Invasive Fungal Infections Flashcards
Endemic Mycoses
Histoplasmosis, Blastomycosis, Coccidiomycosis
Opportunistic Mycoses
Candidiasis, Cryptococcosis, Aspergillosis
Risk factors for fungal infection
Organ and Bone marrow transplantation, cytotoxic chemotherapy, indwelling IV catheter, burns, surgery, trauma, broad spectrum ABX
candida species
albicans, krusei, glabrata, tropicalis, parapsilosis
Candida albicans signs and sympotoms
- acute onset of fever, tachycardia, tachypnea
- Intermittent fevers and only symptomatic when febrile
- progressive deterioration +/- fevers
- Hepatosplenic :only manifested as fever in a neutropenic patient (s)
Albicans lab tests
- culture (takes 1 month)
- Germ tube - (non-HIV = albicans; HIV = several different fungi)
- PNA - FISH (results in 90 min)
- serologic tests (not specific for albicans, tests for (1,3)-B-D-glucan
albicans treatment
Recent azole exposure or severely ill: Echinocandin, Amph B, other azole(itra, vori)
Otherwise: Fluconazole, other azole(itra, vori) echinocandin, amph B
albicans treatment duration
for 2 weeks after the last positive blood culture
fluconazole dose and fungi
6 mg/kg/day for c. albicans, C. parapsilosis, C. tropicalis
12 mg/kg/day for C. glabrata
do not use for C. krusei
Other azoles (itra, vori) fungi
may have expanded activity against C. glabrata and C. krusei
More drug interactions and side effects
Echinocandin fungi
- expanded coverage against C. glabrata and C. Krusei
- less potent against C. parapsilosis
- IV only
Amphotericin B
Active against common Candida pathogens
IV only
Aspergillosis predisposing factor
- prolonged neutropenia (> 7 days)
2. chronic high dose steroid therapy
Aspergillosis clinical presentation
Pleuritic chest pain, fever, hemoptysis, Organ specific symptoms (CNS, liver, spleen, etc…)
Aspergillosis Diagnosis
galactomannan levels, BG[(1,3)-B-D-glucan] test, CT abnormalities, Platelia aspergillus EIA test (HSCT & leukemia patients)
Aspergillosis therapy
1st line: Voriconazole
2nd line: lipid form of Amph B
Aspergillosis salvage therapy
- Voriconazole + Echinocandin
- Lipid Amph B + Echinocandin
- Monotherapy: Posaconazole
Cryptococcus predisposing factors
HIV infection, Lymphoma, sarcoidosis, long term steroid therapy
Cryptococcus diagnosis
antigen test, CSF analysis
Cryptococcus pulmonary treatment
- mild-to-moderate: Fluconazole for 6 months (alternative: itra, amph B)
- Severe: treat like CNS disease
Cryptococcus CNS treatment
amph B + flucytosine then fluconazole
cryptococcus maintanence therapy for AIDS patients
fluconazole
Histoplasmosis diagnosis
Antigen test, Direct microscopic exam with 10% KOH, histopathologic exam (takes 30 days)
histoplasmosis treatment
mild to moderate: no treatment needed, unless symptoms last for more than one month, then itraconazole
moderate to severe: amph B then itraconazole
Blastomycosis diagnosis
weight loss, N/V/D, CNS involvement, skin, bone, joint, GI tract; often though to be TB
Blastomycosis treatment
mild to moderate: itraconazole
life threatening: Amph B, then itraconazole
CNS lipid Amph B then an azole
Cocciodiomycosis asymptomatic treatment
No Treatment
coccidiomycosis respiratory or disseminated Non-CNS treatment
fluconazole
Coccidiomycosis disseminated CNS treatment
fluconazole for life
Azole monitoring
drug interactions, hepatic/renal function, QT prolongation, skin rash, alopecia.
Itra (netagive ionotropic effect)
Vori(visual disturbances, hallucinations)
echinocandin monitoring
hepatic function (only caspo), rash, facial swelling, phlebitis, hypersensitivity (mica), hypokalemia (anidula)
Amph B monitoring
- direct damage of distal tubular membranes leading to wasting of electolytes
- constriction of the afferent arterioles leading to decreased glomerular filtration
5-FC monitoring
GI distress, Hepatic/Renal, bone marrow toxicity, drug levels
