Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ID 2014 > Invasive Fungal - Lee > Flashcards

Invasive Fungal - Lee Flashcards

1
Q

Endemic Mycoses

A

mold in environment; yeast in body
Histoplasmosis
Blastomycosis
Coccidioidomycosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Opportunistic Mycoses

A

Candidiasis
Cryptococcosis
Aspergillosis - multiple forms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Risk factors for fungal infections

A
  1. Organ and bone marrow transplantation
  2. Cytotoxic chemotherapy
  3. Indwelling intravenous catheters, burns, surgery, or trauma
  4. Widespread use of potent broad-spectrum antimicrobial agents
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Candida - approximately ___ C. albicans

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

C. krusei is resistant to

A

fluconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

C. glabrata is

A

somewhat resistant to fluconazole, so use high dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

C. tropicalis

C. parapsilosis

A

fluconazole susceptible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Risk factors for invasive candidiasis

A

Immunocompromised
o Neutropenia
o Lymphoreticular or hematologic malignancies
o Uncontrolled Diabetes
o Immunodeficiency diseases
o High-dose corticosteroids
o Immunosuppressants, antineoplastic agents

Loss of Protective Barrier:
o	Central venous catheters
o	Total parenteral nutrition (TPN)
o	Extensive surgery (especially, surgery of GI tract)
o	Burns
o	Renal failure and hemodialysis

Other:
o Prior fungal colonization
o Receipt of multiple antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Clinical Presentation of Candida infection

A
  1. acut onset of fever, tachycardia/tachypnea. maybe chills and/or hypotension
  2. intermittent fevers. symptomatic when febrile
  3. PROGRESSIVE DETERIORATION +/- FEVER
  4. Hepatosplenic (< 1000 wbc/mm3)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Not severely ill and treatment naive

Treatment of suspected/documented candidemia or invasive candidiasis.

A
  1. Fluconazole (FIRST LINE)
  2. other azole (itra, vori)
  3. Echinocandin
  4. Amphotericin B
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Recent azole exposure
OR Severely ill. (severe sepsis or septic shock)
Treatment of suspected/documented candidemia or invasive candidiasis.

A
  1. Echincocandin (FIRST LINE) -(Caspo/Mica/Anidala-fungin)
  2. Amphotericin B
  3. Other azole (itra, vori)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Duration of therapy for candidemia or hematogenous candidiasis

A

2 weeks after last positive blood culture and resolution of signs/symptoms of inf.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Fluconazole dose for C. albicans, C. parapsilosis, and C. tropicalis

A

6mg/kg/day dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Fluconazole dose of C. glabrata

A

12 mg/kg/day dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Echinocandins

A

expanded coverage against C. glabrata and C. Krusei (less potent for parapsilosis)
IV only
need for de-escalation after culture results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Amphotericin B

A

problems: infusion -toxicity, nephrotoxicity

IV only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Aspergillosis

A

A. fumigatus
A. flavus
A. niger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Aspergillosis Pathopsy

A

by inhalation of spores (airbone candida) + imparied host defense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Aspergillosis prediposing factors/risk factors

A

o prolonged neutropenia (> 7 days) (most important)
o chronic high dose steroid therapy (30-200 mg/day of prednisone)
o cytotoxic agents
o recent and/or concurrent broad-spectrum antimicrobial therapy

20
Q

Apersgillosis presentation

A 
o	Pleuritic chest pain
o	Fever
o	Hemoptysis
o	friction rubs
other sites of  inf: CNS! liver, spleen, heart. GI tract, pericaridum
21
Q

Empiric therapy for Aspergillosis

A

1st line: Voriconazole

2nd line: Amphotericin B

22
Q

Asperigillosis salvage therapy

if 1st/2nd line didn’t work

A

Combo:

  • vori + echinocandin
  • lipid form amphot. B + echinocandin

Mono: posaconazole

23
Q

Crytococcus predisposing/risk factors

A

o HIV infection
o Lymphoproliferative disorders (ex: Hodgkin’s lymphoma)
o Sarcoidosis
o Long-term steroid therapy

24
Q

primary cypt presentation

A

o Always in the lungs, usually subclinical infection

o Cough, rales, shortness of breath (resolve spontaneously)

