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ABIM > ID-Fungal Infections > Flashcards

ID-Fungal Infections Flashcards

1
Q

Risk factors for candidemia?

A

Neutropenia, malignancies, organ transplantation, broad-spectrum antimicrobial agents, intravascular catheters, hemodialysis, parenteral nutrition, major abdominal surgery

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2
Q

How is systemic candidiasis usually diagnosed?

A

By a positive blood culture or a positive culture from a normally sterile site

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3
Q

When disseminated candidiasis is suspected what consults should you get?

A

Ophthalmology! You get these white exudate splotches on the retina

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4
Q

What are common focal infections in systemic candidiasis?

A

UTIs, peritonitis, bone and joint infections, CNS infections

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5
Q

For disseminated candidiasis which anti fungal do you start ASAP?

A

An echinocandin: anidulafungin, caspofungin, micafungin

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6
Q

What candida infections at specific sites do you not treat with an echinocandin?

A

Do not treat meningitis, UTI, endopthalmitis because echinocandins have poor organ penetration!

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7
Q

What do you do for C. glabrata?

A

You have to do susceptibility testing to see if it is susceptible to an -azole

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8
Q

What antifungal is recommended for C. parapsilosis?

A

An azole!

Because it is not susceptible to an echinocandin

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9
Q

Treatment duration for uncomplicated candidemia?

A

14 days after first negative cultures

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10
Q

Treatment duration of candidiasis focal organ infection?

A

For several weeks to months… based on resolution of signs and symptoms

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11
Q

When is treatment of asymptomatic candiduria indicated?

A

ONLY treat in neutropenic patients and those undergoing urological procedures

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12
Q

With positive blood culture for candida what can’t you forget?

A

to remove central lines!!!

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13
Q

Risk factors for invasive or disseminated aspergillosis?

A

profound and prolonged neutropenia and immunosuppression associated with chemo or organ transplantation… now being reported in ppl who are critically ill in the ICU and are exposed to glucocorticoids

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14
Q

Radiographic signs of aspergillus infection?

A

wedge shaped densities that look like infarcts, target lesion with a necrotic center surrounded by a ring of hemorrhage (halo sign)

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15
Q

What is the best way to diagnose disseminated aspergillus disease?

A

Galactomannan antigen assay, blood cultures are rarely positive

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16
Q

What is the most common way that mucormycosis presents?

A

Rhinocerebral infection with headache, epistaxis, ocular findings (proptosis periorbital edema, decreased vision)

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17
Q

How can cryptococcal infection be diagnosed?

A

suggestive histopathology or by the detection of cryptococcal antigen in the serum or CSF

Diagnosis is confirmed by culture

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18
Q

What is the most sensitive and specific assay for the diagnosis of cryptococcal meningitis?

A

Latex agglutination assay for cryptococcal antigen

19
Q

How good is the serum assay for cryptococcal infection?

A

Not as good, it’s sensitivity is lower so a negative test cannot be used to exclude meningitis

20
Q

CSF profile of cryptococcal meningitis?

A

Lymphocyte pleocytosis

High opening pressure

21
Q

Treatment of cryptococcal infection in AIDS patients

A

Maintenance therapy required until they have responded to antiretroviral therapy (CD 4 count greater than 100 for more than 3 months) and have been receiving antifungal therapy for at least a years

22
Q

Treatment of cryptococcal infection in those without AIDS

A

maintenance therapy for 6-12 months

23
Q

What happens if a patient has received appropriate antifungal therapy and other measures to reduce elevated ICP have failed? In crypto infection…

A

give frequent lumbar punctures and removal of CSF or placement of a VP shunt is required

24
Q

What happens to organ transplant patients with cryptococcus on high dose immunosuppressive therapy?

A

They may require life-long antifungal therapy

25
Q

Where is blasto endemic?

A

It is endemic to the Ohio and Mississippi River valleys , great lakes and st. Lawrence river

26
Q

How does blasto infection occur?

A

Inhalation of spores!

27
Q

What sites can blasto infect?

A

Bones, joints, prostate, skin, lungs

28
Q

How is blasto diagnosis made?

A

Diagnosis made based on characteristic yeast forms with broad based buds on histopathologic samples, definitive diagnosis by culture

29
Q

If disseminated blasto is expected, what should be done in addition to antifungal therapy?

A

Bone scan to detect occult osteoarticular involvement

Obtain urine to screen for prostate involvement

30
Q

How is histo diagnosed?

A

It is small yeast forms within neutrophils… growth takes 6+ weeks

31
Q

What are some complications of histo infection?

A

Acute and chronic pulmonary disease, granulomatous mediastinitis, fibrosing mediastinitis, broncholithiasis, pulmonary nodules (histoplasmosis), and acute/chronic disseminated disease may occur

32
Q

Cocci–where endemic?

A

SW US, Texas, California Central Valley and parts of central/South America

33
Q

How does cocci infection usually present?

A

It usually presents as a community acquired pneumonia 1-3 weeks after infection

34
Q

What is Valley Fever?

A

Valley Fever is a subacute infection with respiratory symptoms, fever, and erythema nodosum, joint athralgias also common

35
Q

Where does cocci most commonly disseminate too?

A

It most commonly disseminates to skin, bones, joints, and meninges

36
Q

How is cocci best diagnosed?

A

Serological tests and also useful for monitoring therapy–repeat tests may be needed to improve sensitivity

37
Q

What is the antifungal of choice for sporotrichosis?

A

itraconazole

38
Q

What is first choice antifungal for aspergillus infection?

A

Voriconazole

39
Q

Treatment of choice for mucormycosis?

A

Liposomal amphoteracin B

40
Q

Treatment of crypto?

A

Induction: Ampho or flucytosine for two weeks

Consolidation/maintenance: Fluconazole

41
Q

Treatment of blasto?

A

Ampho B followed by itraconazole?

42
Q

Treatment of cocci pulmonary infection?

A

Itraconazole, *fluconazole

43
Q

Treatment of cocci meningitis?

A

Fluconazole

ABIM (58 decks)

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