Brainscape's Knowledge GenomeTM

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


See full index

Infectious disease > Fungal Diseases and Antifungals > Flashcards

Fungal Diseases and Antifungals Flashcards

1
Q

7 classes of antifungal agents

A
  1. azoles
    - Triazoles
    - Imidazoles
  2. polyenes
  3. echinocandins
  4. mitotic inhibitors
  5. allyamines
  6. fluctyosine (Ancobon)
  7. ibrexafungerp (Brexafemme)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

fluconazole (Diflucan)

A

Triazoles - azoles

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

itraconazole (Sporanox)

A

Triazoles - azoles

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

Voriconazole (Vfend)

A

Triazoles - azoles

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

posaconazole (Noxafil)

A

Triazoles - azoles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

isavuconazole (Cresemba)

A

Triazoles - azoles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

clotrimazole (Mycelex)

A

Imidazoles - azole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

miconazole (Monistat)

A

Imidazoles - azole

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

ketoconazole (Nizoral)

A

Imidazoles - azole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

terconazole (Terazol)

A

Imidazoles - azole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

tioconazole (Vagistat)

A

Imidazoles - azole

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

econazole (Spectazole)

A

Imidazoles - azole

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

sulconazole (Exelderm)

A

Imidazoles - azole

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

which type of azole has the tendency to have better distribution, fewer SE, fewer DDI

A

triazoles

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

which azole is for systemic or cutaneous infections

A

triazoles

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

which azole is primarily topicals

A

imidazoles

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

which azole is primarily topicals

A

imidazoles

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

MOA that Inhibits synthesis of ergosterol

A

azoles

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

DDI of azoles

A
  1. CYP 450 inhibitors and inducers
    * Inhibitors - slow down azole metabolism
    - Grapefruit juice, alcohol (binge), several antibiotics and stomach acid-reducing products
    * Inducers - speed up azole metabolism
    - Alcohol (chronic), several anticonvulsants
  2. Not recommended with certain BZDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

which azole may have less DDI than others

A

fluconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SE of azole

A
  1. GI upset
  2. HA
  3. taste changes
  4. Major:
    - hepatotoxicity
    - prolonged QT
    - seizures
    - leukopenia
    - thrombocytopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

CI of azole

A
  1. hypersensitivity to rx
  2. coadministration with drugs that can cause same SE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

caution with azole in who?

A
  1. hepatic or renal impairment
  2. pregnancy
    - greatest risks with systemic therapy, 1st trimester
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the prototype azole drug

A

fluconazole (diflucan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

which azole has the most limited spectrum of activity
Candida albicans, Cryptococcus

A

Fluconazole (Diflucan)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

indications for fluconazole

A
  1. superficial fungal infections
  2. uncomplicated systemic infections

Gets into CSF well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Drug of choice against histoplasmosis, sporotrichosis, blastomycosis

A

Itraconazole (Sporanox)
Variable bioavailability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Drug of choice for invasive aspergillosis

A

Voriconazole (Vfend)
Gets into CSF well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

which azoles have
very broad-spectrum
used for invasive fungal infections in immunocompromised pts, or resistant infections

A
  1. Posaconazole (Noxafil) - CSF
  2. isavuconazole (Cresemba) - brain tissue, no CSF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

dosing for azoles

A
  1. mostly BID
  2. QD
    - Econazole (Spectazole)
    - ketoconazole (Nizoral)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

efficacy of azoles

A
  1. mostly equal
  2. may have slightly more efficacy than older azoles (clotrimazole, miconazole)
    - Econazole (Spectazole)
    - ketoconazole (Nizoral)
    - sulconazole (Exelderm)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

which azoles are more expensive and inexpensive

A
  1. expensive
    - Sulconazole (Exelderm) - no generic
    - ketoconazole
  2. inexpensive/OTC
    - Clotrimazole
    - miconazole
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

which antifungal binds to ergosterol in the fungal cell membrane, creating pores in the cell and causing leakage of cell contents

