M6 PART 2 Flashcards
1
Q
FUNGI
targets immunocompromsed & immunosupressed
A
OPPORTUNISTIC MYCOSES
2
Q
OPPORTUNISTIC MYCOSES
part of normal microbiota
A
endogenous
3
Q
OPPORTUNISTIC MYCOSES
from external sources
A
exogenous
4
Q
immune system is working
A
immunocompetent
5
Q
OPPORTUNISTIC MYCOSES
- dimorphic - can exist as mold or yeast
- Causative agents – Candida parapsilosis, Candida glabrata, Candida tropicalis, Candida guilliermondii, and Candida dubliniensis
- They form a pseudohyphae
- Members of the normal flora of the skin, mucous membrane, and gastrointestinal tract
- Endogenous
A
CANDIDIASIS
6
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS
main causative agent
A
C. albicans
endogenous
7
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS
they form a ____
A
pseudohyphae
8
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS
Members of the ____ of the skin, mucous membrane, and gastrointestinal tract
A
normal flora
9
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS | CLINICAL FINDINGS
Cutaneous and Mucosal Candidiasus:
characterized by patchy to confluent, whitish pseudomembraneous lesion that can occur on the tongue, lips, gums, or palate
A
ORAL THRUSH
10
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS | CLINICAL FINDINGS
RISK FACTORS
A
Corticosteroids or antibiotics
Diabetes
Cellular immunodeficiency
11
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS | CLINICAL FINDINGS
- characterized by irritation, pruritus, and discharge in the vaginal mucosa
- the acidity of vagina is disturbed
A
VULVOVAGINITIS
12
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS | CLINICAL FINDINGS
occurs in moist, warm parts of the body
o Diaper rash in newborns
o Repeated prolonged immersion in water
o Onychomycosis – thickening and loss of nail
A
CUTANEOUS CANDIDIASIS
13
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS | CLINICAL FINDINGS
CUTANEOUS CANDIDIASIS:
thickening and loss of nail
A
ONYCHOMYCOSIS
14
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS | CLINICAL FINDINGS
- Most often associated with chronic administration of corticosteroids or immunosuppressive agents; with hematologic diseases; or with chronic granulomatous disease
- Candidal endocarditis associated with prosthetic heart valves
A
SYSTEMIC CANDIDIASIS
15
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS | CLINICAL FINDINGS
- It is rare but distinctive clinical manifestation characterized by the formation of granulomatous candidal lesions on any or all cutaneous and/or mucosal surfaces.
- Crusty lesions
A
CHRONIC MUCOCUTANEOUS CANDIDIASIS (CMC)
16
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS | TREATMENT
Thrush and other mucocutanenous forms of candidiasis
A
topical nystatin
oral ketoconazole
fluconazole
17
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS | TREATMENT
systemic candidiasis
A
amphotericin B
18
Q
OPPORTUNISTIC MYCOSES | CANDIDIASIS | TREATMENT
Chronic mucocutaneous candidiasis
A
oral ketoconazole & other azoles
19
Q
OPPORTUNISTIC MYCOSES
- Causative agent – Cryptococcus neoformans and C. gattii
- Possess a large polysaccharide capsules
- May be visualize using India ink
- Forms a narrow based body
A
CRYPTOCOCCOSIS
20
Q
OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS
Causative agent
A
C. neoformans
21
Q
OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS
possess a ____
A
large polysaccharide capsules
22
Q
OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS
may be visualized using ____
A
indiana ink
23
Q
OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS
forms a ____ body
A
narrow based
24
Q
OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS | CLINICAL FINDINGS
transmission
A
from bird droppings (pigeon)
bird itself is not infected, only humans will be infected
