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Exam2 fungal infections Flashcards

1
Q

Adverse effects of nystatin

A

80% of patients are nephrotoxic if given orally

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2
Q

Distribution of azoles

A

Orally available; cola/acid helps absorption of itraconazole

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3
Q

Distribution of griseofulvin

A

Lipids increase oral absorption, concentrates in dead keratinized layer of the skin

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4
Q

How to treat diaper rash (Candida albicans)

A

Keep skin dry, azole creams, clotrimazole

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5
Q

In ergosterol production, where do allylamines (terbinafine, tolnaftate) and azoles act, respectively?

A

Squalene epoxidase (squalene –> 2,3-oxidosqualene); C14-a-demethylase (Lanosterol–> ergosterol and cholesterol)

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6
Q

Mechanism of Nystatin?

A

Fungicidal; Binds ergosterol and opens a pore to make membrane leaky

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7
Q

Mechanisms of benzalamine (butenafine) and allyamine (tervinafine, tolnaftate)

A

Fungicidal; Inhibits squalene epoxidase leading to a toxic accumulation of squalene

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8
Q

Mechanisms of griseofulvin

A

Fungistatic; Binds microtubules to inhibit spindles leading to multinucleate effects

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9
Q

Name cutaneous fungal infections

A

Malassezia, Dermatophytes (microsporum, epidermophyton, trichophyton)

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10
Q

Name different skin mycoses

A

Cutaneous fungal infections, subcutatneous infections, opportunistic mycoses

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11
Q

Name mechanism of azoles (Fluconazole, Itraconazole, Clotrimazole, Miconazole, Ketoconazole

A

Fungistatic; Binds fungal p450 (Erg11, C14-a-demethylase) blocking production of ergosterol

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12
Q

Name opportunistic mycoses

A

Candida albicans part of normal flora

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13
Q

Name subcutaneous fungal infections and how they infect

A

Enter through skin followed by subcutaneous or lymphatic spread; Sporothrix

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14
Q

Pathogenesis of dermatophytes

A

Monomorphic molds secrete proteases and keratinases, fungal antigens cause inflammation, grow best in cooler temps (not 37C)

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15
Q

Resistance of nystatin

A

acquired is rare, fungi can reduce ergosterol on membrane

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16
Q

Resistance to azoles

A

Altered cytochrome p450, increased efflux

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17
Q

Resistance to butenafine, terbinafine, tolnaftate

A

rare

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18
Q

Spectrum of azoles

A

Most widely used antifungal and spectrum varies by agent

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19
Q

Spectrum of butenafine, terbinafine, tolnaftate

A

Broad, dermatophytes, Candida, Sporothrix

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20
Q

Spectrum of griseofulvin

A

Dermatophytes

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21
Q

Spectrum of nystatin

A

Active against yeast and molds, dermatophytes are intrinsically resistant

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22
Q

Three major genuses of dermatophytes: ring worm, tinea jock itch, athlete’s foot

A

Trichophyton, Microsporum, Epidermophyton

23
Q

Three modes of dermatophyte transmission

A

Anthropophillic (persion to person fomite), Zoophilic (animal to human), Geophilic (soil)

24
Q

Toxicity of azoles

A

Drug-drug interactions, hepatotoxicity, neurotoxicity, alters hormone synthesis (avoid during pregnancy)

25
toxicity of griseofulvin
TERATOGENIC, DISULFIRAM-LIKE REACTION, monitor hematology, renal and hepatic fxn
26
Toxicity to butenafine, terbinafine, tolnaftate
Topical, severe hepatitits if given orally, and drug-drug interactions; avoid giving to pts with liver disease
27
Treatment of dermatophytes
Topical griseofulvin, terbinafine, itraconazole for 1 month; Oral for hair and nail infections (monitor for hepatotoxicity)
28
Treatment of cradle cap?
Selenium sulfide shampoo
29
What can also lead to infection with Candida
Immune difficiencies and prior antibiotic use (opportunistic infection)
30
What causes cradle cap?
Inflammatory reaction to Malassezia
31
What causes diaper rash?
Candida albicans, usually a secondary infection with an antibiotic treatment
32
What causes rose gardener's disease? Pathogensis? Treatment?
A puncture wound with Sporothrix schenckii; spread along lymphatic channels forming nodular lesions, need to biopsy a lymph node to diagnose; Oral itraconazole for 3-6 months, heat for pregnant women
33
What causes tinea pedis (ringworm), and tinea capitis?
Trichophyton rubrum (transfers at swimming pools); Trichopyton tonsurans (child to child)
34
What causes tinea versicolor?
Malassezia furfur: yest converts to mold and requires lipids for growth, grows in areas rich with sebaceous glands. Looks hypopigmented or hyperpigmented.
35
What is a less common cause of tinea pedis and cruris?
Epidermophyton floccosum
36
What is the main way to diagnose a fungal infection? Others?
10% KOH test and collect the skin on to a slide to look under a microscope; Wood's lamp, can culture on Sabouraud media, skin biopsy w/ periodic acid-schiff stain
37
What is the resistance to griseofulvin
change in beta-tubulin
38
What to dermatophytes require for growth?
Keratin
39
Where does Microsporum grow? Diagnosis?
Hair (ectothrix) and skin; Wood's light blue-green
40
Why is compliance a problem with griseofulvin?
Patient has a hard time taking drug for 4-6 weeks.
41
T/F: Candida albicans is an opportunistic infections
True
42
How do you diagnose a Candida albicans infection?
typically based on clinical appearance
43
Name three genera of dermatophytes
Trichophyton, Microsporum, Epidermophyton
44
most common cause of tinea capitis in US
Trichophyton tonsurans
45
most common cause of tinea pedis
Trichophyton rubrum
46
What microsporum is zoophilic that transfers through cats and dogs?
Microsporum canis
47
What microsporum is geophilic?
Microsporum fulvum
48
How should you treat a pregnant pt who has Sporothrix schenckii?
Apply heat to affected are (itraconazole is harmful during pregnancy)
49
What is this disease? What typically causes it? What does its KOH test look like? What's the treatment?
Tinea versicolor; *Malassezi furfur;* Spaghetti and meatballs; Salenium sulfide shampoo
50
What organism is identified by the KOH test below (macro and microconidia)
*Trichophyton rubrum*
51
What organism if identifiable by its KOH test below (spindle shaped macroconidia)
*Microsporum*
52
What organism is identifiable by it's KOH test below? (Dumbell shaped macrosporidum)
*Epidermophyton floccosum*
53
What organism is identifiable by its KOH test below? (rosette formation)
*Sporothrix schenckii*

Skin/MSk (31 decks)

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