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Exam 4 Therapeutics > Kays Fungal Infection > Flashcards

Kays Fungal Infection Flashcards

1
Q

Oropharyngeal candidiasis is

A

an Infection of the oral mucosa with Candida species

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2
Q

Esophageal candidiasis is

A

an Infection of the esophagus with Candida species

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3
Q

Candida are normal flora in the GI tract and what is the most common candida in the GI tract

A

C. albicans

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4
Q

Most common opportunistic infection in HIV patients

A

OPC

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5
Q

What is the primary line of host defenses against superficial Candida infections is

A

cell mediated immunity

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6
Q

Risk Factors for OPC and EC

A
  • steroid use
  • dentures
  • xerostomia due to drugs , chemo, and radiotherap
  • smoking
  • disruption of oral mucosa
  • drugs
  • neonates or elderly
  • HIV infection/AIDS
  • Diabetes
  • Malignancies
  • Nutritional deficiencies
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7
Q

Clinical presentation of OPC

A
  • cottage cheese appearing plaques

- painful mouth, burning tongue, metallic taste

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8
Q

Clinical Presentation of EC

A
  • painful and difficulty swallowing

- fever, few white/ beige plaques

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9
Q

Topical treatment for mild OPC

A
  • treat for 7-14 days
  • clotrimazole 10mg troche 5xday
  • Nystatin 5mL swish and swallow
  • Miconazole 50mg buccal tablet
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10
Q

Systemic treatment for refractory OPC patients who can’t tolerate or respond to mild therapy

A
  • FLuconazole Daily
  • Itraconazole solution Daily
  • Posaconazole daily for 14 days
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11
Q

Treatment for Fluconazole-Refractory OPC

A

treat from 14-28 days

  • itraconazole daily
  • posaconazole suspension for 28 days
  • Amphotericin B deoxycholate
  • Voriconazole
  • Caspofungin
  • Micafungin
  • Anidulafungin
  • Amphotericin B deoxycholate
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12
Q

Treatment of Esophageal Candidiasis

A

treatment 14-21 days

  • fluconazole
  • itraconazole
  • echinocandin
  • voriconazole
  • posaconazile
  • amphotericin B
  • Fluconazole refractory treat for 21-28 days
  • higher dose itraconazole
  • caspofungin
  • micafungin
  • anidulafungin
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13
Q

Vulvovaginal candidiasis is

A
  • an infection in women with or without symptoms who have positive vaginal cultures
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14
Q

Complicated versus uncomplicated vulvovaginal candidiasis

A

uncomplicated - sporadic infection susceptible to all anti fungal therapy
complicated - recurrent VVC severe disease; non-candida albicans infection

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15
Q

Candida albicans and its role in VVC

A
  • responsible for the overwhelming majority of VVC
  • C. glabrata is increasing in frequency
  • terminated candida associated with tissue invasion
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16
Q

VVC Risk factors

A
  • contraceptives
  • antibiotic use
  • increased incidence in post-menopausal women taking HRT
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17
Q

VVC Symptoms

A
  • intense culcular itching, burning on urination
  • curl cheese like discharge
  • test for vaginal pH
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18
Q

VVC Treatment

A
  • Over the counter topical agents for uncomplicated VVC are butoconazole, clotrimazole, miconazole, tioconazole.
  • prescription Uncomplicated VVC Nystatin and Terconazole, fluconazole, ibrecafangerp
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19
Q

Complicated VVC Treatment

A

treatment duration 10-14 days and use the same drugs

- topical agents are safe throughout pregnancy, oral agents contraindicated.

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20
Q

Recurrent VVC Treatment

A

Two stage treatment with Topical or oral azole 10-14 days followed by fluconazole once a week for 6 months

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21
Q

Antifungal Resistance VVC

A
  • Boric acid 600mg capsule, intravaginally daily, then 1 capsule twice a week
  • FLucytosine cream 1000mg
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22
Q

Dermatophytoses is a superficial mycotic infection of

A

the skin

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23
Q

Typical organisms involved in Mycotic infections of ski, hair, and nails

A

TRICHOPHYTON, EPIDERMOPHYTON, MICROSPORUM

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24
Q

Risk factors for mycotic infections

A

prolonged exposures to sweaty clothes, failure to bathe regularly,skin folds

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25
Q

Tinea pedis

A

athletes foot

- topical treatment for 2-4 weeks is adequate in mild infections

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26
Q

Tinea manuum

A
  • involves the palmar surfaces
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27
Q