25
Q

crypt meningitis non- AIDS presentation

A

o Headaches, fever, vomiting, mental status changes, neck stiffness
o Less common: visual disturbances, papilledema, seizures, aphasia

26
Q

crypt meningitis AIDS presentation

A

o Fever, headache
o Meningismus* and photophobia are less common than non-AIDS patients
*Evidence of meningeal infection: nuchal rigidity, Kernig’s sign, brudzinski’s sign

27
Q

crypt treatment

pulmonary (mild/mod)

A

o Fluconazole for 6 mos

o Alternatives: itraconazole, amphotericin B

28
Q

crypt treatment
severe pulmonary
CNS disease

A

o Induction: Amphotericin B + flucytosine x 2 wks, then ± fluconazole x 8wks
o Alternatives
Monotherapy: lipid form amphotericin B

29
Q

crypt maintenance therapy for AIDS

A

o Fluconazole until CD4 > 200 /µl

30
Q

Echinocandins in Cryotococcus therapy

A

Not used. Modified glucan struct so synthesis is no inh. significantly

31
Q

Histoplasmosis treatment

for mild/mod disease

A

Treatment is usually not needed unless

Symptoms > 1 month: itraconazole

32
Q

Histoplasmosis treatment

for mod severe to severe

A

Amphotericin B, then
itraconazole

OR

Methylprednisolone for patients with acute respiratory complications (hypoxemia, significant respiratory distress)

33
Q

Treatment of Blastomycosis
pulmonary (non-CNS)
mild/mod

A

Itraconazole

34
Q

Treatment of Blastomycosis
pulmonary (non-CNS)
life threatening

A

Amphotericin B, then itraconazole

35
Q

Treatment of Blastomycosis

CNS disease

A

Amphotericin B (Lipid formulation is preferred) x 4-6 weeks, then Azole (fluconazole, itraconazole, or voriconazole) x 12 months OR resolution of CSF abnormalities

36
Q

Treatment Histoplasmosis/Blastomycosis after initial therapy in AIDS

A

Lifelong suppressive therapy with oral azoles until CD4 > 200 /µl

37
Q

Risk factors for severe/disseminated inf of Coccidioidomycosis

A

o Race (Filipinos > African-American > Native American > Hispanics > Asians)
o Pregnancy (especially 2nd or 3rd trimester)
o Compromised immune system (AIDS pts, on steroids, immunosuppressive agents, chemotherapy)
o Male gender
o Neonates
o Patients with B or AB blood types

38
Q 
Coccidioidomycosis 
Asymptomatic patients (60%) presentation
A

o Non-specific symptoms (fever, cough, headache, sore throat, myalgias, fatigue)
o Fine diffuse rash during the first few days of illness

39
Q

Coccidioidomycosis primary pneumonia presentation

A

o Productive cough (+/- blood streaked)

o Dense homogenous hilar or basal infiltrate(s)

40
Q

Coccidioidomycosis presentation

chronic, persistant pneumonia (>6 wk of primary)

A

o Hemoptysis
o Pulmonary scarring
o Necrosis of pulmonary tissue with drainage of cavities or bronchopleural fistulas
o Persistent cough, fevers, and weight loss

41
Q 
Coccidioidomycosis   presentation
Valley fever (25%)
A

o Erythema nodosum and erythema multiforme
o Diffuse joint aches
o Fever
o Diffuse, mild erythroderma or macropapular rash
o Pleuritic chest pain
o Peripheral eosinophilia

42
Q

Coccidioidomycosis presentation

disseminated (<1%)

A

o Common sites include skin, lymph nodes, bone, meninges

o Other sites: spleen, liver, kidney, adrenal gland

43
Q

Coccidioidomycosis treatment

asymptomatic

A

no treatment

44
Q

Coccidioidomycosis treatment

Disseminated CNS disease

A 
o	Fluconazole (for life... first line)
o	Itraconazole (for life... doesn't work well)
o	Amphotericin B intrathecal therapy ± fluconazole or itraconazole
45
Q

Coccidioidomycosis treatment

Primary respiratory or disseminated (NON-CNS) infection

A

o Azole antifungal (usually FIRST LINE is fluconazole, , or itraconazole for bone disease)
o Amphotericin B formulation

ID 2014 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions