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Infectious Disease > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

VVC

A

vulvovaginal candidiasis

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2
Q

Uncomplicated VVC

A

Sporadic or infrequent
Mild to moderate infections
Likely to be C. albicans
Normal, non-pregnant women

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3
Q

Complicated VVC

A

Recurrent (> 4 episodes e/in 1 year; usually caused by azole-susceotible C. albicans)
Severe infections
Abnormal host

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4
Q

Uncomplicated VVC treatment

A

Fluconazole 150mg PO x 1
OR
Topical antravaginal azole x 1-3 days

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5
Q

Complicated VVC treatment

A

Fluconazole 150mg q72h x 3 doses
OR
Topical antivaginal azole daily x 7 days

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6
Q

Treatment of VVC in pregnancy

A

Topical antivaginal azole for 7 days (avoid systemic azoles; fluconazole is pregnancy category C)

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7
Q

Recurrent VVC treatment

A

Induction: topical or fluconazole 150mg daily for 10-14 days followed by
Suppression: fluconazole 150mg once weekly for at least 6 months

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8
Q

Oropheryngeal and esophageal candidiasis risk factors

A

Drugs - immunosuppressive, anticholinergic
Diseases - HIV, diabetes, leukemias, other malignancies, trauma, burns, xerostomia
Age - neonates or advanced age
Nutritional - vitamin B and C, iron, and folate
Other - dentures, radiation, ETT, smoking

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9
Q

Symptoms of oropharyngeal candidiasis

A

Asymptomatic
Mouth pain
Burning tongue
Metallic Taste

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10
Q

Symptoms of esophageal candidiasis

A

Dysphagia
Odynophagia
Retrosternal chest pain

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11
Q

Signs of oropharyngeal candidiasis

A

Erythema
White patches of buccal mucosa, tongue, throat or gums
No constitutional signs

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12
Q

Signs of Esophageal Candidiasis

A

Constitutional signs occasionally occur
Few to numerous white or beige plaques
Plaques may be edematous, with ulceration in severe cases

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13
Q

Preferred treatment of mild oropharyngeal candidiasis

A

Clotrimazole troche 10mg 5 times/day
OR
Miconazole mucoadhesive buccal 50mg tablet to upper gum QD x 7-14 days

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14
Q

Preferred treatment of moderate-severe oropharyngeal candidiasis

A

Fluconazole 100-200mg QD x 7-14 days

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15
Q

Preferred treatment of esophageal candidiasis

A

Fluconazole 200-400mg PO QD
OR
Fluconazole 400mg IV QD or an echinocandin
Duration: 14-21 days

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16
Q

Patient counseling tips

A
  1. Clean oral cavity prior to using topical agents
  2. Use topical agents after meals
  3. Troches should slowly dissolve in mouth, not chewed or swallowed whole; swallow saliva
  4. Suspension should be swished around mouth to cover all areas, then gargled, then swallowed
  5. Remove dentures before use of oral agents
  6. Remove and disinfect dentures overnight
  7. If patient has xerostomia, use suspension
  8. Complete course
  9. Maintain good oral hygiene, brush teeth twice daily, floss
  10. Stop smoking, avoid alcohol
17
Q

Empiric therapy for non-neutropenic adults with moderately severe to severe candida

A

Echinocadin x 14 days after 1st negative blood cx

18
Q

Empiric therapy for non-neutropenic adults with less critical candida and no recent azole exposure

A

Echinocandin
OR
Fluconazole 800mg x 1, then 400mg QD
For 14 days afetr 1st negative blood cx

19
Q

Empiric therapy for neutropenic adults with candida

A

Echinocandin only

Duration: 14 days after 1st negative blood cx

20
Q

When is prophylaxis recommended for Candida?

A

Solid-organ transplant recipients
ICU patients in an ICU with high incidence of invasive candidiasis
Chemo-induced neutropenia
Stem cell transplant recipients with neutropenia

21
Q

Pregnant patients with Candida

A 
Systemic ampho. B 
Avoid azoles (category C)
22
Q

Candiduria clinical presentation

A

Generally asymptomatic

If symptomatic, would be similar to bacterial cystitis and pyelonephritis

23
Q

Candiduria diagnosis

A

Suggestive
10,000 organisms or visualization of both yeast and pseudohyphae from fresh midstream urine or from single catheterization urine collections

24
Q

Treatment of asymptomatic cystitis with possible candida

A

Treatment usually not indicated unless at risk

If undergoing urologic procedure: fluconazole or ampho. B for several days before and after procedure

25
Q

Treatment of symptomatic cystitis with possible candida

A

Fluconazole 200mg QD x 2 weeks

26
Q

Treatment of Pyelonephritis with possible candida

A

Fluconazole 200-400mg QD x 2 weeks

27
Q

Aspergillosis

A

Spectrum of disease attributed to allergy, colonization or tissue invasion caused by members of the fungal genus Aspergillus

28
Q

3 most common species of Aspergillus

A

A. fumigatus
A. flavus
A. niger

29
Q

Most common Aspergillus species in infections

A

A. fumigatus

30
Q

Pathophysiology of aspergillus infections

A

Produce conidia

Considered opportunistic pathogen

31
Q

Conidia

A

Aerial hyphal stalks
Inhaled
Growth results in pulmonary inflammation, tissue destruction, and potential dissemination into other organs

32
Q

Allergic bronchopulmonary aspergillosis

A

BPA
A. fumigatus
Clinical presentation: severe asthma with wheezing, fever, malaise, weight loss, chest pain, and productive cough with blood tinged sputum

33
Q

Aspergilloma

A

Sinuses, pulmonary
Treatment:
-Single: no therapy or surgical removal
-Chronic cavitary pulmonary: similar to invasive pulmonary aspergillosis

34
Q

Invasive aspergillosis (IA) risk factors

A

Drugs - high dose corticosteroids, immunosuppressants, cytotoxic agents, receiving multiple ABX
Diseases - leukopenia, alcoholism, leukemia/lymphoma, DM, immunodeficiency diseases, chronic granulomatoud disease, chronic hepatitis

35
Q

IA clinical presentation

A

Lung is common site (also liver, CNS, spleen)
Vascular invasion leads to thrombosis, infarction, necrosis, dissemination
Variable presentation, but pulmonary IA usually involves fever, hemoptysis, cough and chest pain
Often rpesents late after infection, sometimes after dissemination has occured

36
Q

IA diagnosis

A

Galactomannan antigen
Cultures of the respiratory tract
Tissue biopsy - definitive
Radiographic studies: Chest xray, CT scans

37
Q

IA therapy

A

Voriconazole 6mg/kg IV q12h x 1, then 4mg/kg IV q12h

Oral maintenance: 200-300mg q12h or weight based

38
Q

IA duration of therapy

A

Not well defined

Minimum 6-12 weeks

39
Q

IA prophylaxis

A

Not typically recommended.
Recommended for patients with prolonged neutropenia who are at high risk for invasive aspergillosis. Also appropriate for immunocompromised who were successfully treated for IA.
DOC: Posaconazole

Infectious Disease (19 decks)

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