Mycoses treatment-Sparks Flashcards
What are the 2 types of pathogens?
Endemic and Opportunistic
What is the most common Candida?
Candida Albicans
What are all the species of Candida discussed?
Albicans, Tropicals, Parapsilos, Glabrata, Krusei, and Lusitaniae
What are all the antifungals used for Candidas?
Fluconazole, Itraconazole, Vari/Posa/Isavuconazole, Amphotericin B, Echinocandins
Brand Name for Fluconazole?
Diflucan
What species of fungus does Fluconazole?
Albicans, Tropicals, Parapsilos, Lusitania and some of Glabarta
What Candida species is hardest to kill? what agent?
C. Glabrata; Echinocandins
What is the most common Candida in neonates?
C. Parapsilosis
What agent to use for C. Parapsilos?
Amphotericin B and Flucanozole
What are some of the risk factors for invasive Candidiasis?
- 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
Which Anti candidas agents have the broadest coverage?
Echinocandins
What are some of the examples of Echinocandins?
Caspofungins,
Micafungins,
Anidulafungin
What are the directions of taking Capsofungins for Anti candidal effect?
70 mg IV x 1 dose, then 50 mg daily
What are the directions of taking Micafungins for Anti candidal effect?
100 mg IV daily
What are the directions of taking Anidulafungins for Anti candidal effect?
200mg IV x 1 dose, then 100 mg daily
When do we use Rezafungin?
Candidemia and invasive candidiasis.
It is reserved for limited or no other alternatives
What is the dose for Rezafungin?
400mg day 1
200 mg weekly
up to 4 doses
What are good alternatives from Echinocandins for Candida treatment? dose?
Fluconzole 800mg (12mg/kg) x1 dose then 400 mg (6mg/kg) daily
Why would Amphotericin B be used for Candida?
not typically used except in cases for Endocarditis or serious infections.
What are 2 examples of Cryptococcus spp?
- C. Neoformans
- C. Gatti
Which fungus is associated with Pigeon droppings?
Cryptococcus
What are clinical presentations of Crytpcoccus spp?
- Meningitis (HA, confusion, elevated intracranial pressure) Mainly
what is the gold standard for diagnosing Cryptococcus spp?
Culture
What are the 3 stages of Meningoencephalitis cryptococcus infection treatment
Induction, Consolidation, Maintenance
What are the treatment recommended with Meningoencephalitis Induction?
a. Amphotericin B deoxygenated + Flucytosine
b. liposomal Amphotericin B (better in renal impairment)
About 2 weeks
What should be the targeted Flucytosine levels in serum concentrations?
Serum concentrations of Flucytosine should be checked 2 hrs post-dose 3-5 days into therapy to maintain 30-80 mg/L
What is the treatment available for Consolidation stage?
Fluconazole 400-800 mg PO daily 8 weeks
What is the recommended treatment for Maintenance stage?
Fluconazole 200-400 mg po daily 6-12 months
What are the treatments for Non-meningiococcal cryptococcosis?
Mild to moderate: Fluconazole 400 mg PO daily x 6-12 months
Where can one commonly pick up the infection of Aspergillosis?
Mold found in soil, food, water, and decaying vegetation.
What pts group Aspergillosis is commonly seen in?
Commonly seen in immunocompromised pts
How does Aspergillosis appear?
Skin lesions, sinusitis or pneumonia and involves liver, kidney, or brain; often rapidly fatal
What is require to diagnose aspergillosis?
A definitive requires a tissue biopsy
how do you treat aspergillosis?
Voriconazole 6mg/kg IV BID daily x 2 doses, then 4 mg/kg IV BID daily
How long should the Aspergillosis be treated for?
6-12 weeks
what are some alternative treatment that can be used beside Voriconazole?
Isavuconazole
How do dimorphic fungi presents in environment vs in infections?
Mold in environment and yeast form in infections
Mold in cold/yeast in heat
What fungus is found in Ohio river and Mississippi river valleys?
