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Mycoses treatment-Sparks Flashcards

1
Q

What are the 2 types of pathogens?

A

Endemic and Opportunistic

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2
Q

What is the most common Candida?

A

Candida Albicans

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3
Q

What are all the species of Candida discussed?

A

Albicans, Tropicals, Parapsilos, Glabrata, Krusei, and Lusitaniae

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4
Q

What are all the antifungals used for Candidas?

A

Fluconazole, Itraconazole, Vari/Posa/Isavuconazole, Amphotericin B, Echinocandins

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5
Q

Brand Name for Fluconazole?

A

Diflucan

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6
Q

What species of fungus does Fluconazole?

A

Albicans, Tropicals, Parapsilos, Lusitania and some of Glabarta

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7
Q

What Candida species is hardest to kill? what agent?

A

C. Glabrata; Echinocandins

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8
Q

What is the most common Candida in neonates?

A

C. Parapsilosis

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9
Q

What agent to use for C. Parapsilos?

A

Amphotericin B and Flucanozole

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10
Q

What are some of the risk factors for invasive Candidiasis?

A
  • Broad Spectrum antibiotics
  • Prolonged hospital stay; ICU higher risk
  • Central venous catheter
  • Hemodialysis or parenteral nutrition
  • Corticosteroids, Chemotherapy or other immunosuppressive therapies
  • Surgery; Intra-abdominal higher risk
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11
Q

Which Anti candidas agents have the broadest coverage?

A

Echinocandins

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12
Q

What are some of the examples of Echinocandins?

A

Caspofungins,
Micafungins,
Anidulafungin

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13
Q

What are the directions of taking Capsofungins for Anti candidal effect?

A

70 mg IV x 1 dose, then 50 mg daily

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14
Q

What are the directions of taking Micafungins for Anti candidal effect?

A

100 mg IV daily

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15
Q

What are the directions of taking Anidulafungins for Anti candidal effect?

A

200mg IV x 1 dose, then 100 mg daily

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16
Q

When do we use Rezafungin?

A

Candidemia and invasive candidiasis.
It is reserved for limited or no other alternatives

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17
Q

What is the dose for Rezafungin?

A

400mg day 1
200 mg weekly
up to 4 doses

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18
Q

What are good alternatives from Echinocandins for Candida treatment? dose?

A

Fluconzole 800mg (12mg/kg) x1 dose then 400 mg (6mg/kg) daily

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19
Q

Why would Amphotericin B be used for Candida?

A

not typically used except in cases for Endocarditis or serious infections.

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20
Q

What are 2 examples of Cryptococcus spp?

A
  • C. Neoformans
  • C. Gatti
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21
Q

Which fungus is associated with Pigeon droppings?

A

Cryptococcus

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22
Q

What are clinical presentations of Crytpcoccus spp?

A
  • Meningitis (HA, confusion, elevated intracranial pressure) Mainly
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23
Q

what is the gold standard for diagnosing Cryptococcus spp?

A

Culture

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24
Q

What are the 3 stages of Meningoencephalitis cryptococcus infection treatment

A

Induction, Consolidation, Maintenance

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25
Q

What are the treatment recommended with Meningoencephalitis Induction?

A

a. Amphotericin B deoxygenated + Flucytosine

b. liposomal Amphotericin B (better in renal impairment)
About 2 weeks

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26
Q

What should be the targeted Flucytosine levels in serum concentrations?

A

Serum concentrations of Flucytosine should be checked 2 hrs post-dose 3-5 days into therapy to maintain 30-80 mg/L

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27
Q

What is the treatment available for Consolidation stage?

A

Fluconazole 400-800 mg PO daily 8 weeks

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28
Q

What is the recommended treatment for Maintenance stage?

A

Fluconazole 200-400 mg po daily 6-12 months

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29
Q

What are the treatments for Non-meningiococcal cryptococcosis?

A

Mild to moderate: Fluconazole 400 mg PO daily x 6-12 months

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30
Q

Where can one commonly pick up the infection of Aspergillosis?

A

Mold found in soil, food, water, and decaying vegetation.

31
Q

What pts group Aspergillosis is commonly seen in?

A

Commonly seen in immunocompromised pts

32
Q

How does Aspergillosis appear?

A

Skin lesions, sinusitis or pneumonia and involves liver, kidney, or brain; often rapidly fatal

33
Q

What is require to diagnose aspergillosis?

A

A definitive requires a tissue biopsy

34
Q

how do you treat aspergillosis?

A

Voriconazole 6mg/kg IV BID daily x 2 doses, then 4 mg/kg IV BID daily

35
Q

How long should the Aspergillosis be treated for?

A

6-12 weeks

36
Q

what are some alternative treatment that can be used beside Voriconazole?

A

Isavuconazole

37
Q

How do dimorphic fungi presents in environment vs in infections?

A

Mold in environment and yeast form in infections
Mold in cold/yeast in heat

38
Q

What fungus is found in Ohio river and Mississippi river valleys?

