invasive aspergillosis & candidiasis

Question 1

antifungal that is less attractive for candidemia

Answer 1

voriconazole
due to the need for more frequent administration, less predictable PK, more drug interactions, and poor tolerance to the drug

Question 2

which antifungals have activity against aspergillus

Answer 2

liposomal ampho B
itraconazole
voriconazole
posaconazole
isavuconazonium
echinocandins: caspofungin, micafungin, anidulafungin

Question 3

which antifungals are the drugs of choice for mucormycoses

Answer 3

lipid or liposomal ampho B IV
posaconazole
isavuconazole

Question 4

risk factors for invasive candidiasis

Answer 4

recent broad spectrum antibiotics
recent use of a central venous catheter
TPN
renal replacement therapy in ICU
neutropenia
implantable prosthetic devices
immunosuppressive therapy
GI perforation or recent surgery

Question 5

duration of therapy for candidemia

Answer 5

without obvious metastatic complications: 2 weeks after documented clearance of candida from the bloodstream & resolution of symptoms attributable to candidemia

Question 6

initial therapy for candidemia in non-neutropenic patients

Answer 6

echinocandin recommended initially

alternative: fluconazole, for patients who are not critically ill and unlikely to have resistance

alternative: liposomal amphotericin B if intolerance to other antifungals, limited availability of other antifungals, known resistance to other antifungals

Question 7

initial therapy for candidemia in neutropenic patients

Answer 7

initial therapy: echinocandin is recommended

less attractive alternative is liposomal amphotericin B: effective but increased risk of toxicity, more expensive

alternative fluconazole in patients who are not critically ill & unlikely to have resistance

C. krusei: echinocandin, lipid amphotericin formulation, or voriconazole recommended

Question 8

monitoring response to therapy candidemia

Answer 8

document clearance with follow-up blood cultures at a minimum of every other day until clearance: expected clearance within 72 hours

Fever, WBC, blood pressure, and tachycardia should improve

central venous catheters should be pulled: use temporary peripheral lines until blood sterilized

eye exam

Question 9

routes of transmission of invasive pulmonary aspergillosis

Answer 9

major: inhalation of environmental fungal spores

minor: direct contact with environmental fungal spores through cuts, scrapes, puncture wounds to the skin

Question 10

is invasive pulmonary aspergillosis contagious

Answer 10

nope it is not transmissible from person to person