A

polyenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

why doesn’t polyenes bind to our cells

A

Our cells have similar molecules, but polyenes bind to
ergosterol with a greater affinity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

which polyene is considered too toxic to use systemically

A

nystatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

which polyene is indicated for Severe, disseminated mycotic infection
has very broad spectrum of activity

A

Amphotericin B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

SE of Amphotericin B

A
  1. infusion-related - fever, chills, N/V, headache
  2. Renal - renal impairment, nephrotoxicity
  3. Electrolytes - hypokalemia, hypomagnesemia, hyperchloremic acidosis
  4. Others - anemia, hypotension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

which polyene is indicated for non-invasive candidal infections
- Oral, vulvovaginal, intertrigo

A

Nystatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

SE of nystatin

A
  1. Topical - local irritation, allergic reaction
  2. Oral - local irritation, allergic reaction, GI upset (N/V/D, abdominal pain)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

which antifungal inhibits synthesis of β-(1,3)-d-glucan, needed for fungal cell walls

A

Echinocandins
caspofungin (Cancidas), anidulafungin (Eraxis), micafungin (Mycamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

which antifungal class is indicated for invasive fungal infections
- Disseminated candidiasis
- Aspergillosis (especially in HIV+ patients)

A

Echinocandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

DDI with Echinocandins

A

minimal effect on CYP 450 system - fewer DDI than azoles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

SE of Echinocandins

A
  1. Infusion-related - dyspnea, flushing, hypotension
  2. Common - GI upset, HA, fever, insomnia
  3. Serious - hepatotoxicity, hypokalemia, anemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what antifungal has the possibility to act on cell wall and DNA synthesis

A

Mitotic Inhibitors (Griseofulvin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

how is Mitotic Inhibitors (Griseofulvin) absorbed best

A

with fatty meals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

which antifungal is indicated for Dermatophyte (tinea) infections of hair and skin

A

Mitotic Inhibitors (Griseofulvin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

DDI with Mitotic Inhibitors (Griseofulvin)

A
  1. alcohol
    - Can cause “disulfiram”-type rxn
  2. contraceptives
  3. warfarin
  4. barbiturates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

CI of Mitotic Inhibitors (Griseofulvin)

A
  • allergy to med
  • liver failure
  • porphyria
  • pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

SE of Mitotic Inhibitors (Griseofulvin)

A
  1. HA, GI upset, skin rashes, dizziness
  2. Serious - hepatotoxicity, teratogenic, granulocytopenia
    - Need weekly CBCs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

what antifungal interferes with ergosterol synthesis

A

Terbinafine (Lamisil) - Allyamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

indications for allyamines

A
  1. Oral - onychomycosis, dermatophyte (tinea) infections of hair and skin
  2. Topical - Dermatophyte (tinea) infections of hair and skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

DDI with allyamines

A

numerous - certain beta-blockers, certain TCAs, tamoxifen, tramadol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

CI with allyamines

A

allergy to med, liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

SE of allyamines

A
  1. HA, GI upset, skin rashes, taste disturbances
  2. Serious - hepatotoxicity, neutropenia
    - Monitor LFTs and CBC before and during tx
    - Liver damage usually reversible, but case reports of liver failure and death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

which antifungal enters cells and is converted to 5-fluorouracil, which inhibits fungal RNA and protein synthesis

A

flucytosine (Ancobon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

which antifungal is indicated for
- adjunct treatment used in combination with amphotericin B
- For severe candidal or cryptococcal infections (immunocompromised pts)

A

flucytosine (Ancobon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

which medication has a BBW with possible renal failure

A

flucytosine (Ancobon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

SE of flucytosine (Ancobon)

A

BBW
1. Renal - renal failure
- increased renal function testing
2. GI - hepatic injury, hepatotoxicity, GI upset
3. Heme - pancytopenia/aplastic anemia
4. CNS - peripheral neuropathy, confusion, psychosis, dizziness, ataxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

which antifungal inhibits glucan synthase, used to make part of the cell wall

A

ibrexafungerp (Brexafemme)
First drug in new novel antifungal class, triterpenoids

60
Q

which antifungal is indicated for Vulvovaginal candidiasis (single-day treatment option)

