Fungi Flashcards
What is the treatment of choice for thrush in an otherwise immunocompetent child?
Gentian violet or nystatin (something topical)
A 17 year old sexually active female complains of vaginal itching and erythema. She does have a discharge. You successfully treated it with fluconazole. Most likely:
- What color was the discharge?
- What range was the vaginal pH?
- White discharge
- pH < 4.5
An leukopenic 9 year old is recovering from a round of chemo and she develops swelling and edema of the upper body only. She has a broviac catheter. She is febrile. Blood cultures have been negative.
- What do you suspect?
- What must you do first?
- For how long should you treat?
- With what should you treat?
- Septic thrombosis of great veins, possibly fungal.
- Remove the broviac
- 2 weeks after first negative culture.
- Ampho B or an echinocandin. You could treat with fluconazole but there is resistance in C. glabrata and C. krusei.
For systemic fungal infection, what is the preferred antifungal agent in neonates?
Ampho B
What type of stain is used to identify cryptococcus?
India ink stain, shows a halo around the organism.
You are seeing a patient with round, nodular skin lesions a shown. India ink stain shows round organisms with a clear halo. Suppose this patient had HIV or a T-cell mediated immunodeficiency. What is the most likely severe presentation of this illness? How should it be treated?
- Cryptococcal meningoencephalitis
- Ampho B + 5-Flucytosine
True or False? Cryptococcus has a predilection for the desert southwest.
False. This one has no geographic predilection.
Coccidioides, Histoplama, or Blastomyces?
- “Beaver dam”
- Southwest US
- Bird and bat droppings
- Valley Fever
- Skin and bone lesions
- Ertyhema multiforme
- Sarcoid-like presentation
- Palate ulcers
- Arkansas and Wisconsin
- Mississippi and Ohio River Valleys
- Similar to C psittaci infection
- Treated with itraconazole
- Acute pulmonary disease generally doesn’t require therapy.
- Treat with fluconazole
- Blastomyces
- Coccidioides
- Histoplasma
- Coccidiodes
- Blastomyces
- Coccidioides
- Coccidioides
- Histoplasma
- Blastomyces
- Histoplasma
- Histoplasma
- Histoplasma and blastomyces
- Histoplasma
- Coccidioides
A neonate was born in the wilderness and had no antenatal care. He is growing an angioinvasive organism that grew best on Sabouraud dextrose agar. In addition to surgical debridement where appropriate, what anti-infective agent should he be getting?
Ampho B, since he is a neonate. You would use voriconazole if older.
Ampho B is the drug of choice for invasive aspergillosis in neonates. What is the drug used otherwise?
Voriconazole
What patients are at high risk of infection from aspergillus?
- New onset or relapsing leukemia/lymphoma
- Stem cell transplant
True or False? For severe ringworm, you can use ampho B.
FALSE. Never use ampho B in this setting.
A child has an oval lesion on his neck with raised ridge. It doesn’t itch or hurt. KOH scraping is shown below. What are the treatment options?
- Topical clotrimazole
- Topical miconazole
- Topical terpinafine (if > 12)
What is the causative organism of tinea versicolor?
Malassezia furfur
What is the causative infection for pityriasis?
Malassezia furfur
(Pityriasis is another name for tinea versicolor.)
Scraping of this skin leasion showed “spaghetti and meatballs.” What is the treatment?
Treat tinea versicolor (pityriasis) with either:
- Selenium sulfide shampoo
- Oral ketoconazole, itraconazole, or fluconazole
A 17 year old track athlete is evaluated for a skin infection and scraping has the following microscopic appearance:
- What is the organism?
- What is the condition called?
- What is the treatment?
- Malassezia furfur
- Pityriasis or tinea versicolor
- Topical selenium sulfide or oral keto, itra, or fluconazole
A baby in the NICU has a serious infection. CXR shows bilateral pulmonary infiltrates. He has leukocytosis and thrombocytopenia. He gets TPN for nutrition. The isolated organism grew on an olive oil overlay.
- What is the organism?
- What is the treatment?
- Malassezia furfur
- Remove all catheters and give Ampho B
What infection is associated with innoculation from gardening activities and tends to cause chronic, nodular ulcerations over lymphatic channels?
- Sporothrix schenckii (sporotrichosis), a fungal infection associated with gardening.
What is the treatment for disseminated infection with Sporothrix schenckii?
Ampho B followed by itraconazole
Skin infection after prick by rose thorn is associated with what organism?
Sporothrix schenckii
What is the topical treatment used in some cases of cutaneous sporotrichosis?
Saturated solution of potassium iodide.
A 17 year old female works part time in a plant nursery and frequently handles rose bushes. She has had these nodular lesions for several months. What is the treatment?
Itraconazole
This is sporotrichosis.
A patient with sickle cell and history of iron overload routinely gets deferoxamine. She has developed this lesion on her nose.
- True or False: Sickle cell disease was her risk factor.
- What is the likely organism?
- What is the treatment?
- False. Deferoxamine was the risk factor.
- Mucormycosis
- Surgical debridement, ampho B.
Is Pneumocystis jirovecci a bacteria or fungus?
Fungus, even though bactrim is used to treat it. It is resistent to most antifungals.
A 16 year old without HIV infection but on chronic steroids for Crohn’s disease presents with fulminant respiratory failure, high fever, dry cough, hypoxia, and CXR showing bilateraly interstitial infiltrates.
- What opportunistic organism should you suspect?
- What is the treatment?
- PJP
- IV bactrim
An 18 year old with HIV infection presents with fulminant respiratory failure, high fever, dry cough, hypoxia, and CXR showing bilateraly interstitial infiltrates. BAL shows the following organisms on methenamine silver stain:
- What opportunistic organism should you suspect?
- What is the treatment?
- PJP
- IV bactrim
For how long after engraftment from BMT should patients receive PJP prophylaxis?
6 months