Histoplasmosis Capsulatum
What fungus is found in Northern America (US/Canada/Great lakes)?
Blastomycosis dermatitids
What fungus is found in California-San Joaquin valley?
Coccidioidomycosis immitis
What fungus is found in Southwest US, Mexico, south america?
Coccidioidomycosis posadasii
How do you diagnose mild coccidioidomycoses?
Observation with serial antigen or serologic studies
How long do you treat the mild cases of Coccidioidomycoses?
6-12 weeks
How do you treat Coccidiodomycoses?
Itraconazole
How do you treat Coccidiodomycoses if you can’t take Itraconazole?
Fluconazole may be used if GI side effects, drug-drug interactions
How long you treat severe Coccidiodomycoses?
12 weeks or until stable
How do you treat severe Coccidiodomycoses?
Amphotericin B, Liposomal amphotericin B —> transition to FLuconzaole once stable
How do you diagnose Histoplasmosis?
observation with serial antigen or serologic studies.
How do you long should you treat Histoplasmosis?
6-12 weeks
What agents should you use for Histoplasmosis?
Itraconazole Oral, Fluconazole maybe used in cases of GI side effects
How long should you treat the severe cases of Histoplasmosis?
12 weeks
How do you treat the severe cases of Histoplasmosis?
AMphotericin B, Liposomal Amphotericin B —> transition to Itraconazole once stable (fluconazole is an alternative)
How long should you treat the mild cases of Blastomycosis?
6-12 months
How do you treat Mild cases of Blastomycosis?
Itraconazole oral (Dialy for 3 days then twice daily for 6-12 months)
What is pre-medication regimen for fungizone?
administer 30-60 minutes prior therapy:
- APAP or NSAIDS
- Benadryl and or hydrocortisone
- NS bolus
- Meperidine for rigors
What is the generic for Fungizone?
Amphotericin B
Which antifungal is pH dependent?
Itrazconazole
increase in pH decreases the absorption
How should the pH dependent antifungal administer in pts who have digestion problems and might be on medications for it?
- antacids should be separated by 2 hours
- Administer with 8 oz non diet coke to bring down the pH
What antifungal agents penetrate CNS?
Fluconzaole, Voriconazole, Flucytosine
What is the most common type of Mucormycosis?
Rhinocerebral
What are the criteria for endemic infections requiring hospitalization?
- 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
What is the affect on the INR when azole therapy is started with warfarin?
- Fluconazole and voriconazole increase INR and may increase bleeding risk.
- Azoles increase the risk of bleeding when used concomitantly with apixaban and rivaroxaban
What pathogens are more common in neonates?
Candida parapsilosis (Associated with foreign devices)
What is the treatment for Candida parapsilosis?
Amphotericin B and Fluconazole
How should the posaconazole suspension be given?
200mg TID or 400mg BID
- Give with a full meal (during or within 20 minutes)
How should the Posaconazole tablets be given?
300 mg BID once and then 300 mg daily with food.
How should the Posaconazole IV be given?
300 mg BIDx1 then 300 mg daily
Which antifungals are required to be renally adjusted?
- Fluconazole:
CrCl 50ml/min or less requires dose adjustment
decrease dose by 50% - Flucytosine:
CrCl 40 ml/min or less
What is the fungal organisms that has been in news lately, Why?
Candida Auris,
outbreaks found in Healthcare facilities and can spread through contact with affected patients, Surfaces or equipment
What is the route of transmission of dimorphic fungi?
Inhalation
What is the classic sign of pulmonary aspergillosis in CT scan?
Halo sign
What is the drug of choice for mucormycosis?
- Lipid formula Amphotericin B
- Isavuconazole was recently approved for invasive mucormycosis
How d you administer Amphotericin B for Mucormycosis?
- 5 mg/kg IV daily
- some recommendations 7.5–10 mg/kg
Who is Domingo Ezcurra?
First case of Coccidioidomycosis