25
# **OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS | CLINICAL FINDINGS**
* usually in **immunocompromised**
* **major clinical manifestation** which can resemble:
o Brain tumor
o Brain abscess
o Degenerative CNS disease
o Any mycobacterial or fungal meningitis
chronic meningitis
26
# **OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS | CLINICAL FINDINGS**
diseases
primary pulmonary ifection
chronic meningitis
27
# **OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS | TREATMENT**
menigitis
Amphotericin B + flucocytosine
28
# **OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS | TREATMENT**
non-AIDS px
amphotericin B
29
# **OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS | TREATMENT**
**HIV/AIDS patient** treated with highly____ may develop **immune reconstitution inflammatory syndrome (IRIS)**, which **greatly exacerbates** the illness
| used to manage HIV
ANTI-RETROVIRAL THERAPY (ART)
30
# **OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS | TREATMENT**
**HIV/AIDS patient** treated with **highly active anti-retroviral therapy (ART)** may develop ____, which greatly **exacerbates** the illness
IMMUNE RECONSTITUTION INFLAMMATORY SYNDROME (IRIS)
31
# **OPPORTUNISTIC MYCOSES | CRYPTOCOCCOSIS | TREATMENT**
what to do to **prevent** IRIS
treat infection first before giving ART
32
# **OPPORTUNISTIC MYCOSES**
* Causative agents – A. **fumigatus** (most common human pathogen), Aspergillus **flavus** (produces aflatoxin causing mycotoxicosis), Aspergillus **niger**, Aspergillus **terreus**, and Aspergillus **lentulus**
* **Acquired** through **inhalation of conidia**
* Exists **only** as **mold**; **not** dimorphic
* Forms a **v-shaped branches**
ASPERGILLOSIS
33
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS**
CAUSATIVE AGENTS:
most common **human pathogen**
A. fumigatus
34
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS**
CAUSTIVE AGENTS:
produces **aflatoxin** causing mycotoxicosis
A. flavus
35
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS**
acquired through **inhalation** of ____
conidia
36
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS**
**spores** produced by the microorganism
conidia
37
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS**
exists as ____
only as **mold**, NOT dimorphic
38
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS**
forms a ____ branches
v-shaped
39
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS | CLINICAL FINDINGS**
* **Hypersensitivity reaction** because of the **presence** of **aspergillosis** in the **bronchi** of the lungs
* Produce **asthmatic symptoms** and there is allergy because of **IgE** antibodies
Allergic Bronchopulmonary Aspergillosis (ABPA)
40
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS | CLINICAL FINDINGS**
* Happens because of the ability of the organism to **grow in the cavities within the lungs**
* Forms an **asperula** known as **fungus ball**
* Some patients may be **asymptomatic** from aspergilloma but others develop **cough**, **dsypnea**, **weight loss**, **fatigue**, **haemoptysis**
* **Rarely invasive**
* **Extrapulmonary colonization** – nasal sinuses, ear canal, cornea canals, nails
ASPERGILOMA AND EXTRAPULMONARY COLONIZATION
41
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS | CLINICAL FINDINGS**
**Aspergiloma** and Extrapulmonary Colonization forms an ____ known as **fungus ball**
asperula
42
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS | CLINICAL FINDINGS**
* Hyphae **invade** the **lumens** and **walls** of **blood vessels** causing **thrombosis**, **infarction**, and **necrosis**
* From the lungs, the disease **may spread** to the **GI tract**, **kidney**, **liver**, **brain**, or **other organs**, producing **abscesses** and **necrotic lesions**.
INVASIVE ASPERGILLOSIS
43
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS | CLINICAL FINDINGS**
INVASIVE ASPERGILLOSIS:
____ **invade** the **lumens** & **walls** of the **blood vessels**
HYPHAE
44
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS | TREATMENT**
aspergilloma
itraconazole
amphotericin B
45
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS | TREATMENT**
**invasive** aspergillosis
amphotericin B
voriconazole
46
drug that is always used for **systemic** infections
amphotericin B
47
# **OPPORTUNISTIC MYCOSES | ASPERGILLOSIS | TREATMENT**
**allergic** forms of aspergillosis
corticosteroids
disodium comoglycate
48
# **OPPORTUNISTIC MYCOSES | MUCORMYCOSIS**
**most prevalent** causative agent
RHIZOPUS ORYZAE
49
# **OPPORTUNISTIC MYCOSES | MUCORMYCOSIS**
____ of the cases of **Mucormycosis** are **caused** by **Rhizopus oryzae**
60%
50
# **OPPORTUNISTIC MYCOSES | MUCORMYCOSIS**
RISK FACTORS
diabteic ketoacidosis
dialysis w/ deferoxamine
51
# **OPPORTUNISTIC MYCOSES | MUCORMYCOSIS**
**siderophore**; **sequester iron** from the patient and then **supplying iron to the fungi**
deferoxamine
52
# **OPPORTUNISTIC MYCOSES | MUCORMYCOSIS | CLINICAL FINDINGS**
* **major clinical form**
* Spores germinate within the **sinuses** and forms an **abundant of hyphae** invading the **blood vessels** that **supply the brain** causing **thrombosis**
RHINOCEREBRAL MUCORMYCOSIS
53
# **OPPORTUNISTIC MYCOSES | MUCORMYCOSIS | CLINICAL FINDINGS**
* Happens following the inhalation of organism
* **Sporangospores** invades the **lungs** but **necrosis** may be observed resulting to the **destruction of the tissue**
* Patients **can survive** but there is a possibility of **long-term effect** like **facial paralysis**, **lose their eye**
THORACIC MUCORMYCOSIS
54
# **OPPORTUNISTIC MYCOSES | MUCORMYCOSIS | TREATMENT**
DOC
amphotericin B
| surgical debridement also
55
# **OPPORTUNISTIC MYCOSES**
* Morphologically distinct forms – **thin-walled** **trophozites** and **thick-walled cysts**
* **Pneumocytis pneumonia** – fever, nonproductive cough and dyspnea, chest x-rayshows a “ground-glass” pattern
* Before, it was the **major cause of death among AIDS patients**; seen when CD4 positive T cells count drops below 400 microliters
* **Lacks ergosterol**; **resistant** to many **antifungal agents**
PNEUMOCYSTIS PNEUMONIA
56
# **OPPORTUNISTIC MYCOSES | PNEUMOCYSTIS PNEUMONIA**
MORPHOLOGICALLY DISTINCT FORMS:
**thin**-walled ____
trophozites
57
# **OPPORTUNISTIC MYCOSES | PNEUMOCYSTIS PNEUMONIA**
MORPHOLOGICALLY DISTINCT FORMS:
**thick**-walled ____
CYSTS
58
# **OPPORTUNISTIC MYCOSES | PNEUMOCYSTIS PNEUMONIA**
causative agent
Pneumocytis jirovecii
59
# **OPPORTUNISTIC MYCOSES | PNEUMOCYSTIS PNEUMONIA**
it is **formerly** classified as a ____
protozoa
60
# **OPPORTUNISTIC MYCOSES | PNEUMOCYSTIS PNEUMONIA**
what makes it **unique**
it lacks **ergosterol**, hence resistant to many antifungal agents
61
# **OPPORTUNISTIC MYCOSES | PNEUMOCYSTIS PNEUMONIA | CLINICAL FINDINGS**
fever, **nonproductive** cough and dyspnea, **chest x-ray** shows a “**ground-glass**” pattern
PNEUMOCYTIS PNEUMONIA
62
# **OPPORTUNISTIC MYCOSES | PNEUMOCYSTIS PNEUMONIA | CLINICAL FINDINGS**
before it was known to be the **major cause of death** among ____
AIDS patients
63
# **OPPORTUNISTIC MYCOSES | PNEUMOCYSTIS PNEUMONIA | TREATMENT**
DOC
trimethoprim-sulfamethoxazole
pentamidin isethionate
64
# **OPPORTUNISTIC MYCOSES**
* Causative agent – **Talaromyces marneffei**
* Clinical manifestations – **fungemia**, **skin lesions**, and **systemic involvement** of **multiple organs**
o Fungemia – when fungi reaches the blood
* **70%** of patients, **with** or **without AIDS**, develop cutaneous or subcutaneous **papules**, **pustules**, or **rashes**
PENICILLOSIS
65
# **OPPORTUNISTIC MYCOSES | PENICILLOSIS**
causative agent
Talaromyces marneffei
66
# **OPPORTUNISTIC MYCOSES | PENICILLOSIS | CLINICAL FINDINGS**
when fungi **reaches** the **blood**
FUNGEMIA
67
# **OPPORTUNISTIC MYCOSES | PENICILLOSIS | CLINICAL FINDINGS**
____% of patients, **with or without AIDS**, develop
**cutaneous** or **subcutaneous** **papules**, **pustules**, or **rashes**
70%
68
# **OPPORTUNISTIC MYCOSES | PENICILLOSIS | TREATMENT**
DOC
amphotericin B followed by itraconazole
69
70
# **ANTI-FUNGAL CHEMOTHERAPY**
* **Polyene** antibiotic
* Indication – major **systemic** mycoses
* Side effects – **nephrotoxic**, **azotemia** almost always occur
o **Not ideal** to patients with **kidney damage**
o **Azotemia** – **high levels** of **nitrogen** in the **blood**
* **Toxicity** is greatly diminished with the **lipid formulations**
AMPHOTERICIN B
71
# **ANTI-FUNGAL CHEMOTHERAPY | AMPHOTERICIN B**
____ antibiotic
polyene
72
# **ANTI-FUNGAL CHEMOTHERAPY | AMPHOTERICIN B**
indication
major systemic mycoses
73
# **ANTI-FUNGAL CHEMOTHERAPY | AMPHOTERICIN B**
side effects
nephrotoxic
azotemia
74
# **ANTI-FUNGAL CHEMOTHERAPY | AMPHOTERICIN B**
* **almost always** occur with amphotericin B therapy
* **high levels** of **nitrogen** in the **blood**
azotemia
75
# **ANTI-FUNGAL CHEMOTHERAPY | AMPHOTERICIN B**
not ideal to patients with ____
kidney damage
76
# **ANTI-FUNGAL CHEMOTHERAPY | AMPHOTERICIN B**
**Toxicity** is greatly diminished with the ____
lipid formulations
77
# **ANTI-FUNGAL CHEMOTHERAPY | AMPHOTERICIN B**
targets what
ergosterol
78
# **ANTI-FUNGAL CHEMOTHERAPY**
* Indication – **with amphotericin B** for **treatment** of **cryptococcosis** and **candidiasis**
* Side effect – **prolonged** administration results in **bone marrow suppression**, **hair loss** and **abnormal liver function**
* **Development of resistance** if the drug is **used alone**
FLUCYTOSINE
79
# **ANTI-FUNGAL CHEMOTHERAPY | FLUCYTOSINE**
indication
combined w amphotericin B for treatment of **cryptococcosis** & **candidiasis**
80
# **ANTI-FUNGAL CHEMOTHERAPY | FLUCYTOSINE**
side effects
bone marrow suppression
hair loss
abnormal liver function
81
# **ANTI-FUNGAL CHEMOTHERAPY | FLUCYTOSINE**
will develop ____ if **used alone**
resistance
82
# **ANTI-FUNGAL CHEMOTHERAPY | FLUCYTOSINE**
side effects are caused by
5FU
| a drug used in cancer
83
