Fungal infections - candida Flashcards
types of infections associated with candida
muscosal - orpharyngeal, esophageal, vulvovaginitis
candidemia
invasive (acute disseminated) - involves visceral sites/orgnas
hepatosplenic (chronic disseminated) - most commun in hematologic malignency with recent neutropenia
most common species
albicans - 50% glabrata parapsilosis - catheters tropicalis krusei
what makes someone more likely to be infected with non albicans
fluconazole prophylaxis/preemptive use
c.auris is what
emerging health care associated multi drug resistant pathogen
risk factors for candidiasis
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
bassis for diagnosing candidiasis
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
describe the skin lesions and additional diagnostic
pustules on a red base
scrape sample or punch biopsy for histopathology and culture
a patient with hepatosplenic micro abscesses presents with
RQ pain
persistent fever
increased alkaline phosphatase
describe endopthalmitis and additional diagnosistics
choroid and retina with fluffly yellow white lesions, viritis, or retinal hemorrhages
funduscopic eye exams indicated in candidemia
what is the prognosis of candidemia
30-40% mortality
directly related to the speed of getting treatment
>3x with a 12-24 hour delay
what is the likely source of candidemia in non neutropenic patients
central venous catheter
what is the likely source of candidemia in neutropenic patients
GI
first antifungal therapy for candidemia in non neutropenic patients
echiocandin
dosing the same as given
iv only
antifungal therapy for candidemia in non critically ill non invasive and without risk factors for fluconazole r
fluconazole 88mg load
400mg q24hr
alternative for candidemia in non neutropenic patients in pregnancy, allergy, intolerance
amphotericin B
when would you consider step down to fluconazole 400 q24 for candidemia non neutropenic
5-7 days if symptoms resolved and clinically stable
flucon susceptible isolate
negative repeat blood culture (cultures should be taken every 1-2d)
duration of treatment for candidemia non neutropenic
2 weeks after negative repeat blood culture
what might you consider in candidemia in patients with persistent infection and prolonged neutropenia
granulocyte colony stimulatin factors
granulocyte infusions
antifungal therapy for candidemia in neutropenic
echinocandin
alternative for candidemia in neutropenic patients in pregnancy, resistance, intolerance
amphotericin b
what do you use for non critically ill non invasive without risk factors for flucon R in candidemia neutropenic patients
fluconazole 800mg load 400mg q24hr
why is static cautioned in neutropenic patients
static relies on the patients immune system to kill the bug and in these patients the number of WBC is decreased
what can you use as additional fungal/mold coverage in candidemia neutropenic
voriconazole
same dose as in chart higher end
duration of therapy in candidemia neutropenic
2 weeks past negative blood culture, symptoms resolve, and neutropenia resolved (ANC>500)
considerations when treating c.glabrate
dose dependent antifungal activity
increasign fluconR
treatment for c.glabrata
echinocandin alternatives: (use the high dose) amphoB fluconazole voriconazole (no better more AE)
considerations for treating c.krusei
intrinsically flucon-R
relatively high amphoB MICs
treatment for c.krusei
echinocandin
alternatives:
voriconazole if susceptible
high dose amphoB
what is the purpose of having amphotericin as a liposomal drug
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
a way to avoid nephrotoxicity of amphotericin b
give as continuous infusion
special considerations in treating invasive candidiasis
prompt aggresive
prolonged
treatment of infections in the eye
fluconazole treatment of choice
echinocandins dont penetrate the eye fluid
who gets empirical antifungal therapy for candidiasis
persistent fever despite broad spectrum antibiotics in high risk patient
based on preliminary microbiology or histopathology or plasma b-d-glucan
who are high risk patients
critically ill in ICU neutropenic fever IC total parenteral nutrition recent GI surgery candida colonization
empirical antifungal therapy options
echinocandin
fluconazole - fluconazole naive, colonized with susceptible candida
alternative: amphoB
approved candidiasis indication for fluconazole
oropharyngeal
esophageal
invasive
prophylaxis
approved candidiasis indications for itraconazole
oropharyngeal
esophageal candidiasis
candidiasis indications for voriconazole
esophageal
invasive
posaconazole indications for candidiasis
oropharyngeal
prophylaxis
