Fungal infections

Question 1

What is the #1 prophylaxis drug that we give if we suspect a fungi?

Answer 1

Fluconazole

Question 2

What is the treatment of choice for invasive aspergillosis?

Answer 2

Voriconazole

Question 3

What do you suspect if someone is a farmer, works in construction or lives in a place where there is black mold?

Answer 3

1. ALLERGY (hypersensitivity reaction)
2. Stachybotrys chartarum (black mold)

Question 4

What is the important biomarker of candida species?

Answer 4

β-D-glucan (IMPORTANT FOR DX)

Question 5

How do dimorphic invasive fungi present?

Answer 5

• Blastomyces dermatitidis: can spread to lymphatics
• Presents as pneumonia (similar to TB)

Question 6

What are the superficial types of molds?

Answer 6

• Tinea pedis (athletes foot) Ž treat with topical
• Tinea corporis (Ringworm) Ž treat with topical
• Tinea unguium (onuchomycosis) Ž treat with oral antifungal

Question 7

What are the superficial Candidiasis infections?

Answer 7

• OPC (thrush)
• Esophageal candidiasis
• Vaginitis
• Skin and nail infections

Question 8

How do a Cryptococcus presents?

Answer 8

By Inhalation, presents as pneumonia or meningitis (invasive)

Question 9

What is the most common type of invasive mold disease?

Answer 9

Aspergillus

• Most common in immunosuppressed patients
• Pulmonary or sinonasal infection by inhalation with subsequent dissemination
• Very aggressive, destructive
• DX: BIOPSY, diagnostic challenge (criteria), Galactomannan (GM) Assay

Question 10

How do we investigate a fungi infection?

Answer 10

• Serology (antibodies) worthless
• Culture of respiratory secretions requires rich media with antimicrobials to suppress bacteria
• Blood cultures (fungal bottles)
• Antigen tests (on urine)
• β-D-glucan biomarker (IMPORTANT): candidate
• Biopsy + diagnostic challenge (criteria) + Galactomannan (GM) Assay: Aspergillus mold infection

Question 11

What is the treatement of choice for superficial fungal infections?

Answer 11

Allylamines

Question 12

Why are used Polyenes?

Answer 12

1. Dimorphic fungus
2. Cryptococcus
3. Aspergillus

Question 13

What are the 3 mechanisms of action of anti-fungal medication?

Answer 13

1. Cell membrane: Fungi use principally ergosterol instead of cholesterol
2. DNA Synthesis: Some compounds may be selectively activated by fungi, arresting DNA synthesis
3. Cell Wall: Unlike mammalian cells, fungi have a cell wall

Question 14

5-Flucytosine (DNA synthesis blocker) medication is used for what?

Answer 14

Cryptococcus

Question 15

Echinocandins (cell wall destruction medication) is used for what?

Answer 15

Candida (NOT for Cryptococcus!!)

Question 16

What is super fucking important to do when you treat a fungi infection?

Answer 16

You NEED to investigate and remove the SOURCE (ex. Cathether, abscess) of the fungal infection + use empirical therapy