A

Histoplasmosis Capsulatum

39
Q

What fungus is found in Northern America (US/Canada/Great lakes)?

A

Blastomycosis dermatitids

40
Q

What fungus is found in California-San Joaquin valley?

A

Coccidioidomycosis immitis

41
Q

What fungus is found in Southwest US, Mexico, south america?

A

Coccidioidomycosis posadasii

42
Q

How do you diagnose mild coccidioidomycoses?

A

Observation with serial antigen or serologic studies

43
Q

How long do you treat the mild cases of Coccidioidomycoses?

A

6-12 weeks

44
Q

How do you treat Coccidiodomycoses?

A

Itraconazole

45
Q

How do you treat Coccidiodomycoses if you can’t take Itraconazole?

A

Fluconazole may be used if GI side effects, drug-drug interactions

46
Q

How long you treat severe Coccidiodomycoses?

A

12 weeks or until stable

47
Q

How do you treat severe Coccidiodomycoses?

A

Amphotericin B, Liposomal amphotericin B —> transition to FLuconzaole once stable

48
Q

How do you diagnose Histoplasmosis?

A

observation with serial antigen or serologic studies.

49
Q

How do you long should you treat Histoplasmosis?

A

6-12 weeks

50
Q

What agents should you use for Histoplasmosis?

A

Itraconazole Oral, Fluconazole maybe used in cases of GI side effects

51
Q

How long should you treat the severe cases of Histoplasmosis?

A

12 weeks

52
Q

How do you treat the severe cases of Histoplasmosis?

A

AMphotericin B, Liposomal Amphotericin B —> transition to Itraconazole once stable (fluconazole is an alternative)

53
Q

How long should you treat the mild cases of Blastomycosis?

A

6-12 months

54
Q

How do you treat Mild cases of Blastomycosis?

A

Itraconazole oral (Dialy for 3 days then twice daily for 6-12 months)

55
Q

What is pre-medication regimen for fungizone?

A

administer 30-60 minutes prior therapy:
- APAP or NSAIDS
- Benadryl and or hydrocortisone
- NS bolus
- Meperidine for rigors

56
Q

What is the generic for Fungizone?

A

Amphotericin B

57
Q

Which antifungal is pH dependent?

A

Itrazconazole
increase in pH decreases the absorption

58
Q

How should the pH dependent antifungal administer in pts who have digestion problems and might be on medications for it?

A
  • antacids should be separated by 2 hours
  • Administer with 8 oz non diet coke to bring down the pH
59
Q

What antifungal agents penetrate CNS?

A

Fluconzaole, Voriconazole, Flucytosine

60
Q

What is the most common type of Mucormycosis?

A

Rhinocerebral

61
Q

What are the criteria for endemic infections requiring hospitalization?

A
  • Hypoxia,
  • Hypotension
  • Altered mental Status
  • Anemia
  • Leukopenia
  • Live enzyme elevation
  • ALT and AST 5 times higher
  • Bilirubin 2.5 times higher
  • Coagulopathy; Impaired clotting
  • Dissemination evidence;
  • Meningitis
62
Q

What is the affect on the INR when azole therapy is started with warfarin?

A
  • Fluconazole and voriconazole increase INR and may increase bleeding risk.
  • Azoles increase the risk of bleeding when used concomitantly with apixaban and rivaroxaban
63
Q

What pathogens are more common in neonates?

A

Candida parapsilosis (Associated with foreign devices)

64
Q

What is the treatment for Candida parapsilosis?

A

Amphotericin B and Fluconazole

65
Q

How should the posaconazole suspension be given?

A

200mg TID or 400mg BID
- Give with a full meal (during or within 20 minutes)

66
Q

How should the Posaconazole tablets be given?

A

300 mg BID once and then 300 mg daily with food.

67
Q

How should the Posaconazole IV be given?

A

300 mg BIDx1 then 300 mg daily

68
Q

Which antifungals are required to be renally adjusted?

A
  • Fluconazole:
    CrCl 50ml/min or less requires dose adjustment
    decrease dose by 50%
  • Flucytosine:
    CrCl 40 ml/min or less
69
Q

What is the fungal organisms that has been in news lately, Why?

A

Candida Auris,
outbreaks found in Healthcare facilities and can spread through contact with affected patients, Surfaces or equipment

70
Q

What is the route of transmission of dimorphic fungi?

A

Inhalation

71
Q

What is the classic sign of pulmonary aspergillosis in CT scan?

A

Halo sign

72
Q

What is the drug of choice for mucormycosis?

A
  • Lipid formula Amphotericin B
  • Isavuconazole was recently approved for invasive mucormycosis
73
Q

How d you administer Amphotericin B for Mucormycosis?

A
  • 5 mg/kg IV daily
  • some recommendations 7.5–10 mg/kg
74
Q

Who is Domingo Ezcurra?

A

First case of Coccidioidomycosis

ID (13 decks)

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