNS
What is the GOLD standard for diagnosing Cryptococcus neoformans?
Culture the organism
-Antigen detection on CSF or serum
What is the treatment for mild to moderate Cryptococcus neoformans in the lungs?
FLUCONAZOLE
What is the treatment of severe infection in the lungs of Cryptococcus neoformans or CNS infection?
Amphotericin B + Flucytosine
What is the name of the common skin infection caused by rose bushes or other plant material?
Sporotrichosis
What is the causative organism of Sporotrichosis?
Sporothrix schenckii
How is Sporotrichosis treated?
Itraconazole (Sporonox) for 3-6 months
