Invasive Fungal Infections

Question 1

Endemic Mycoses

Answer 1

Histoplasmosis, Blastomycosis, Coccidiomycosis

Question 2

Opportunistic Mycoses

Answer 2

Candidiasis, Cryptococcosis, Aspergillosis

Question 3

Risk factors for fungal infection

Answer 3

Organ and Bone marrow transplantation, cytotoxic chemotherapy, indwelling IV catheter, burns, surgery, trauma, broad spectrum ABX

Question 4

candida species

Answer 4

albicans, krusei, glabrata, tropicalis, parapsilosis

Question 5

Candida albicans signs and sympotoms

Answer 5

1. acute onset of fever, tachycardia, tachypnea
2. Intermittent fevers and only symptomatic when febrile
3. progressive deterioration +/- fevers
4. Hepatosplenic :only manifested as fever in a neutropenic patient (s)

Question 6

Albicans lab tests

Answer 6

1. culture (takes 1 month)
2. Germ tube - (non-HIV = albicans; HIV = several different fungi)
3. PNA - FISH (results in 90 min)
4. serologic tests (not specific for albicans, tests for (1,3)-B-D-glucan

Question 7

albicans treatment

Answer 7

Recent azole exposure or severely ill: Echinocandin, Amph B, other azole(itra, vori)
Otherwise: Fluconazole, other azole(itra, vori) echinocandin, amph B

Question 8

albicans treatment duration

Answer 8

for 2 weeks after the last positive blood culture

Question 9

fluconazole dose and fungi

Answer 9

6 mg/kg/day for c. albicans, C. parapsilosis, C. tropicalis
12 mg/kg/day for C. glabrata
do not use for C. krusei

Question 10

Other azoles (itra, vori) fungi

Answer 10

may have expanded activity against C. glabrata and C. krusei

More drug interactions and side effects

Question 11

Echinocandin fungi

Answer 11

• expanded coverage against C. glabrata and C. Krusei
• less potent against C. parapsilosis
• IV only

Question 12

Amphotericin B

Answer 12

Active against common Candida pathogens

IV only

Question 13

Aspergillosis predisposing factor

Answer 13

1. prolonged neutropenia (> 7 days)

2. chronic high dose steroid therapy

Question 14

Aspergillosis clinical presentation

Answer 14

Pleuritic chest pain, fever, hemoptysis, Organ specific symptoms (CNS, liver, spleen, etc…)

Question 15

Aspergillosis Diagnosis

Answer 15

galactomannan levels, BG[(1,3)-B-D-glucan] test, CT abnormalities, Platelia aspergillus EIA test (HSCT & leukemia patients)

Question 16

Aspergillosis therapy

Answer 16

1st line: Voriconazole

2nd line: lipid form of Amph B

Question 17

Aspergillosis salvage therapy

Answer 17

1. Voriconazole + Echinocandin
2. Lipid Amph B + Echinocandin
3. Monotherapy: Posaconazole

Question 18

Cryptococcus predisposing factors

Answer 18

HIV infection, Lymphoma, sarcoidosis, long term steroid therapy

Question 19

Cryptococcus diagnosis

Answer 19

antigen test, CSF analysis

Question 20

Cryptococcus pulmonary treatment

Answer 20

1. mild-to-moderate: Fluconazole for 6 months (alternative: itra, amph B)
2. Severe: treat like CNS disease

Question 21

Cryptococcus CNS treatment

Answer 21

amph B + flucytosine then fluconazole

Question 22

cryptococcus maintanence therapy for AIDS patients

Answer 22

fluconazole

Question 23

Histoplasmosis diagnosis

Answer 23

Antigen test, Direct microscopic exam with 10% KOH, histopathologic exam (takes 30 days)

Question 24

histoplasmosis treatment

Answer 24

mild to moderate: no treatment needed, unless symptoms last for more than one month, then itraconazole
moderate to severe: amph B then itraconazole

Question 25

Blastomycosis diagnosis

Answer 25

weight loss, N/V/D, CNS involvement, skin, bone, joint, GI tract; often though to be TB

Question 26

Blastomycosis treatment

Answer 26

mild to moderate: itraconazole
life threatening: Amph B, then itraconazole
CNS lipid Amph B then an azole

Question 27

Cocciodiomycosis asymptomatic treatment

Answer 27

No Treatment

Question 28

coccidiomycosis respiratory or disseminated Non-CNS treatment

Answer 28

fluconazole

Question 29

Coccidiomycosis disseminated CNS treatment

Answer 29

fluconazole for life

Question 30

Azole monitoring

Answer 30

drug interactions, hepatic/renal function, QT prolongation, skin rash, alopecia.
Itra (netagive ionotropic effect)
Vori(visual disturbances, hallucinations)

Question 31

echinocandin monitoring

Answer 31

hepatic function (only caspo), rash, facial swelling, phlebitis, hypersensitivity (mica), hypokalemia (anidula)

Question 32

Amph B monitoring

Answer 32

1. direct damage of distal tubular membranes leading to wasting of electolytes
2. constriction of the afferent arterioles leading to decreased glomerular filtration

Question 33

5-FC monitoring

Answer 33

GI distress, Hepatic/Renal, bone marrow toxicity, drug levels