fungal infection

Question 1

what bodily systems does aspergillosis affect?

Answer 1

most commonly respiratory tract
invasive forms can affect heart, brain, skin

Question 2

1st line and alternatives for aspergillosis infection

Answer 2

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

Question 3

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

Answer 3

itraconazole

Question 4

what are the echinocandins?

Answer 4

end in -fungin e.g. caspofungin

Question 5

for invasive or disseminated candidiasis, the following anti fungal class can be given

Answer 5

echinocandin (-fungin)

Question 6

what is an alternative for invasive or disseminated Candida albicans infection in clinically stable pt who have not received an azole antifungal recently

Answer 6

fluconazole

Question 7

what should be considered for initial treatment of CNS candidiasis

Answer 7

amphotericin B

Question 8

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

Answer 8

voriconazole

Question 9

in refractory cases of invasive or disseminated candidiasis what can you give

Answer 9

flucytosine + IV amphotericin B

Question 10

greater risk of candial infections if the following RF

Answer 10

• inhaled CCs
• chemo
• broad spectrum abx
• serious sytemic disease associated with reduced immunity e.g. hIV, malignancy, leukemia

Question 11

how to reduce risk of oral candidiasis associated with CC inhalers

Answer 11

rinse mouth with water or clean teeth immediately after using inhaler
or use spacer
or using inhaler at lowest effective dose

Question 12

mild and localised oral thursh infections and alternative

Answer 12

miconazole oral gel
oral nystatin
consider oral fluconazole for pt with extensive or severe infection, or when the above are unsuitable or ineffective

Question 13

what to do if oral thrush infection fails to respond to treatment after 1 week

Answer 13

consider extending course for another week or specialist referral as appropriate

Question 14

Acute erythematous candidiasis

Answer 14

usually associated with a burning sensation of the mouth or tongue
oral candidiasis that causes soreness and redness, especially on the tongue and palate

Question 15

name two potential causes of acute erythematous candidiasis

Answer 15

CC or BS abx use

Question 16

Acute erythematous candidiasis treatment

Answer 16

Treatment is the same As for pseudomembranous Candidiasis
○ Oral miconazole gel
○ Nystatin
○ Fluconazole
Denture related problems should be managed prior to antifungal treatment

Question 17

Denture stomatitis
also known as

Answer 17

chronic atrophic candidiasis

Question 18

Denture stomatitis
AKA chronic atrophic candidiasis . What should pt do?

Answer 18

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

Question 19

Denture stomatitis
AKA chronic atrophic candidiasis . Treatment if indicated is with

Answer 19

miconazole oral gel

Question 20

angular cheilitis symptoms

Answer 20

soreness, erythema, fissuring at the angles of the mouth

Question 21

angular cheilitis may be associated with (3)

Answer 21

ill fitting dentures, nutritional deficiency, immunosuppression

Question 22

what is commonly involved in angular cheilitis infection

Answer 22

• Both yeasts (candida spp.) and bacteria (staph aureus and streptococci) are commonly involved as interacting, infective factors

Question 23

angular cheilitis is normally self limiting. however while the underlying cause if being identified and treated, may be helpful to use the following treatments

Answer 23

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

Question 24

miconazole oral gel - is there any risk of systemic absorption

Answer 24

• Miconazole applied locally (as oral gel) in mouth but is absorbed systemically so potential interactions need to be considered

Question 25

does miconazole have some abx action

Answer 25

• Miconazole also has some activity against gram +ve bacteria including streptococci and staphylococci

Question 26

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?

Answer 26

Amphotericin B (IV infusion) + flucytosine (IV infusion) for 2 weeks, followed by fluconazole (PO) for 8 weeks or until cultures negative

Question 27

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

Answer 27

itraconazole

Question 28

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

Answer 28

initially give amph B IV infusion, followed by PO itraconazole.

give itraconazole for prophylaxis

Question 29

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

Answer 29

they have broader spectrum of activity and shorter duration of treatment

Question 30

which tinea is treated systemically

Answer 30

tinea capitits
additioanl topical application of antifungal may reduce transmission

Question 31

what drug to use for tinea capitis in adults and children

Answer 31

griseofulvin

Question 32

when is terbinafine used for tinea capitis

Answer 32

when its caused by T. tonsurans (unlicensed indication)

otherwise you would normally use griseofulvin

Question 33

which one of the following oral drugs should you not use for pityriasis versicolour

• itraconazole
• fluconazole
• terbinafine

Answer 33

itraconazole can be used by mouth if topical therapy ineffective. alternative is oral fluconazole.

do not use oral terbinafine, it is not effective

Question 34

if systemic treatment of onychomycosis is needed esp of the toenail, what oral drugs can you give

Answer 34

terbinafine (drug of choice)
itraconazole can be given as intermittent pulse therapy
these two have largely replaced griseofulvin

Question 35

immunocompromised patients are at particular risk of fungal infections and may receive antifungal drugs prophylactically. what is the drug of choice

Answer 35

oral triazoles

e.g. flu and itra

Question 36

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

Answer 36

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.

Question 37

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…

Answer 37

invasive aspergillosis

Question 38

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

Answer 38

posaconazole

Question 39

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.

Answer 39

caspofungin