A

ibrexafungerp (Brexafemme)

61
Q

CI for ibrexafungerp (Brexafemme)

A

allergy
pregnancy

62
Q

SE of ibrexafungerp (Brexafemme)

A
  1. GI - abdominal pain, nausea, diarrhea in 10-17%
    - Rare - elevated AST/ALT, flatulence, vomiting
  2. GU - vaginal bleeding, dysmenorrhea
  3. Other - rash, dizziness, back pain
63
Q

what are the other Topical Therapies for Tineas

A
  1. Butenafine (Lotrimin)
  2. Tolnaftate (Tinactin)
  3. Naftifine (Naftin)
64
Q

what topicals are OTC and indicated for dermatophytes (tineas)

A
  1. Butenafine (Lotrimin)
  2. Tolnaftate (Tinactin)
65
Q

which topical antifungal is:
rx only, newly generic but still may be a little expensive
may be more effective than clotrimazole and miconazole
Indicated for dermatophytes (tineas)

A

Naftifine (Naftin)

66
Q

what are the Topical Therapies for Onychomycosis

A
  1. Ciclopirox (Loprox, Penlac)
  2. Tavaborole (Kerydin)
  3. Efinaconazole (Jublia)
67
Q

which topical:
- Expensive , but now generic, more effective than clotrimazole and miconazole
- Indicated for dermatophytes, onychomycosis, seborrheic dermatitis

A

Ciclopirox (Loprox, Penlac)

68
Q

which topical:
- Expensive, but has a generic version; equally effective as ciclopirox
- Indicated for onychomycosis

A

Tavaborole (Kerydin)

69
Q

which topical:
- Expensive (no generic)
- More effective than clotrimazole, miconazole, and even ciclopirox
- Indicated for onychomycosis

A

Efinaconazole (Jublia)

70
Q

Risk factors for candidiasis

A
  1. Chronic disease - chronic kidney disease, cancer, HIV, DM
  2. Medications - corticosteroids, immunosuppressants, broad-spectrum abx
  3. Vascular access - IV drug use, intravascular catheters
  4. Other - recent surgery (especially abdominal), prolonged neutropenia, organ transplant
71
Q

what fungal infection is part of normal flora of the mouth and esophagus or the lower respiratory tract are AIDS-defining opportunistic infections!

A

Candidiasis

72
Q

epidemiology of Oral Candidiasis

A

infants
elderly
DM
immune deficiency
after use of meds like antibiotics/steroids

73
Q

symptoms for Oral Candidiasis

A

Early - asymptomatic
Later - abnormal or diminished taste, pain with eating/swallowing

74
Q

pt has
Beefy red, edematous mucosa of oral cavity
+/- white plaques on tongue, palate, buccal mucosa, oropharynx
Plaques can be scraped off with a tongue depressor
what could be their diagnosis?

A

Oral Candidiasis

75
Q

how do you diagnose oral candidiasis

A
  1. Often clinically
  2. KOH prep - budding yeasts, pseudohyphae
  3. Culture - + for candidal species - more accurate, longer to results
76
Q

tx for oral candidiasis

A
  1. Topical Therapy
    - Nystatin
    - Clotrimazole
    - Miconazole
  2. Systemic Therapy
    - Fluconazole
    - May cut down to 100 mg after day 1
  3. Gentian Violet (alternative)

tx for 7-14 days

77
Q

epidemiology of Esophageal Candidiasis

A

typically in HIV + or other severely
immunosuppressed pts; often also have oral thrush

78
Q

if a pt is experiencing odynophagia, nausea, reflux, +/- oral thrush
what could be their diagnosis?

A

Esophageal Candidiasis

79
Q

diagnosing Esophageal Candidiasis

A

endoscopy

80
Q

tx for esophageal candidiasis

A
  1. Oral azoles
    - Fluconazole (Diflucan)
    - Itraconazole (Sporanox) - More costly, more nausea, must use solution rather than tablet
  2. IV therapy
    - Fluconazole (Diflucan)
81
Q

if you are treating for esophageal candidiasis and have resistance to fluconazole, what could you use?

