Superficial and Invasive Fungal Infections

Question 1

Histoplasmosis Treatment for immunoCOMPETENT hosts

Answer 1

Asymptomatic or have mild-moderate symptoms lasting < 4 weeks:
- NO treatment required

Mild - moderate w/ symptoms > 4 weeks:
1.) Itraconazole (DOC)

Moderately severe - severe:

1. ) Amphotericin B FOLLOWED by Itraconazole
2. ) Amphotericin deoxycholate
3. ) Methylprednisolone

Question 2

Histoplasmosis treatment for disseminated & immunoCOMPROMISED hosts

Answer 2

Less severe:
1.) itraconazole

Moderately severe - severe:
1.) Amphotericin B (1-2 wks) FOLLOWED by itraconazole (12 months)

Question 3

Blastomycosis causative pathogen?

Answer 3

Blastomyces Dermatitides

Question 4

Blastomycosis presentation?

Answer 4

Acute:
- Asymptomatic or flu-like symptoms (fever, productive cough)

Chronic:
- Fever, malaise, weight loss, night sweats, productive cough

Question 5

Blastomycosis diagnosis

Answer 5

• Serologic exam (testing for blastomyces antigen in blood or urine)
• Microscopic exam of the sputum

Question 6

Pulmonary blastomyces Treatment in immunoCOMPETENT patients?

Answer 6

Mild - moderate:
1.) Itraconazole

Moderately severe - severe
1.) Lipid amphotericin B FOLLOWED by itraconazole

Question 7

Disseminated blastomyces & immunocompetent treatment?

Answer 7

Mild - moderate:
1.) Itraconazole

Moderately severe - severe:
1.) Amphotericin B FOLLOWED by itraconazole

CNS disease:
1.) amphotericin B FOLLOWED by an oral azole (fluconazole, itraconazole, voriconazole)

Question 8

Blastomycosis & immunocompromised treatment?

Answer 8

Amphotericin B FOLLOWED by suppressive therapy (itraconazole) for 12 OR MORE MONTHS

Suppressive therapy may be lifelong if pt is immunocompromised and immunosuppression is irreversible or if they have relapse even with treatment

Question 9

Coccidioidomycosis causative pathogen?

Answer 9

Coccidioides Immitis

Question 10

Coccidiodomycosis presentation?

Answer 10

Usually asymptomatic

But can have Valley Fever

• Non specific symp: fever, malaise, fatigue
• rash

Question 11

Pulmonary Coccidioidomycosis Treatment?

Answer 11

Usually don’t have to treat UNLESS have high risk factors (HIV, pregnancy, high dose steroids, organ transplant), severe infection (>10% weight loss, intense night sweats, symptoms last > 2 months)

Primarily pulmonary infection:

1. ) Fluconazole (1st line)
2. ) Itraconazole

Symptomatic Chronic cavitarypneumonia:

1. ) Fluconazole
2. ) Itraconazole

Diffuse pneumonia with bilateral or miliary infiltrates (severe):
1.) intrathecal amphotericin B FOLLOWED by an azole

Question 12

Disseminated coccidioidomycosis treatment?

Answer 12

Non-meningeal:

1. ) Fluconazole or itraconazole
2. ) Amphotericin B

Meningeal:

1. ) Fluconazole (1st line) –> not curative tho so need to give life long
2. ) Itraconazole
3. ) Intrathecal amphotericin B +/- azole continuation therapy