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General ID 2019 > Fungal and anti-fungals > Flashcards

Fungal and anti-fungals Flashcards

1
Q

Name the molds and shape?

A

hyphae: Aspergillosis, mucormycoses, and fuariosis

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2
Q

Name the yeasts and shape?

A

round budding cells. malassezia, cryptococosis, candidiasis

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3
Q

Basic characteristics of endemic mycoses?

A
  • grows in certain environments as a mold and infects human who inhales spores.
  • All are dimphoric fungi
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4
Q

give examples of endemic fungus (5)

A
  • USA: histoplasmosis, coccidiomycosis, blastomycosis
  • Overseas: talaromycosis marneffei (penicillosis marneffei), paracoccidiomycosis (south american blastomycosis)
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5
Q

what is a dimorphic fungus?

A
  • mold in nature and in room temperature culture
  • rounded form in infected tissue
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6
Q

Describe the acute pneumonia from pulmonary histoplasmosis?

A
  • 2 week after exposure to dust from rich earth, or bat guano (caving)
  • difficult to culture from sputum
  • lung nodule may persist
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7
Q

what species cause “valley fever”

A

Coccidioomycosis immitis and Coccidiomycosis posadasil

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8
Q

how does valley fever pneumonia present?

A

2 weeks after inhalation with acute pneumonia with possible arthralgias and erythema nodosum

residual nodule or thin walled cavity may persist

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9
Q

What are the symptoms of disseminated coccidiomycosis?

A

bone, skin, chronic meningitis

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10
Q

what is the treatment of cocidiomycosis?

A

fluconazole. If nonmeningeal can use itraconazole.

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11
Q

how would you diagnose coccidiomycosis?

A

seurm and CSF serology. Eosinophilia in CSF

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12
Q

what are the species associated with blastomycoses?

A

B.dermatitidis and B.Gilchristi

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13
Q

Where is blastomycoses found?

A

moist earth near river, beaver dams

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14
Q

where does blastomycoses disseminate and tx?

A
  • skin, bone, male GU tract.
  • Itraconazole
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15
Q
A

thick walled budding cells; Blasto

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16
Q
A

cocci spherule big no budding. coccidiomyocisis microscope?

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17
Q

Talarmycosis basics?

A

think blasto in thailand with bamboo rats

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18
Q

Illness script for aspergillus pneumonia?

A

sudden onset of a dense, well-circumscribed lesion in a neutropenic patient.

  • halo sign early, crescent late
    • galactomannan
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19
Q

what can create false positives in the galactomanna test?

A

some beta lactams and fusarium

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20
Q

give examples of mucormycosis?

A
  • Mucor
  • Apophysomyces
  • Rhizopus, Rhizomucor
  • cunninghamella
  • saksenaea
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21
Q

what are risk factors for mucormycosis?

A

DM2, neutropenia, steroids, desferoxamine

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22
Q

how does mucormycosis transmit? treatment?

A
  • infection acquired by inhaling spores into lung or paranasalsinus
  • hyphae invavde blood vessels, causes infarction and necrosis.
  • may form cavity if PMNs return
  • ampho B, posaconazole
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23
Q

illness script for fusariosis? treatment?

A
  • red tender skin nodules, mycetoma, or pneumonia. see in immunocompromised, transplant, aplastic anemia and burn patients.
  • Tx with either ampho or voriconazole
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24
Q

what do you see in Scedsporiosis apiospermum?

A

hyphae and a clinical disease resembling aspergillus

Near drowning patient

Ampho resistant, tx with voriconazole

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25
Q

What do you see in Scedsporiosis prolificans?

A

also known as lomentospora prolificans.

similar to aspergillus

resistant to all antifungals

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26
Q

key point for malessezia furfur

A

needs oil in culture to grow

27
Q

3 key points in candidemia?

A
  • remove IV catheter if possible
  • dilated fundoscopic exam in first week
  • intravitreal drug if vitiritis or macular lesion
28
Q

what is more likely to be seen in C.gatti compared to C.neoformans?

A

C.gatti more likely to be seen in lung, non-HIV patient, S.California, Vancouver island, overseas

29
Q

what is the typical presentation of Cryptococcosis IRIS?

A
  • weeks or months after ARV/antifungal rx for meningitis
  • Fever, headache, seizures, new MRI lesions
  • All cultures negative
  • dry cough, substernal pain
  • swollen nodes in mediastinum, hilum
  • Treat with NSAIDs or prednisone
30
Q

what mycoses DO NOT test positive for beta-d-glucan test?

A

cryptococcosis or mucormycosis

31
Q

ddx for eosinophilic meningitis?

A
  • Hodgkins lymphoma
  • parasites: angiostronglyus, gnathostoma and baylisacaris
  • Coccidiomycosis
32
Q

when should you consider blastomycosis?

A

a previously healthy adult with indolent, ulcerative crusted skin lesions with asymptomatic pulmonary infiltrate

33
Q

Fusarium - you think?

A

skin nodules, blood culture with mold

34
Q

ecthyma gangrenosa - you think?