A

voriconazole, posaconazole, or an echinocandin

82
Q

epidemiology of Vulvovaginal Candidiasis

A

Up to 75% of women will have at least once in their lifetime
HIV, pregnancy, antibiotic use, uncontrolled DM all up the risk

83
Q

pt presents with
Discomfort - itching, burning, and pain around genital area
Discharge - thick, white, nonmalodorous, “cottage cheese”
what is their diagnosis?

A

Vulvovaginal Candidiasis

84
Q

PE findings for Vulvovaginal Candidiasis

A

Erythematous, edematous mucosa
+/- erythema, edema, excoriations of external genitalia
Thick, white, curdy, “cottage cheese” discharge that is easily removed with a swab

85
Q

diagnosing vulvovaginal candidiasis

A

Often can diagnose clinically
KOH prep - budding yeasts, pseudohyphae
Culture - + for candidal species - more accurate, longer to results

86
Q

tx for vulvovaginal candidiasis

A
  1. Topical Therapy
    - Miconazole (Monistat)
    - clotrimazole (Mycelex)
    - terconazole (Terazol)
  2. Systemic Therapy
    - Fluconazole (Diflucan)
    - Ibrexafungerp (Brexafemme)
  3. Recurrent/Prophylactic Therapy
    - Azoles
    - Probiotics - questionable benefit, but little harm
  4. Alternative Tx
    - Gentian Violet
    - Boric Acid PV x 7 days
87
Q

what increases risk of candidal intertrigo

A
  1. obesity
  2. occlusive or tight clothing
  3. sweating
  4. incontinence
  5. DM
  6. immunosuppression
  7. medications
88
Q

during PE you find
Erythematous, macerated, well-defined plaques in skin folds
Satellite erythematous papules and pustules
what could it be?

A

intertrigo

89
Q

how do you diagnose intertrigo?

A
  1. Often clinically
  2. KOH prep (skin scrapings) - budding yeasts, pseudohyphae
  3. Culture - + for candidal species - more accurate, longer to results
89
Q

how do you diagnose intertrigo?

A
  1. Often clinically
  2. KOH prep (skin scrapings) - budding yeasts, pseudohyphae
  3. Culture - + for candidal species - more accurate, longer to results
90
Q

tx for intertrigo

A
  1. Correcting underlying factors
    - Weight loss, controlling DM, wearing different clothing, etc.
    - Drying agents - talc, nystatin powder
  2. Topical Therapy (until resolution)
    - Topical azoles
    - nystatin, BID
  3. Systemic Therapy - if severe/extensive
    - Fluconazole
91
Q

tineas are caused by what organism

A
  1. Dermatophytes
    - “feed” off keratin
    - Infect skin, nails, and hair
    - Epidermophyton, Trichophyton, Microsporum
92
Q

if a pt presents with
Single or multiple scaly, circular patches on scalp
Alopecia; may see “black dots” at follicles
(broken-off hairs)
what do they have?

A

Tinea Capitis
Patches slowly enlarge over time

93
Q

diagnosing tinea capitis

A
  1. clinically
  2. KOH prep and/or culture - usually only in
    ambiguous/refractory cases
94
Q

tinea capitis is MC seen in who?

A

children
Thought to spread via child-to-child contact

95
Q

How is tinea corporis spread?

A

person-to-person contact
can be contracted from infected animals

96
Q

pt presenting with
Center of lesion clearing, while a raised, advancing, scaly red border remains
what do they have?

A

Tinea Corporis

97
Q

pt presenting with
Center of lesion clearing, while a raised, advancing, scaly red border remains
what do they have?

A

Tinea Corporis

98
Q

how do you diagnose tinea corporis

A
  1. clinically
  2. KOH prep and/or culture - usually only in ambiguous/refractory cases
99
Q

Tinea Cruris is MC in who? risk factors?

A
  1. Males > females
  2. Risk factors - obesity, DM, immunodeficiency, sweating
100
Q

if a pt presents with
Erythematous lesions with scaly, sharp, spreading
margins; may have central clearing
confining to the groin and gluteal cleft
what is it?

