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Clinical 2.0 > Fungal infections - candida > Flashcards

Fungal infections - candida Flashcards

1
Q

types of infections associated with candida

A

muscosal - orpharyngeal, esophageal, vulvovaginitis
candidemia
invasive (acute disseminated) - involves visceral sites/orgnas
hepatosplenic (chronic disseminated) - most commun in hematologic malignency with recent neutropenia

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2
Q

most common species

A 
albicans - 50% 
glabrata 
parapsilosis - catheters
tropicalis 
krusei
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3
Q

what makes someone more likely to be infected with non albicans

A

fluconazole prophylaxis/preemptive use

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4
Q

c.auris is what

A

emerging health care associated multi drug resistant pathogen

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5
Q

risk factors for candidiasis

A 
ICU  >4days
septic shock 
liver transplant 
peritoneal dialysis related peritonitis 
severe pancreatitis 
GI surgery particularly if associated with a leak 
IC esp hematologic malignancy, chemo, transplant, corticosteroids
central venous catheter
broad spectrum antibiotics
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6
Q

bassis for diagnosing candidiasis

A

culture- triazole susceptibility
microscopic examination - budding yeast with hyphae = candida
histology critical for deep seated infections, particularly mold
PCR - 90%spec/sens but lacks standardization
beta d-glucan - non specific cell wall component, flase negatives
mass spectrometry - 4 hrs

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7
Q

describe the skin lesions and additional diagnostic

A

pustules on a red base

scrape sample or punch biopsy for histopathology and culture

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8
Q

a patient with hepatosplenic micro abscesses presents with

A

RQ pain
persistent fever
increased alkaline phosphatase

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9
Q

describe endopthalmitis and additional diagnosistics

A

choroid and retina with fluffly yellow white lesions, viritis, or retinal hemorrhages
funduscopic eye exams indicated in candidemia

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10
Q

what is the prognosis of candidemia

A

30-40% mortality
directly related to the speed of getting treatment
>3x with a 12-24 hour delay

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11
Q

what is the likely source of candidemia in non neutropenic patients

A

central venous catheter

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12
Q

what is the likely source of candidemia in neutropenic patients

A

GI

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13
Q

first antifungal therapy for candidemia in non neutropenic patients

A

echiocandin
dosing the same as given
iv only

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14
Q

antifungal therapy for candidemia in non critically ill non invasive and without risk factors for fluconazole r

A

fluconazole 88mg load

400mg q24hr

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15
Q

alternative for candidemia in non neutropenic patients in pregnancy, allergy, intolerance

A

amphotericin B

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16
Q

when would you consider step down to fluconazole 400 q24 for candidemia non neutropenic

A

5-7 days if symptoms resolved and clinically stable
flucon susceptible isolate
negative repeat blood culture (cultures should be taken every 1-2d)

17
Q

duration of treatment for candidemia non neutropenic

A

2 weeks after negative repeat blood culture

18
Q

what might you consider in candidemia in patients with persistent infection and prolonged neutropenia

A

granulocyte colony stimulatin factors

granulocyte infusions

19
Q

antifungal therapy for candidemia in neutropenic

A

echinocandin

20
Q

alternative for candidemia in neutropenic patients in pregnancy, resistance, intolerance

A

amphotericin b

21
Q

what do you use for non critically ill non invasive without risk factors for flucon R in candidemia neutropenic patients

A

fluconazole 800mg load 400mg q24hr

22
Q

why is static cautioned in neutropenic patients

A

static relies on the patients immune system to kill the bug and in these patients the number of WBC is decreased

23
Q

what can you use as additional fungal/mold coverage in candidemia neutropenic

A

voriconazole

same dose as in chart higher end

24
Q

duration of therapy in candidemia neutropenic

A

2 weeks past negative blood culture, symptoms resolve, and neutropenia resolved (ANC>500)

25
Q

considerations when treating c.glabrate

A

dose dependent antifungal activity

increasign fluconR

26
Q

treatment for c.glabrata

A 
echinocandin 
alternatives: (use the high dose) 
amphoB 
fluconazole 
voriconazole (no better more AE)
27
Q

considerations for treating c.krusei

A

intrinsically flucon-R

relatively high amphoB MICs

28
Q

treatment for c.krusei

A

echinocandin
alternatives:
voriconazole if susceptible
high dose amphoB

29
Q

what is the purpose of having amphotericin as a liposomal drug

A

to decrease the neprotoxicity of the drug but then decreases the amount of free drug have to increase the dose so really not that effective

30
Q

a way to avoid nephrotoxicity of amphotericin b

A

give as continuous infusion

31
Q

special considerations in treating invasive candidiasis

A

prompt aggresive

prolonged

32
Q

treatment of infections in the eye

A

fluconazole treatment of choice

echinocandins dont penetrate the eye fluid

33
Q

who gets empirical antifungal therapy for candidiasis

A

persistent fever despite broad spectrum antibiotics in high risk patient
based on preliminary microbiology or histopathology or plasma b-d-glucan

34
Q

who are high risk patients

A 
critically ill in ICU 
neutropenic fever
IC
total parenteral nutrition 
recent GI surgery 
candida colonization
35
Q

empirical antifungal therapy options

A

echinocandin
fluconazole - fluconazole naive, colonized with susceptible candida
alternative: amphoB

36
Q

approved candidiasis indication for fluconazole

A

oropharyngeal
esophageal
invasive
prophylaxis

37
Q

approved candidiasis indications for itraconazole

A

oropharyngeal

esophageal candidiasis

38
Q

candidiasis indications for voriconazole

A

esophageal

invasive

39
Q

posaconazole indications for candidiasis

A

oropharyngeal

prophylaxis

Clinical 2.0 (24 decks)

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