Lecture 24.2: Flashcards
What is Oropharynegeal & Esophageal Candidasis?
- Oropharynegeal Candidasis: Infection in mouth [most common OI]
- Esophegeal Candidasis: Infection in throat
Albicans is the most common
What is the clinical presentation of Oropherynegeal Candidasis?
- “Cottage Cheese” look on tougue, gums or throat [can be easily removed]
What is the clinical presentation of esophegeal candidaisis?
- Hard too swallow, sore throat, chest pain
- Fever with white plagues down throat
What is the treatment for Mild Oropharynegeal Candidiasis?
- Clotrimazole 10mg, Nystatin 100,000 units, Miconazole 50mg
- 7-14 day duration
What is the treatment for Moderate [systemic] Oropharynegeal Candidiasis?
- Fluconazole 100mg [Preferred]
- Itraconazole solu. 200mg
- Posaconazole 100mg with food
What is the treatment for Esophageal Candidiasis?
- Fluconazole 200mg
- 14-21 days
What is Vulvovaginal Candidiasis?
- Infection with or without symptoms that have C. Albicans
- Highest risk between 30-40yo
What are some of the general clinical presentations for Vulvovaginal Candidiasis?
General? Symptoms? Signs? Labs? Others?
- Both Vulva and Vagina
- Itchy, sore, irritated, burns
- “cheese” like disacharge
- pH = Normal
What is the treatment for Uncomplicated Vulvovaginal Candidiasis?
- OTC/Topical: Butoconazole, Clotrimazole, Miconazole, Ticonazole
- Rx/Topical: Nystatin, Terconazole
- Rx/PO: Fluconazole 150mg, Ibrexafungerp
What is the treatment for Complicated Vulvovaginal Candidiasis?
- Fluconazole 150mg
What is the treatment for Non-neutronpenic Adults wiht Candidemia?
- Echinocandins
- Fluconazole 800mg LD; then 400mg qd
Remove ALL IV caths, Repeat blood cultres, treat for 14 days after first (-) culture
What is the treatment for Neutronpenic Adults with Candidemia?
Glabrata, Parapsilosis, Krusei?
- Glabrata = Echinocandins
- Parapsilosis = Flucon or L AMP B
- Krusei = Echinocandin, L AMOP B, or Voricon
14 days & remove caths
What is the emperic treatment for Invasive candidiasis in Non-netropenic adults in ICU?
- Echinocandins [alt: flucon, L AMP B]
Treat for 2w from firsts negatvie cultues
What is the emperic treatment for Invasive candidiasis in Netropenic adults in ICU?
- L AMP B, Echinocandins, IV Voricon [Alt: Flucon or Itracon]
Should you treat Asymptomatic Cadiduria [UTIs]?
- NOT recommended unless high risk of dissemination
What is the treatment for Symptomatic Candida Cystitis [UTIs]?
- Fluconazole 200mg [flucon -susceptible]
- AMP B, 5-FC [flucon - resistance]
What is the treatment for ImmunoCOMPETENT host for Histroplasmosis?
“Acute Pulmonary Hisoplasmosis”
- Asymptomatic: NO THERAPY
- Mild-Mod: Itraconazole for 6-12 weeks [Alts: Posacon or Flucon]
- Mod-Severe: L AMP B for 12 weeks
What is the treatment for ImmunoCOMPROMISED host for Histroplasmosis?
“Disseminated Histoplasmiosis”
- Mod-Severe: L AMP B for 12 months
- Less Severe: Itraconazole for 12 months
What is the treatment for Pulmonary Blastomycisis in an ImmunoCOMPETENT patient?
- Mod-severe: L AMP B for 6-12 months
- Mild-Mod: Itraconazole for 6 months
- CNS: induction = L AMP B & consolidation = fluconazole for > 12 months
What is the treatment for Pulmonary Blastomycisis in an ImmunoCOMPROMISED patient?
Acute? Suppressive?
- Acute Disease: L AMP B for > 12 months
- Suppressive: Itraconazole for 12 months
What is the treatment for Coccidiodomyciosis?
- Primary Respiratory: Flucon or Itracon for 3-6 months
- Symptomatic Pneumonia: Flucon or Itracon
- Diffuse Pneumonia: AMP B for 12 months
What is the treatment for Disseminated Coccidiodomycosis?
- Nonmeningeal: Itracon or Flucon, AMP B
- Meningeal: Fluconazole 400-1200mg IV/PO qd
What is the treatment for Non-HIV infected, non-transplant host crytococcal meningeitis?
- Induction: AMP B [or L AMP B + 5-FC]
- Consolidation: Fluconazole 400-800mg
- Maintenance: Fluconazole 200-400mg
What is the treatment for HIV infected crytococcal meningeitis?
- Induction: L AMP B + 5-FC
- Consolidation: Fluconazole 800mg
- Maintenance: Fluconazole 400mg
What are some of the alternative regimens for HIV-infected patietns with cryptococcal meningitis?
- AMP B or L AMP B for 4-6w
- AMP B + Fluconazole, then Fluconazole alone
- Fluconazole 800-1200mg + 5FU
- Fluconazole 1200mg
What is the treatment for Invasive Pulmonary Aspergillosis?
- Voriconazole [Alts: L AMP B, Isavuconn, Voricon + Echincandin]
What is the prohylaxis of aspergillosis?
- Posaconazole