A

Tinea Cruris
can be asx or itchy

101
Q

how to diagnose tinea cruris

A
  1. clinically
  2. KOH prep and/or culture - usually only in ambiguous/refractory cases
102
Q

what fungal infection is known to be
Shared showers, locker rooms, floors around public pools

A

tinea pedis

103
Q

what other fungal infections can be seen with tinea pedis

A

tinea cruris, tinea manuum, tinea unguium

104
Q

Itching, burning, stinging of the toes and feet
Erythematous bullae (acute) → scaling, fissuring, macerated skin, thickened plaques

A

tinea pedis

105
Q

how to diagnose tinea pedis

A
  1. clinically
  2. KOH prep and/or culture - usually only in ambiguous/refractory cases
    - May be falsely negative if taken from macerated skin
106
Q

etiology of tinea unguium

A

dermatophytes
yeasts
molds

107
Q

risk factors of tinea unguium

A

elderly, swimming, tinea pedis,
immunocompromised, DM, psoriasis

108
Q

a pt prsenting with a thickened nail with yellow/brown discoloration, separated from nail bed
what do they have?

A

Tinea Unguium

109
Q

how do you diagnose tinea unguium

A

KOH prep and/or culture
recommended to r/o other nail disorders

110
Q

tx for tinea capitis

A
  1. Systemic
    - griseofulvin
    - terbinafine
    - may consider fluconazole, itraconazole
111
Q

tx for tinea corporis

A
  1. Topical
    - azole
    - butenafine
    - tolnafate
    - ciclopirox
    - terbinafine
    - QD-BID until cleared (1-3 wks)
  2. Systemic - extensive or refractory
    - griseofulvin
    - terbinafine
    - fluconazole
    - itraconazole
112
Q

tx for tinea cruris

A
  1. Topical
    - azole
    - butenafine
    - tolnafate
    - ciclopirox
    - terbinafine
    - until cleared (1 wk)
    - drying powders
  2. Systemic - extensive or refractory
    - griseofulvin
    - terbinafine
    - fluconazole
    - itraconazole
113
Q

tx for tinea pedis

A
  1. Topical
    - azole
    - butenafine
    - tolnafate
    - ciclopirox
    - terbinafine
  2. Systemic - extensive or refractory
    - terbinafine
    - itraconazole
    - fluconazole
    - griseofulvin
  3. If macerated
    - aluminum subacetate soaks 20 min BID
114
Q

tx for tinea unguium

A
  1. Topical
    - efinaconazole
    - tavaborole
    - ciclopirox
  2. Systemic
    - terbinafine
    - itraconazole
115
Q

what should NOT be given for dermatophyte infections

A

topical nystatin

116
Q

presentation of Disseminated Candidiasis

A
  • Varies greatly - minimal fever to septic shock
  • May see skin lesions ranging from pustules to nodules
  • May involve liver, kidney, spleen, eyes, heart
    risk factors: severely immunocompromised state; nosocomial infection
117
Q

diagnosing disseminated candidiasis

A

blood cultures only (+) 50% of the time

118
Q

tx for disseminated candidiasis

A
  1. _First-line (especially if critically ill or non-albicans strain) _
    - IV echinocandins
    - Caspofungin
    - Micafungin, anidulafungin
  2. Mild-Moderate Disease
    - fluconazole

Continue for 2 weeks AFTER last positive blood culture

119
Q

what infection is transmitted via inhaled spores from contaminated bird and bat droppings

A

Histoplasmosis
- Primarily in river valleys (Ohio and
Mississippi River Valleys in US)
- Begins in lungs, but spreads throughout the body

