Infectious Diseases Flashcards
Antifungals: polyenes
MOA: perforates fungal cell membrane
Broad spectrum
E.g. amphotericin, nystatin
SE: nephrotoxic
Antifungals: echinocandins
MOA: inhibits cell wall synthesis, especially Beta 1,3 D glucan synthesis
Well tolerated, does not penetrate CSF or urine
E.g. caspofungin, micafungin
Antifungals: azoles
MOA: interferes with cell membrane synthesis (ergosterol)
Triazoles: fluconazole (C. albicans), voriconazole (Aspergillus fumigatus)
Imidazoles: clotrimazole, miconazole
SE: induces CYP450 –> hepatotoxicity
In an immunosuppressed patient, prolonged fever and neutropenia - antifungal choice
- Amphotericin
- Fluconazole (low risk)
- Caspofungin
Candidaemia or invasive candida infection - antifungal choice
- Fluconazole
- Amphotericin B
- Caspofungin
Invasive aspergillus infection - antifungal choice
- Voriconazole
- Amphotericin B
- Caspofungin
Ganciclovir resistance genes
UL97 and UL54
Clinical features of CMV infection in HSCT patient
Most at risk 1-4mo post-HSCT
Most fatal: pneumonitis
Fever, retinitis, pneumonitis, oesophagitis, gastritis, hepatitis, colitis
Pancytopenia, leukopenia, thrombocytopenia
Side effects of antiviral agents to treat CMV
First line: ganciclovir - Neutropenia, suppresses T cell function - Other main issue with ganciclovir = resistance Second line: foscarnet - Significant nephrotoxicity - GCV-resistant CMV Third line: cidofovir - Significant nephrotoxicity