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pharmacy > Fungal Infection > Flashcards

Fungal Infection Flashcards

1
Q

Mucormycoses Risk

A

Uncontroll DM

Bone marrow or solid organ transplantation

Fe overload or having defroxamine

Systemic steroid use

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2
Q

Endemic Mycoses general treatment guild

A

Acute pulmonary histoplasmosis and coccidioidomycosis often required no treatment in healthy individual

All blastomycosis required aggressitreatment

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2
Q

Histoplasmosis treatment

A

Treatment should be provid to Pt who do not improve after 1 month or who exhibit hypoxia.

DOT 12-24 months

1st line: Itraconazole 200mg PO TID X 3 days then 200mg PO BID/ Daily

Liposomal AMB: 3-5 mg/kg IV daily, may switch to PO when tolerated

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3
Q

ABPA - diagnosis

A

not a true infection but an IgE-mediated hypersensitivity response

can progress to fibrotic end-stage lung disease with honeycomb lung tissue

Cough, wheezing, increase production of sputum

respiratory sample: elevated IgE levels to >500 units/ml IgG or IgE antibodies can be detected to aid in diagnosis

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3
Q

Endemic mycoses diagnosis

A

The best way to diagnosis these mycoses is through tissue biopsy and looking for fungal structure on histology examination, as well as culture from sputum/ BAL samples

Coccidioidomycosis: erythema dodosum (dark blotched skin ) on shins or lower extremities, arthrlagias

Often test for seology testing for IgG and IgM antibodies, however, they are not specific to currently active infection

forms characteristic structure in tissues called “spherules” that reliably diagnostic of valley fever

Hisoplasma and blastomyces can be teste for with a urinary antigen test, a;though sensitivity and specificity is not ideal

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4
Q

Candidiasis - Echinocandins indication

A

neutropenic patients,

patients with recent azole exposure, who are hemodynamically unstable,

currently hospitalized at an institution where >15% of Candida isolates are either C. glabrata or C. krusei.

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4
Q

Coccidioidomycosis treatment

A

Pulmonary disease should be treated for 6 months

disseminated disease 12 months

lifelong suppressive therapy is needed in cocci meningitis

Fluconazole 400mg PO daily

Liposomal AMB: 3-5mg/kg IV daily, may switch to PO when clinically improved and tolerates PO

Alternative: Itraconazole 200mg PO BID

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5
Q

Oropharyngeal candidiasis non-sys treatment

A

clotrimazole troches 10mg 5X/day

Nystatin suspension 400,000-600,000 IU swish and spit QID for 7-14 days

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6
Q

Pulmonary Mucormycosis

A

Hemoptysis with pulmonary hemorrhage

X-ray with infiltrate and cavity

Cavitation may occur as immunosuppression resolves

May spread through body in a contiguous fashion

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8
Q

Mucormycoses treatment

A

aggressive surgical debridement

DOC: AMB (AmBisome) at least 14 days

Maintenance: posaconazole 200mg PO q6hr

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9
Q

Aspergillosis risk

A

Cystic fibrosis ans structure lung

Prolonged and profound neutropenia ( absolute neutrophils <100 cells/mm3)

advanced HIV infection

Solid organ or bone marrow transplantation

GVHD of the lung

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10
Q

complicated VVC - difination

A

more than 4 episode/ yr infection due to non-albicans spp in DM, Pregnancy, immunosuppression Pt.

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10
Q

Aspergillosis presentation and Diagnosis

A

Pneumonia - multiple nodular infiltrates on chest CT scans

Pathologic tissue sample grow 24-72 hrs

+ tissue biopsy show invasion of host tissue with hyphae IPA

SOB, bloody cough,

CT is preferred over CXR

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11
Q

Candidiasis - Echinocandins dosage

A

Micafugin: 100mg IV daily

Caspofugin: LD 70mg then 50 mg IV daily

Anidulafungin: LD 200mg then 100mg IV daily

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13
Q

IPA treatment

A

DOC:

Voriconazole 6mg/kg IV BID x2 then 4mg/kg IV BID or 200mg PO BID

Added AMB lipid for severe:3-5mg/kg IV daily can be Monotherapy

If Vfen not tolerated

Itraconazole

Posaconazole 200mg po ss QID then 400mg

PO BID 300 mg DR/IV BID X2 then 300mg PO daily may be alternative

Coricosteroids must be avoided

DOT: at least 6-12 weeks but most receive for at least 6 months

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14
Q

Candidiasis - cause

A

Candidia spp: C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, C. krusei

15
Q

Candidiasis - Fluconazole dosage

A

Candidemia: LD 800mg (12mg/kg), then 400mg (6mg/kg) PO/IV for 14 days Oropharyngeal: 100-200 mg PO daily 7-14 days Esophageal: 200-400mg PO/IV daily 14-21 days Cystitis: 200mg PO daily X 2wks Pyelonephritis 200-400mg PO daily X2wks VVC: uncomplicated 150mg PO X1 complicated 150 mg PO q73 hr X3