120
Q

4 forms of histoplasmosis presentations

A
  1. MC
    - asx/mild
    - accidental findings of pulmonary and/or splenic calcification may see “eggshell” LN calcification
  2. acute pulmonary - after soil with bird or bat droppings is disturbed
    - Fever, cough, myalgias, minor chest pain -
    - Mild flu-like illness to severe pneumonia - 1 week to 6 months
    - CXR - Miliary infiltrates and mediastinal LAN
  3. Progressive disseminated - Immunocompromised pts (HIV+, TNF-blockers)
    - Fever, cough, dyspnea, weight loss, prostration, oropharyngeal ulcers
    - Multiple organ system involvement - hepatomegaly, splenomegaly, GI inflammation, adrenal insufficiency, bone marrow suppression, CNS infection
    - CXR - miliary infiltrates and mediastinal LAN
    - Can have fulminant, septic shock-like presentation progressing to death without tx
  4. Chronic pulmonary - older pts with underlying chronic lung disease
    - Pts are not necessarily immunosuppressed!
    - CXR - apical cavities, chronic infiltrates, pulmonary nodules
121
Q

complications of histoplasmosis

A
  1. Granulomatous mediastinitis - persistent mediastinal LAN and fibrosis of the mediastinum
    - compromises pulmonary vascular structures
    - SVC syndrome, esophageal constriction
122
Q

work up for histoplasmosis

A
  1. Labs
    - may see anemia of chronic disease elevated LDH, ferritin, and/or AST
    - Disseminated - pancytopenia possible
  2. Cultures
    - sputum culture (chronic disease)
    - blood culture (disseminated)
  3. Bronchoscopy
    - with biopsy
123
Q

tx for histoplasmosis

A
  1. Mild-Moderate = itraconazole (Sporanox)
    - HIV/AIDS pts - need lifelong suppressive tx
  2. Severe = IV amphotericin B
  3. Granulomatous/Fibrosing Mediastinitis
    - itraconazole, +/- rituximab, +/- corticosteroids
    - often need surgical intervention
124
Q

what infection is transmitted via inhaled spores that grows in arid soil, such as SW US, Mexico, and Central America?

A

Coccidioidomycosis
“Valley fever”

125
Q

what infection is transmitted via inhaled spores that grows in arid soil, such as SW US, Mexico, and Central America?

A

Coccidioidomycosis
“Valley fever”

126
Q

Coccidioidomycosis is MC in who?

A
  • immunocompromised, elderly
  • Suspect in patients who live or
    work in endemic areas
127
Q

60% of Coccidioidomycosis cases are ____

A

asx

128
Q

presentations of coccidioidomycosis

A
  1. Primary Coccidioidomycosis - incubation period of 10-30 d followed by fever, chills, fatigue, HA, cough, myalgia
    - arthralgia and joint swelling (knees and ankles)
    - Rash (erythema nodosum) - may appear 2-20 days after s/s onset
    - CXR - infiltrate, cavities, abscesses, nodules, bronchiectasis
  2. Disseminated coccidioidomycosis - 0.1% of white, 1% of nonwhite patients
    - Filipinos, blacks, pregnant women, and immunosuppressed = high risk
    - Worsened pulmonary s/s - mediastinal LAD, cough, increased sputum, lung abscesses
    - Multiorgan involvement - skin, bones, pericardium/myocardium, meningitis
    - Fungemia is possible; usually followed rapidly by death
    - CXR - localized infiltrate, thin-walled cavities, pulmonary abscesses, nodules, mediastinal LAD, pleural effusion
129
Q

how do you diagnose/work up Coccidioidomycosis

A
  1. Labs
    - may see leukocytosis, eosinophilia
    - May test for IgM and IgG complement fixation titer; possible to have false negatives
  2. Cx
    - blood cultures rarely positive
  3. Bronchoscopy
    - with biopsy and culture - most reliable method
  4. CXR - patchy, nodular and lobar upper lobe pulmonary infiltrates are MC
130
Q

tx for coccidioidomycosis

A

“valley fever”
1. Mild-Moderate
- fluconazole/itraconazole - 4-12 wks
- voriconazole, posiconazole if refractory
2. Severe/Disseminated
- IV amphotericin B x 2-3 weeks, then switched to azole
- Abscesses may need surgical management
3. Prophylactic
- AIDS pts with CD4 count <250 - maintenance therapy with azole to prevent relapse