Tinea cruris

A

jock itch topical therapy for mild infections

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28
Q

tine corporis

A
  • infection of skin and trunk and extremities
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29
Q

tinea capitis

A
  • involves scalp and hair
  • usually affects children
  • usually treated with oral therapy Terbinafin
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30
Q

tine barbae

A

infection of hair follicles on beards and mustache

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31
Q

tinea versicolor

A
  • hyper or hypopigmented scaly patches on trink and extremities
  • common for adults in tropical environments
  • topical therapy usually enough
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32
Q 
Topical agents that can be used for:
Tinea Pedis 
Tinea mannum
Tinea cruris
Tinea corporis
A
  • Butenafine
  • Sertaconazole
  • Ciclopirox
  • Clotrimazole
  • Econazole
  • Haloprogin
  • Ketoconazole cream
  • Miconazole
  • Oxiconazole
  • Sulconazole
  • Terbinafine
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33
Q 
Oral agents that can be used for more severe infections of: 
Tinea Pedis 
Tinea mannum
Tinea cruris
Tinea corporis
A
  • FLuconazole
  • Itraconazole
  • Terbinafine
34
Q

Tinea capitis topical treatment

A

Shampo in conjunction with Terbinafine for 4-8 weeks

35
Q

Tinea barbae topical treatment

A
  • Ketoconazole

- Selenium Sulfide

36
Q

Tinea barbae oral treatment

A

Itraconazole

37
Q

Tinea versicolor topical treatment

A
  • Clotrimazole
  • Econazole
  • Haloprogin
  • Ketoconazole
  • Miconazole
  • Oxiconazole cream
  • Sulconazole
38
Q

Tinea versicolor oral treatment

A
  • Fluconazole

- Itraconazole

39
Q

onchyomycosis treatment

A
  • Terbinafine
  • Itraconazole
  • Fluconazole
40
Q

Terbinafine AE

A
  • Potent inhibitor of CYP2D6,
  • rare and severe hepatotoxicity avoid in liver disease
  • may decrease lymphocyte count
41
Q

Histoplamosis potpurri

A
  • Ohio and Mississippi River Valley
  • Caused by Histoplasma capsulatum
  • organism is phagocytized by macrophages but not killers, macrophages migrate to other areas
42
Q

Histoplasmosis and granulomas

A
  • granulomas form to wall off organism and causes necrotic degredation of tissue
  • granulomas become encapsulated and calcified over several years with viable organisms still trapped. can become reinfected if immune system wanes
43
Q

Histoplasmosis presentation

A
  • variable degree of immune suppression
  • low inoculum can result in mild pulmonary infection
  • high innoculum can result in flu-like sympoms and become hypoxic
44
Q

Disseminated histoplasmosis

A
  • seen in immunocompromised or high innoculum where the body cannot form granulomas
  • go through asymptomatic periods and then have periods of weakness and fatigue
45
Q

Histoplasmosis Diagnosis

A
  • standard is serological testing
46
Q

Acute Histoplasmosis Treatment in immunocompetent hosts

A
  • Mild/moderate disease
    Itraconazole 6-12 weeks (also posaconazole or fluconazole_
  • Moderately Severe Disease
    Lipid Amphotericin B for 12 weeks, (may use deoxycholate if low nephrotoxic risk), and methylprednisolone
47
Q

Disseminated Histoplasmosis treatnment in an immunocompromised host

A
  • Less severe disease
    Itraconazole for 12 weeks (posaconazole, voriconazole, or fluconazole are ok substitutes)
  • Moderately severe disease
    Lipid amphotericin B for 1-2 weeks, then Itraconazole for 12 months
48
Q

Blastomyces dermatitides potpurri

A
  • endemic to south eastern south centeral and midwest united states
  • infection occurs after inhalaion of the conidia, this draws neutrophils to the lungs and then disseminates it through the body and forms granulomas
49
Q

