S52(6) Dimorphic molds

Question 1

Blastomycosis

Answer 1

Boston

East Coast

Question 2

Histoplasmosis

Answer 2

Houston

Middle US

Question 3

Coccidioidomyosis

Answer 3

California

South western US

Question 4

C. gattii cryptococcosis

Answer 4

Crips in the West

West Coast

Question 5

Yeast and Dimorphic molds

Answer 5

Itraconazole is drug of choice

Question 6

Blastomycoses

Pathogenesis

Answer 6

Inhalation of conidia

Incubation period: 30-45 days

Question 7

Blastomycoses

Mild to moderate

Answer 7

itraconazloe

Question 8

Blastomycoses

moderate severe to severe

Answer 8

Liposomal AmB 3-5mg/kg/day x 1-2 wks or until improvement then Itraconazole 200mg PO tid x3 days then 200mg PO bid for 6-12 months

Itraconazole TDM after 2 weeks (goal 1-10mg/mL)

Question 9

CNS Blastomycosis

Answer 9

Liposomal AmB 5mg/kg/day x 4-6 wks then Oral triazole x 12 months or until resolution of CSF abnormalities
(ITRACONAZOLE)

Question 10

Coccidioidomyosis
S/Sx
Can present as CAP in endemic regions
Respiratory, dermatologic, and rheumatologic s/sx
Fever, night sweats, and weight loss in acute infection
Extreme fatigue

Answer 10

True

Question 11

Coccidioidomycosis PNA

Answer 11

Oral triazole
Fluconazole ≥ 400mg daily
Duration: 3-6 months

Question 12

Symptomatic chronic cavitary coccidioidal PNA

Answer 12

Fluconazole or itraconazole

Question 13

Extrapulmonary soft tissue

Answer 13

Fluconazole or itraconazole

Duration 6-12 months

Question 14

Meningitis (CM)

Answer 14

Fluconazole 400-1200mg daily

Question 15

Histoplasmosis
Clues to diagnosis

BATS and Bird Droppings

Answer 15

Hepatosplenomegaly
Mucosal ulcers and skin lesions
GI involvement
Pancytopenia
Elevated LFTs
Increased LDH
Increased serum ferritin

Question 16

Histoplasmosis Treatment

Moderately severe to severe acute pulmonary

Answer 16

Lipid AmB 3-5mg/kg/day x1-2wks then
Itraconazole 200mg PO tid x3d then bid x12wks
Methylprednisolone 0.5-1mg/kg daily x1-2wks for severe respiratory complications

Question 17

Histoplasmosis Treatment

Mild to moderate acute pulmonary

Answer 17

Symptoms > 1 month

Itraconazole 200mg PO tid x3d then bid x6-12wks

Question 18

Blastomycoses

Mild to Moderate

Answer 18

Itraconazole 200mg 1-2 times per day

Question 19

Blastomycoses

Severe

Answer 19

Liposomal AmB 3-5mg/kg/day x 1-2 wks or until improvement then Itraconazole 200mg PO tid x3 days then 200mg PO bid

Question 20

Coccidioido-mycosis

Mild to Moderate

Answer 20

Observation and supportive therapy

Question 21

Coccidioido-mycosis

Severe

Answer 21

Fluconazole ≥ 400mg daily

Or itraconazole

Question 22

Histoplasmosis

Mild to Moderate

Answer 22

Sx > 1 month

Itraconazole 200mg PO tid x3d then bid

Question 23

Histoplasmosis

Severe

Answer 23

Lipid AmB 3-5mg/kg/day x1-2wks then

Itraconazole 200mg PO tid x3d then bid