131
Q

tx for coccidioidomycosis

A
  1. Mild-Moderate
    - fluconazole/itraconazole - 4-12 wks
    - voriconazole, posiconazole if refractory
  2. Severe/Disseminated
    - IV amphotericin B x 2-3 weeks, then switched to azole
    - Abscesses may need surgical management
  3. Prophylactic
    - AIDS pts with CD4 count <250 - maintenance therapy with azole to prevent relapse
132
Q

what infection is caused by inhaled spores found in moist soil with decomposing organic matter (wood and leaves)
MC seen in men infected during
outdoor activities for
occupation/recreation

A

Blastomycosis

133
Q

presentation for blastomycosis

A
  1. Asymptomatic - about 50% of cases
  2. MC - chronic pulmonary infection
    - Flu-like - cough, moderate fever, dyspnea, chest pain
    - Extrapulmonary involvement - nodular, wart-like lesions
    - S/S may resolve or progress to pneumonia-like illness
  3. Disseminated - rare; mainly immunocompromised pts
    - Bone - ribs, vertebrae MC affected
    - GU - epididymitis, prostatitis, bladder irritation
    - Skin - may see nodular lesions as above
134
Q

work up for blastomycosis

A
  1. Labs - may see leukocytosis, anemia
    - Urine antigen test - cross-reactivity with Histoplasma
  2. Cultures - sputum cultures; blood cultures if disseminated
  3. Bronchoscopy - with biopsy and culture
  4. CXR - airspace consolidation or masses are most common
135
Q

tx for blastomycosis

A
  1. Mild-Moderate - itraconazole (Sporanox)
  2. Severe/CNS involvement - IV amphotericin B
136
Q

what infection is transmitted by inhaled spores found in soil and pigeon dung

A

Cryptococcosis

137
Q

presentation of Cryptococcosis

A
  1. Pulmonary disease - ranges from mild to respiratory failure
    - May see simple nodules or fever, cough, dyspnea, widespread infiltrates
  2. Meningitis
    - HA followed by altered mental status, fever, CN abnormalities
    - Meningeal signs - often absent, especially in HIV+
  3. Skin - mainly in immunocompromised pts
    - May see nodular lesions
    - May mimic bacterial cellulitis
138
Q

what is the MC cause of fungal meningitis

A

Cryptococcosis

139
Q

work up for Cryptococcosis

A
  1. Serum - may test for serum cryptococcal antigens
  2. Cultures - sputum, blood, and/or urine cultures may be helpful
  3. Bronchoscopy - with culture of sputum
  4. CSF - budding, encapsulated yeast; + cryptococcal antigen
140
Q

tx for Cryptococcosis

A
  1. Pneumonia - fluconazole (Diflucan)
    - HIV patients need continued suppressive therapy
  2. Meningitis - IV amphotericin B plus flucytosine (if tolerated)
    - Followed by 8 wks of fluconazole
    - Frequent LP or CSF shunting to relieve high CSF pressure if needed
141
Q

what infection transmission is believed to have airborne transmission
Most individuals have had asymptomatic infection by a young age

A

pneumocystosis

142
Q

major patterns of clinical infection of pneumocystosis
aka who do they affect the most?

A
  1. Epidemics among premature or debilitated
    infants in underdeveloped countries
  2. Sporadic cases among older children and adults
    with impaired immunity
    - HIV/AIDS patients
143
Q

presentation of pneumocystosis

A
  1. Pulmonary - abrupt onset of fever, tachypnea, SOB, nonproductive cough
    - +/- bibasilar crackles on exam
    - Spontaneous pneumothorax is possible
    - Rapid deterioration and death if not treated
144
Q

work up for pneumocystosis

A
  1. CXR
    - diffuse interstitial infiltration
    - may also see consolidation, nodules, cavitations
  2. Bronchoscopy - special testing of respiratory specimens
    - Giemsa, methenamine silver, PCR, monoclonal antibody testing

cannot be cultured

145
Q

tx for pneumocystosis

A
  1. First-Line
    - TMP-SMZ (Bactrim)
    - HIV patients with CD4 <200 need continued suppressive therapy
  2. Second-Line
    - primaquine/clindamycin
    - trimethoprim-dapsone

Infectious disease (15 decks)

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