16
Q

Mucormycoses - cause

A

OI by several molds primarily group of Zygomycetes Rhizopus, Rhizomucor, and Mucor

17
Q

VVC - treatment

A

No symptom = no treatment topical = clotimazole, miconazole, terconazole 7-14days

17
Q

CNS mucormycosis

A

May occur secondary to extension through the sinuses or via trauma

decreasing consciousness,

altered mental status

18
Q

Candidiasis - presentation & diagnosis

A

Candidia in blood should always be viewed and find source Oropharyngeal: thrush - visually white plaques within mouth associated with local pain EGD: eesophagogastroduodenoscopy Vulcocaginal (VVC): vulvar pruritus, burning, soreness and irritation, dysuria or dyspareunia. often worse during weeks before menses; erythema and edema of external genitalia; white thick, adherent and clumpy discharge w ot w/o odor vaginal culture should be obtained

18
Q

Blastomycosis treatment

A

pulmonary disease should be treated for 6-12 months

disseminated disease required treatmetn for >12 months

1st line 200mg PO TID X3days, then 200mg PO BID/Daily

Liposomal AMB: 3-5mg/kg IV daily, may switch to PO when clinically improved and tolerates PO

alternative: fluconazole 400-800mg PO daily

19
Q

Aspergillosis - cause

A

Aspergillus (mold) Aspergillus fumigatus - IPA & ABPA

ABPA= healthy host

IPA & aspergilloma = immunocompromised host

21
Q

Cutaneous mucormycosis

A

Erythematous and painful skin usually associated with wound dressing

Erythema

Black/ necrotic area

22
Q

Rhinocerebral Mucormycosis

A

persistant mental status changes after correction of DKA

Facial pain or headche

Orbital cellulitis and palate erthema

Black material in mucus or in area of infalmmation

lost of vision

23
Q

Mucormycoses - presentation and diagnosis

A

Rhinocerebral and pulmonary involvement - medical emergency

Maxillofacial sinuses and rapidly progresses to invasion of surrounding tissues - extreme pain and tenderness

Uncontrolled serum blood glucose black mold within sinuses Tissue biopsy and microscopic evaluation and culture

26
Q

Candidiasis AMB indication and dosage

A

Alternative in Pt could not tolerated Fluconazole or Echinocandins AMB deoxycholate 0.5-0.7 mg/kg IV daily, up to 1 mg/kg daily AMB liposomal: 3-5 mg/kg IV daily

27
Q

Aspergilloma

A

fungus ball

28
Q

Endemic Mycoses

Cause

A

Coccidioides immitis (vally fever) - CA -> Maxico

Histoplasma capsulatum -> missipi river

Blastomyces dermatitidis -> Missipi river

29
Q

Candidiasis - risk factor

A

Recent use of Broad-spectrum antibacterial agents Use of central lines Receipt of parenteral nutrition Receipt of renal replacement therapy Pt in ICU Neutropenia or receipt of Immunosuppressive agents use of implantable prosthetic devices

31
Q

Candidiasis - Fluconazole indication

A

1st line for C. albican, C. parapsilosis, C. tropicalis and in mild-moderated hemodynamically stable Pt w/o previous azole exposure who are not at high risk for glabrata or kuseii infection. DOA: 14 days after culture become clear remove the central line is essential

32
Q

Endemic Mycoses - persentation

A

asymptomatic, pneumonia, or disseminated disease

mostly asymptomatic: spore clear by natural immune responce

Pneumonia: fever, cough, positive infiltrate. Granulomas with calcifications

dissminated: chronic cavity lesions, weight loss, night sweats, and low grade fever, meningitis, bone infection, skin granulomas, and legions on/ in other organs - most occurs in immunocompromised Pt.

33
Q

ABPA treatment

A

Corticosteriod is the mainstay of ABPA treatment of decrease inflammation associated destruction of airways DOT: 4wks to 6months Itraconazole: 200mg PO BID X 16 weeks

34
Q
A

pharmacy (15 decks)

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