Acute pulmonary blastomycosis symptoms

A
  • fever chills and productive cough in immunocompetent host
50
Q

Chronic pulmonary blastomycosis symptoms

A
  • fever, malaise, weight loss, night sweats, chest pain, and productive cough
51
Q

Treatment of pulmonary blastomycosis in immunocopetent patients

A
  • mild-moderate disease
    itraconazole for 6 months
  • moderately severe-severe disease
    lipid amphotericin B for 1-2 weeks then itraconazole for 6-12 months
52
Q

Disseminated or extrapulmonary Blastomycosis in immunocompetent patients

A
  • CNS disease
    induction lipid amphotericin B 4-6 weeks followed by oral azole for at least 12 months (fluconazole, voriconazolem or itraconazole)
  • Moderately severe and mild to moderate disease treat the same as pulmonary disease
53
Q

Blastomycocis treatment in immunocompromised host

A
  • Acute disease
    Lipid amphotericin B for 1-2 weeks until improvement and then suppressive therapy for at least 12 months
    Itraconazole for at least 12 months
  • suppressive therapy might be considered for lifelong patients that we cannot reverse immunocuppression
54
Q

coccidiodomycosis potpurrie

A
  • endemic in southwestern and western united states
  • causative pathogen is coccidiodes immits
  • initial infection almost always involves lungs
55
Q

Primary coccidiodomycosis facts

A
  • valley fever
  • symptoms are fever, cough, headache, sore throat and arthralguas and myalgias, diffuse macropapular rash appears in a few days, pneumonia can be seen later with a blood streaked cough
56
Q

coccidiodomycosis clinical presentation

A
  • persistent pulmonary coccidiodomycosis
    disease last more than 6 weeks and is complicated by scarring and spiting blood
  • disseminated coccidiodomycosis
    seen in skin, lymph nodes, bone, CNS infections we can see headache weakness, neck stiffness, and low grade fever
57
Q

coccidiodomycosis treatment

A
  • primary respiratory infection
    fluconazole and itraconazole for 3-6 months
  • symptomatic chronic cavitary pneumonia
    fluconazole and itraconazole
  • diffuse pneumonia with bilateral or miliary infiltrates
58
Q

disseminated coccidiodomycosis treatment

A
  • nonmeningeal disease
    itraconazole or fluconazole, or amphotericin B
  • meningeal disease
    choice treatment is fluconazole for lifelong suppresivetherapy, other options include itraconazole or intrathecal amphotericin B
59
Q

Cryptococcus potpurri

A
  • Cryptococcus neoformans found more in immunocompromised hosts
  • Cryptococcus gattii more in immunocompetent hosts.
  • found in soil and pigeon droppings
  • cell mediated immunity plays important role in this
60
Q

Cryptococcus Clinical Presentation

A 
- pulmonary
cough, rales, SOB
- Meningitis
Non-Aids: photophobia, neck stiffness
HIV/AIDS: Fever, malaise, headache
61
Q

Cryptococcal meningitis treatment

A
  • non-HIV, non-transplant host
    induction: L amphotericin deoxycholate + flucytosine for 4 weeks, may use lipid amphotericin B, extend amphotericin to minimum of 6 weeks if neurologic conditions worsen or if there is no flucytosine given. consider 2 week duration for induction if low risk for failure
    consolidation: fluconazole for 8 weeks
    Maintenance: fluconazole for 6-12 months
  • HIV infected agents
    Induction: liposomal amphotericin B + flucytosine for a minimum of 4 weeks,
    Consolidation: fluconazole 8 weeks
    Maintenance: minimum of at least 1 year of azole therapy. consider stopping after a year if CD4 count is greater than or equal to 100 cells and undetectable viral load for 3 months
62
Q

Cryptococcal meningitis for HIV infected patients alternative regimens

A
  • amphotericin deoxycholate or lipid amphotericin B for 4-6 weeks
  • amphotericin B plus fluconazole for 2 weeks then fluconazole for 8 weeks
  • fluconazole + flucytosine for 6 weeks
  • fluconazole for 10-12 weeks
63
Q

Cryptococcal meningitis treatment for organ transplant recipients

A
  • Induction: Liposomal amphotericin B + flucytosine for at least 2 weeks
    Consolidation: FLuconazole for 8 weeks
    Maintenacne fluconazole for 6-12 months
64
Q