A

aspergillosis, mucor, bacteria

35
Q

Histo, you think?

A

TNF alpha blockers, miliary infiltrates

36
Q

aspergillosis think?

A

halo sign, crescent sign

37
Q

mucormyocisis think?

A

mimic cavernous sinus thrombosis, aseptate, ampho

38
Q

cocci think?

A

solitary lung cavity, eosinophilic meningitis

39
Q

blasto think?

A

indolent skin + lung lesion

40
Q

candida think?

A

liver, spleen lesion in neutropenic

41
Q

Name the echinocandins?

A

caspofungin, micafungin, anidulafungin

42
Q

what is the MOA of the echinocandins?

A

inhibit glucan synthase, block synthesis of 1-3 beta glucans in the fungal cell wall

43
Q

what is the MOA of azoles?

A

inhibit sterol C-14 demethylase, block synthesis of sterol

44
Q

what is the MOA of ampho?

A

damages fungal cytoplasmic membranes

45
Q

what is the MOA of flucytosine?

A

flucytosine is converted to 5FU, inhibits DNA synthesis

46
Q

what are the mechanisms of antifungal resistance in Azoles?

A
  • Mutations in CYP51AS (code for C14 demethylase) gene in candida and aspergillus
  • mutations in CYPT51A promoter region in aspergillus
  • increased drug efflux in candida glabrata
47
Q

what are the mechanisms of antifungal resistance in Echinocandins?

A

mutations in FKS1 and FKS2 (code for glucan synthase)

48
Q

which species are resistant to amphotericin?

A
  • Scedosporium apiospermum (Pseudallescheria boydii)
  • Lomentospora (Sc) prolificans
  • Aspergillus terreus
  • variable in candida lusitaniae
  • Variable in candida auris
49
Q

which species are resistant to fluconazole?

A
  • All molds
  • candida krusei
  • candida auris
  • candida haemluonii
  • some candida glabrata
50
Q

which species are resistant to voriconazole?

A
  • mucormycosis
  • fusarium solani
  • rarer aspergillus species (lentulus, ustus, calidoustus)
51
Q

which species are resistant to posaconazole?

A
  • mucormycosis (variable)
  • fusarium solani
  • rarer aspergillus species (lentulus, ustus, calidoustus)
52
Q

which species are resistant to echinocandins?

A
  • Cryptococcus
  • Trichosporon
  • Molds other than aspergillus
53
Q

Basics of voriconazole?

A
  • Good CSF levels, none in urine
  • Use oral formulation in azotemia
  • Drug interactions: photosensitivity, hallucinations, hepatitis, visual changes, peripheral neuropathy
  • Long term use need to worry about skin cancer, periostitis (bone pain, alk phos, plasma fluoride high)
54
Q

what combination therapy can you use for invasive pulmonary aspergillosis?

A
  • voriconazole + echinocandin
  • Isavuconazonium/isavuconazole (Cresemba)
55
Q

basics of cresemba?

A
  • no drug in CSF or urine
  • teratogenic
  • approved for mucor
  • noninfrior to vori in invasive aspergillosis
  • no dose change for renal or liver failure
56
Q

basics of posaconazole?

A
  • approved for prophylaxis in GVHD or prolonged neutropenia
  • can use in mucor once responded to ampho
  • CYP3A4 inhibitor
  • well tolerated, check trough levels
57
Q

basics on echinocandins?

A

cryptococcus, trichosporon resistant

no drug in urine

poor penetration into CSF and vitreous humor of eye

all candida species susceptible

active against mold aspergillus

58
Q

basics on ambisome?

A
  • deoxycholate formulation: conventional ampho b
  • liposomal formulation: ambisome
  • low urine concentrations
  • penetrates CSF and vitreous humor poorly
  • can cause acute chest pain or back pain with the first infusion
  • potassium wasting in urine
59
Q

basics of flucytosine?

A
  • 100% bioavailability
  • good levels in CSF and urine
  • drug resistance arises during monotherapy
  • Used with ampho in cryptococcal meningitis
  • Accumulates in azotemia: bone marrow depression, hepatitis, colitis
  • leukopenia, thrombocytopeenia, diarrhea, hepatitis
60
Q

what can you use to treat a Scedosporium apiospermum lung abscess?

A
  • oral voriconazole, no dose adjustment in azotemia
  • Itraconazole relatively contraindicated in HF
  • ampho has little efficacy
  • Echinocandins not active
61
Q

primary treatment for mucor?

A

ampho

62
Q

Azole interacts with what drugs? (increase/decrease)?

A

Increase drug levels: cyclosporine, tacrolimus, steroids, imantinib

phenytoin, rifmapin decrease azole levels

63
Q

when organisms can you not use ampho?

A

Not Scedosporium, candida lusitaniae, asperillus terreus

64
Q

what do you need to watch out for while on ambisome?

A

renal failure, hypokalemia, hypomagnesemia, pancytopenia, hepatitis

General ID 2019 (19 decks)

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