# **ANTI-FUNGAL CHEMOTHERAPY | AZOLES**
have a **signature** ____ structure
five-membered ring structure
84
# **ANTI-FUNGAL CHEMOTHERAPY | AZOLES**
has **2 nitrogen** that are **non-adjacent**
IMIDAZOLE
85
# **ANTI-FUNGAL CHEMOTHERAPY | AZOLES**
has **3** nitrogen
TRIAZOLES
86
# **ANTI-FUNGAL CHEMOTHERAPY | AZOLES**
given for **fungal meningitis** because it has **good penetration** in the **CNS**
FLUCONAZOLE
87
# **ANTI-FUNGAL CHEMOTHERAPY | AZOLES**
imidazole
ketoconazole
88
# /**ANTI-FUNGAL CHEMOTHERAPY | AZOLES**
fluconazole
voriconazole
itraconazole
posaconazole
TRIAZOLE
89
# **ANTI-FUNGAL CHEMOTHERAPY | AZOLES**
may **inhibit** the **synthesis** of **testosterone** and **cortisol**, which may result to:
▪ Gynecomastia
▪ Decreased libido
▪ Impotence
▪ Menstrual irregularity
▪ Occasionally adrenal insufficiency
| **not** used **systemically** because it is **toxic**
KETOCONAZOLE
90
# **ANTI-FUNGAL CHEMOTHERAPY**
responsible for the **metabolism** of drugs
CYP450
91
# **ANTI-FUNGAL CHEMOTHERAPY | AZOLES | DRUG INTERACTIONS**
**Isoniazid**, **phenytoin**, or **rifampin** can ____ **azole concentration**
INCREASE
92
# **ANTI-FUNGAL CHEMOTHERAPY | AZOLES | DRUG INTERACTIONS**
____ can **increase** **cyclosporine**, **phenytoin**, **oral hypoglycemics**, **anticoagulants**, **digoxin**
ANTIFUNGAL AZOLE THERAPY
93
# **ANTI-FUNGAL CHEMOTHERAPY | ECHINOCANDINS**
The **first licensed drug** that has shown efficacy **against aspergillosis** and **systemic candidiasis.**
CASPOFUNGIN
94
# **ANTI-FUNGAL CHEMOTHERAPY | ECHINOCANDINS**
targets what
glucan
| found in cell wall
95
# **ANTI-FUNGAL CHEMOTHERAPY**
* **caspofungin**
* targets **glucan**
ECHINOCANDINS
96
# **ANTI-FUNGAL CHEMOTHERAPY**
* **Orally** administered antibiotic **derived** from a species of **penicillum**
* Indication – **dermatophyte infections** of the **skin**, **hair**, and **nails**
* Side effect – **headache**
* Targets **mitotic spindle** (found in **cell division**)
GRISEOFULVIN
97
# **ANTI-FUNGAL CHEMOTHERAPY | GRISEOFULVIN**
**derived** from a species of ____
PENICILLUM
98
# **ANTI-FUNGAL CHEMOTHERAPY | GRISEOFULVIN**
indication
dermatophyte infections of the skin, hair, nails
99
# **ANTI-FUNGAL CHEMOTHERAPY | GRISEOFULVIN**
side effect
headache
100
# **ANTI-FUNGAL CHEMOTHERAPY | GRISEOFULVIN**
targets what
mitotic spindle
| found in cell division
101
102
# **ANTI-FUNGAL CHEMOTHERAPY | GRISEOFULVIN**
what increases its absorption
high fat diet
103
# **ANTI-FUNGAL CHEMOTHERAPY**
* Indication – **dermatophyte infections** (**nail** infections)
* Side effects – **GI distress**, **HA**, **skin reactions**, and **loss of sense of taste**
TERBINAFINE
104
# **ANTI-FUNGAL CHEMOTHERAPY**
* **Nystatin** – polyene antibiotic
* **Clotrimazole** and **miconazole**
TOPICAL ANTI-FUNGAL AGENTS
105
# **ANTI-FUNGAL CHEMOTHERAPY | OTHER ANTI-FUNGAL AGENTS**
* **natural** antifungal
* **extracted** from **castor oil**
* given for **Tinea infections** such as **athlete’s foot**
UNDECYLENIC ACID
106
# **ANTI-FUNGAL CHEMOTHERAPY | TOPICAL ANTI-FUNGAL AGENTS**
* **vaginal** **suppository**
* **polyene** antibiotic
NYSTATIN