Candidiasis potpurri

A
  • C. albicans is the most common cause of invasive fungal infections
  • PMNs play a major role in patients host defense
65
Q

Candidiasis and candidemia presentation

A
  • acute onset of fever, tachycardia, chills and hypotension
66
Q

Candidemia Treatment in nonneutropenic adults

A
  • Eichinocandins recommended as initial therapy (may transition later to fluconazole if susecptible)
  • FLuconazole daily for patients who are unlikely to have fluconazole-resistant Candida species
  • azole susceptibility testing recommended for all clinically relevant isolates
  • alternative therapy is Lipid amphotericin B, or voriconazole, remove catheters if possible. treat for 14 days after negative blood culture
67
Q

Candidemia treatment in neutropenic adults

A
  • eichinocandin recommended as initial therapy
  • lipid formulation of amphotericin B
  • if not critically ill and no prior azalea exposure use fluconazole or voriconazole
68
Q

pathogen specific treatments candidemia in neutropenic adults

A

C. glabrata - echinocandin
C. parapsilosis - fluconazole or lipid amphotericin B
C. krusei - eichinocandin, lipid amphotericin B or voriconazole preferred
- treat for 14 days after documented clearance of candida from blood, resolution of symptoms and neutropenia. remove IV catheters

69
Q

Chronic Disseminated candidiasis treatment

A
  • lipid amphotericin B or an eichinocandin for several weeks, followed by fluconazole
  • continue therapy until documentation fo lesion resolution on repeat
70
Q

Empiric Treatment of suspected invasive candidiasis in nonneutropenic adults in ICU

A
  • eichinocanfin preferred
  • alternative regimens fluconazole in patients who are not colonized with an azalea resistant Candida species
  • recommended treatment duration is 2 weeks
71
Q

Empiric treatment of suspected invasive candidiasis in neutropenic adults in the ICU

A
  • lipid amphotericin B
  • echinocadin
  • voriconazole
  • alternative agents
    fluconazole, itraconazole
  • azalea should not be used in patients who have received azalea for prophylaxis
72
Q

prophylaxis of invasive candidiasis in the ICU treatment

A
  • fluconazole in patients in ICUs greater than 5% 0f invasive candidiasis
  • echinocandin is an alternative
  • daily bathing with chlorhexidine
73
Q

intraabdomnial candidiasis treatment

A
  • consider empiric anti fungal therapy for patients with clinical evidence of an intra-abdominal infection, treatment the same as candidiasis in nonneutropenic adults
74
Q

growth of candida species from respiratory secretions, does it require anti fungal therapy

A

no it doesn’t

75
Q

symptomatic treatment of candida UTIs

A
  • for fluconazole susceptible candida cystitis, fluconazole for 2 weeks
  • for fluconazole resistant candida species amphotericin B deoxycholate for 1-7 days. amphotericin bladder irrigation. flu cytosine 7-10 days.
  • remove or replace indwelling catheters
76
Q

aspergillus potpurri

A
  • causative pathogens are, A. fumigatus, A. flavus, A. niger, A. terries and generally acquired by conidia
  • impaired host defenses are required for development of invasive disease. prolonged neutropenia is the most important predisposing factor
77
Q

aspergillosis clinical presentation

A
  • commonly presents in the lungs
  • survival beyond 2 or 3 weeks is uncommon, chest pain
  • hyphae invade walls of bronchi and surrounding parenchyma resulting in necrotization
78
Q

aspergillus diagnosis

A
  • based on septate hyphae
79
Q

treatment of aspergillosis in invasive pulmonary aspergillosis

A
  • voriconazole
  • lipid amphotericin, isavuconazole plus echinocandin in select patients
  • echinocandin primary therapy not recommended
  • therapy recommended for 6-12 weeks
80
Q

invasive pulmonary aspergillosis salvage therapy treatment options

A
  • amphotericin B, Caspofungin, Micafungin, Posaconazole, or itraconazole
81
Q

prophylaxis of aspergillosis

A
  • posaconazole primary

- alternative agents are voriconazole, itraconazole, micafungin. aerosilized amphotericin B

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