S52(6) Dimorphic molds Flashcards
Blastomycosis
Boston
East Coast
Histoplasmosis
Houston
Middle US
Coccidioidomyosis
California
South western US
C. gattii cryptococcosis
Crips in the West
West Coast
Yeast and Dimorphic molds
Itraconazole is drug of choice
Blastomycoses
Pathogenesis
Inhalation of conidia
Incubation period: 30-45 days
Blastomycoses
Mild to moderate
itraconazloe
Blastomycoses
moderate severe to severe
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)
CNS Blastomycosis
Liposomal AmB 5mg/kg/day x 4-6 wks then Oral triazole x 12 months or until resolution of CSF abnormalities
(ITRACONAZOLE)
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
True
Coccidioidomycosis PNA
Oral triazole
Fluconazole ≥ 400mg daily
Duration: 3-6 months
Symptomatic chronic cavitary coccidioidal PNA
Fluconazole or itraconazole
Extrapulmonary soft tissue
Fluconazole or itraconazole
Duration 6-12 months
Meningitis (CM)
Fluconazole 400-1200mg daily
Histoplasmosis
Clues to diagnosis
BATS and Bird Droppings
Hepatosplenomegaly Mucosal ulcers and skin lesions GI involvement Pancytopenia Elevated LFTs Increased LDH Increased serum ferritin
Histoplasmosis Treatment
Moderately severe to severe acute pulmonary
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
Histoplasmosis Treatment
Mild to moderate acute pulmonary
Symptoms > 1 month
Itraconazole 200mg PO tid x3d then bid x6-12wks
Blastomycoses
Mild to Moderate
Itraconazole 200mg 1-2 times per day
Blastomycoses
Severe
Liposomal AmB 3-5mg/kg/day x 1-2 wks or until improvement then Itraconazole 200mg PO tid x3 days then 200mg PO bid
Coccidioido-mycosis
Mild to Moderate
Observation and supportive therapy
Coccidioido-mycosis
Severe
Fluconazole ≥ 400mg daily
Or itraconazole
Histoplasmosis
Mild to Moderate
Sx > 1 month
Itraconazole 200mg PO tid x3d then bid
Histoplasmosis
Severe
Lipid AmB 3-5mg/kg/day x1-2wks then
Itraconazole 200mg PO tid x3d then bid
