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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
What do you see in Scedsporiosis prolificans?
also known as lomentospora prolificans. similar to aspergillus resistant to all antifungals
26
key point for malessezia furfur
needs oil in culture to grow
27
3 key points in candidemia?
* remove IV catheter if possible * dilated fundoscopic exam in first week * intravitreal drug if vitiritis or macular lesion
28
what is more likely to be seen in C.gatti compared to C.neoformans?
C.gatti more likely to be seen in lung, non-HIV patient, S.California, Vancouver island, overseas
29
what is the typical presentation of Cryptococcosis IRIS?
* 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
what mycoses DO NOT test positive for beta-d-glucan test?
cryptococcosis or mucormycosis
31
ddx for eosinophilic meningitis?
* Hodgkins lymphoma * parasites: angiostronglyus, gnathostoma and baylisacaris * Coccidiomycosis
32
when should you consider blastomycosis?
a previously healthy adult with indolent, ulcerative crusted skin lesions with asymptomatic pulmonary infiltrate
33
Fusarium - you think?
skin nodules, blood culture with mold
34
ecthyma gangrenosa - you think?
aspergillosis, mucor, bacteria
35
Histo, you think?
TNF alpha blockers, miliary infiltrates
36
aspergillosis think?
halo sign, crescent sign
37
mucormyocisis think?
mimic cavernous sinus thrombosis, aseptate, ampho
38
cocci think?
solitary lung cavity, eosinophilic meningitis
39
blasto think?
indolent skin + lung lesion
40
candida think?
liver, spleen lesion in neutropenic
41
Name the echinocandins?
caspofungin, micafungin, anidulafungin
42
what is the MOA of the echinocandins?
inhibit glucan synthase, block synthesis of 1-3 beta glucans in the fungal cell wall
43
what is the MOA of azoles?
inhibit sterol C-14 demethylase, block synthesis of sterol
44
what is the MOA of ampho?
damages fungal cytoplasmic membranes
45
what is the MOA of flucytosine?
flucytosine is converted to 5FU, inhibits DNA synthesis
46
what are the mechanisms of antifungal resistance in Azoles?
* 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
what are the mechanisms of antifungal resistance in Echinocandins?
mutations in FKS1 and FKS2 (code for glucan synthase)
48
which species are resistant to amphotericin?
* Scedosporium apiospermum (Pseudallescheria boydii) * Lomentospora (Sc) prolificans * Aspergillus terreus * variable in candida lusitaniae * Variable in candida auris
49
which species are resistant to fluconazole?
* All molds * candida krusei * candida auris * candida haemluonii * some candida glabrata
50
which species are resistant to voriconazole?
* mucormycosis * fusarium solani * rarer aspergillus species (lentulus, ustus, calidoustus)
51
which species are resistant to posaconazole?
* mucormycosis (variable) * fusarium solani * rarer aspergillus species (lentulus, ustus, calidoustus)
52
which species are resistant to echinocandins?
* Cryptococcus * Trichosporon * Molds other than aspergillus
53
Basics of voriconazole?
* 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
what combination therapy can you use for invasive pulmonary aspergillosis?
* voriconazole + echinocandin * Isavuconazonium/isavuconazole (Cresemba)
55
basics of cresemba?
* 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
basics of posaconazole?
* approved for prophylaxis in GVHD or prolonged neutropenia * can use in mucor once responded to ampho * CYP3A4 inhibitor * well tolerated, check trough levels
57
basics on echinocandins?
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
basics on ambisome?
* 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
basics of flucytosine?
* 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
what can you use to treat a Scedosporium apiospermum lung abscess?
* oral voriconazole, no dose adjustment in azotemia * Itraconazole relatively contraindicated in HF * ampho has little efficacy * Echinocandins not active
61
primary treatment for mucor?
ampho
62
Azole interacts with what drugs? (increase/decrease)?
Increase drug levels: cyclosporine, tacrolimus, steroids, imantinib phenytoin, rifmapin decrease azole levels
63
when organisms can you not use ampho?
Not Scedosporium, candida lusitaniae, asperillus terreus
64
what do you need to watch out for while on ambisome?
renal failure, hypokalemia, hypomagnesemia, pancytopenia, hepatitis

General ID 2019 (19 decks)

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