fungal infection Flashcards
what bodily systems does aspergillosis affect?
most commonly respiratory tract
invasive forms can affect heart, brain, skin
1st line and alternatives for aspergillosis infection
1st line voriconazole
2nd line liposomal amphotericin B
caspofungin or itraconazole in pt who are refractory to, or intolerant of voriconazole and liposomal amphotericin B
vaginal candidiasis can be treated with locally acting antifungals or with fluconazole given by mouth. for resistant organisms in adults, the following can be given by mouth
itraconazole
what are the echinocandins?
end in -fungin e.g. caspofungin
for invasive or disseminated candidiasis, the following anti fungal class can be given
echinocandin (-fungin)
what is an alternative for invasive or disseminated Candida albicans infection in clinically stable pt who have not received an azole antifungal recently
fluconazole
what should be considered for initial treatment of CNS candidiasis
amphotericin B
what can you use for infections caused y fluconazole resistant Candida spp. when oral therapy is required, or in pt intolerant of amphotericin B or an echinocandin
voriconazole
in refractory cases of invasive or disseminated candidiasis what can you give
flucytosine + IV amphotericin B
greater risk of candial infections if the following RF
- inhaled CCs
- chemo
- broad spectrum abx
- serious sytemic disease associated with reduced immunity e.g. hIV, malignancy, leukemia
how to reduce risk of oral candidiasis associated with CC inhalers
rinse mouth with water or clean teeth immediately after using inhaler
or use spacer
or using inhaler at lowest effective dose
mild and localised oral thursh infections and alternative
miconazole oral gel
oral nystatin
consider oral fluconazole for pt with extensive or severe infection, or when the above are unsuitable or ineffective
what to do if oral thrush infection fails to respond to treatment after 1 week
consider extending course for another week or specialist referral as appropriate
Acute erythematous candidiasis
usually associated with a burning sensation of the mouth or tongue
oral candidiasis that causes soreness and redness, especially on the tongue and palate
name two potential causes of acute erythematous candidiasis
CC or BS abx use
Acute erythematous candidiasis treatment
Treatment is the same As for pseudomembranous Candidiasis
○ Oral miconazole gel
○ Nystatin
○ Fluconazole
Denture related problems should be managed prior to antifungal treatment
Denture stomatitis
also known as
chronic atrophic candidiasis
Denture stomatitis
AKA chronic atrophic candidiasis . What should pt do?
cleanse their dentures thoroughly, soak them overnight in disinfectant solution, and allow to air dry
- Do not wear dentures for more than six hours or more in each 24 hour period to promote gum healing
- Refer to a dentist for ill fitting dentures
- Patient should also brush the mucosal service regularly with a soft brush
Denture stomatitis
AKA chronic atrophic candidiasis . Treatment if indicated is with
miconazole oral gel
angular cheilitis symptoms
soreness, erythema, fissuring at the angles of the mouth
angular cheilitis may be associated with (3)
ill fitting dentures, nutritional deficiency, immunosuppression
what is commonly involved in angular cheilitis infection
- Both yeasts (candida spp.) and bacteria (staph aureus and streptococci) are commonly involved as interacting, infective factors
angular cheilitis is normally self limiting. however while the underlying cause if being identified and treated, may be helpful to use the following treatments
apply topical emollients, miconazole cream or ointment for mild candida infection, or fusidic acid ointment if evidence of bacterial infection
If unresponsive to treatment, HC with miconazole cream or ointment can be used
miconazole oral gel - is there any risk of systemic absorption
- Miconazole applied locally (as oral gel) in mouth but is absorbed systemically so potential interactions need to be considered
does miconazole have some abx action
- Miconazole also has some activity against gram +ve bacteria including streptococci and staphylococci
CRYPTOCOCCOSIS - this is an uncommon infection but if in immunocompromised, esp HIV, it is life threatening.
Cryptococcal meningitis is the most common form of fungal meningitis. How would you treatit?
Amphotericin B (IV infusion) + flucytosine (IV infusion) for 2 weeks, followed by fluconazole (PO) for 8 weeks or until cultures negative
histoplasmosis is rare in tempterature climates. it can be life threatening esp in HIV+ve pt. What can you use for the treatment of IMMUNOCOMPETENT patients with indolent non meningeal infection including chronic pulmonary histoplasmosis
itraconazole
histoplasmosis is rare in tempterature climates. it can be life threatening esp in HIV+ve pt. what can you use for treatment of fulminant or severe infections (initially and then after). and what would you use for prophylaxis against relapse until immunity occurs
initially give amph B IV infusion, followed by PO itraconazole.
give itraconazole for prophylaxis
why are oral imidazole or triazole antifungals (particularly itraconazole) and terbinafine used more freq than griseofulvin if systemic treatment if needed for skin and nail infections
they have broader spectrum of activity and shorter duration of treatment
which tinea is treated systemically
tinea capitits
additioanl topical application of antifungal may reduce transmission
what drug to use for tinea capitis in adults and children
griseofulvin
when is terbinafine used for tinea capitis
when its caused by T. tonsurans (unlicensed indication)
otherwise you would normally use griseofulvin
which one of the following oral drugs should you not use for pityriasis versicolour
- itraconazole
- fluconazole
- terbinafine
itraconazole can be used by mouth if topical therapy ineffective. alternative is oral fluconazole.
do not use oral terbinafine, it is not effective
if systemic treatment of onychomycosis is needed esp of the toenail, what oral drugs can you give
terbinafine (drug of choice)
itraconazole can be given as intermittent pulse therapy
these two have largely replaced griseofulvin
immunocompromised patients are at particular risk of fungal infections and may receive antifungal drugs prophylactically. what is the drug of choice
oral triazoles
e.g. flu and itra
Immunocompromised patients are at particular risk of fungal infections and may receive antifungal drugs prophylactically; oral triazole antifungals are the drugs of choice for prophylaxis.
discuss the use of fluconazole and itraconazole
Fluconazole is more reliably absorbed than itraconazole, but fluconazole is not effective against Aspergillus spp. Itraconazole is preferred in patients at risk of invasive aspergillosis.
Immunocompromised patients are at particular risk of fungal infections and may receive antifungal drugs prophylactically; oral triazole antifungals are the drugs of choice for prophylaxis.
Itraconazole is preferred in pt at risk of…
invasive aspergillosis
Immunocompromised patients are at particular risk of fungal infections and may receive antifungal drugs prophylactically; oral triazole antifungals are the drugs of choice for prophylaxis.
….. can be used for prophylaxis in patients who are undergoing haematopoietic stem cell transplantation or receiving chemotherapy for acute myeloid leukaemia or myelodysplastic syndrome
posaconazole
Amphotericin B by intravenous infusion or caspofungin is used for the empirical treatment of serious fungal infections; but this drug is not effective against fungal infections of the CNS.
caspofungin
