Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

446- ID and transplant > Systemic Fungal Infections > Flashcards

Systemic Fungal Infections Flashcards

1
Q

what are the steps in ID

A
  1. what is the dx
  2. microbiological testing orders
  3. empiric antimicrobials
  4. culture directed therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are unicellular, colorless, oval shaped fungi that reproduce by budding

A

yeast

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are multicellular, colorful, branching with hyphae/ septa

A

molds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what fungi are yeast in the heat and mold in the cold

A

dimorphic fungi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

name 2 yeasts

A

candida spp
cryptococcus spp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

name 3 molds

A

asperigillus
mucorales/ rhizopus
dermatophytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

name 2 dimorphic yeasts

A

histoplasma spp
blastomyces

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

_____ pathogens cause disease in otherwise healthy individuals if exposed to infectious microorganism

A

primary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

_____ cause disease in pts who can’t defend themselves against fungus

A

opportunists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

dimorphic fungi is a
1. primary pathogen
2. opportunist
3. both, depending

A

1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

yeast is a
1. primary pathogen
2. opportunist
3. both, depending

A

2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

aspergillus is a
1. primary pathogen
2. opportunist
3. both, depending

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

aspergillosis in a severely immunodeficient pt causes

A

invasive pulmonary aspergillosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

aspergillosis in a moderately immunodef pt causes

A

chronic cavitating pulmonary aspergillosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

aspergillosis in a strong and immunocompetent pt causes

A

allergic bronchopulmonary aspergillosis (ABPA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

list 2 early gen azole antifungals

A

fluconazole
itraconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

list 3 late gen azole antifungals

A

voriconazole
posaconazole
isavuconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

name 1 echinocandin

A

micafungin
caspofungin
anidulafungin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

name 2 polyene antifungals

A

amphotericin B
nystatin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

name 2 misc antifungals

A

flucytosine
terbinafine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

polyene antifungal MOA

A

directly inserts pores into ergosterol cell wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

polyene antifungals are used for

A

endemic mycoses, resistant fungi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

echinocandins MOA

A

inhibits b-1,3-glucan synthase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

echinocandins are used for

A

invasive candidiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

azole antifungal MOA

A

inhibits lanosterol 14-a demethylase (CYP enzyme)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

azole antifungals are used for

A

candida, invasive mold infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

T or F: there is bacterial in the CNS and brain

A

F- should always be sterile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

which of the following are sterile sites
1. biliary tree
2. skin
3. peritoneum
4. LRT

A

3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

opportunistic candidiasis yeast infection of the mouth/ esophagus is common in pts with ______ from chemo but any pt who is even _____________ (ex- newborns)

A

mucositis
partially immunodeficient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

vaginal candidiasis is an _____ yeast infection in those who are locally ______

A

opportunistic yeast infection
locally immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

candidemia means

A

candida spp isolated in blood

32
Q

what is invasive candidiasis

A

generic term for systemic fungal infection with candida spp (can involve distant organs0

33
Q

yeast in blood represents

A

a major breakdown in normal host immune capability

34
Q

T or F: normally our immune system is extremely effective at clearing yeast in blood

A

T- yeast in blood is never a contaminant + req urgent assessment + tx
- 30% will die

35
Q

loss of host immune defense may be due to (3)

A

exposure to broad spec antibiotics
uncontrolled DM
neutropenia

36
Q

loss of host barrier defenses may be due to (3)

A

IV catheters
TPN
intraabdominal surgery

37
Q

candidemia can cause _____ or ______

A

nonspec febrile illness
septic shock

38
Q

candida can cause ____ by seeding from initial source

A

metastatic infection

39
Q

sites of possible candida seeding include

A

candida endophthalmitis (eyes)
infective endocarditis
osteoarticular infections
hepatic/ splenic abscess formation

40
Q

candidemia should prompt eval for

A

potential seeding sites for metastatic infection

41
Q

metastatic sites of infection can serve as _____ or _____ of ——–

A

new sources or niduses of persistent infection

42
Q

how long does it take to get the first gram stain report

A

12-24hrs

43
Q

how long does it take to get an identity report

A

24-48hrs after yeast is isolated

44
Q

how long does it take to get a susceptibility report

A

24-48hrs, sometimes 3-4 days after receipt of pathogen identity = need to start empiric antifungals beforehand

45
Q

____________ are not detectable via regular bacterial blood cultures

A

molds- require special fungal blood cultures

46
Q

can yeast be found in regular bacterial blood culture? how long will it take/

A

yes- will flag as yeast on gram stain
as late as 4-5 days

47
Q

T or F: yeast in nonsterile sites is not always pathogenic

A

T

48
Q

what is the majority of the candida species

A

candida albicans

49
Q

T or F; antifungal drug resistance is a prominent clinical issue

A

T- but not the same way as bacteria

50
Q

why is antifungal drug resistance not the same as antibacterial resistance

A

fungi do not make antifungal hydrolyzing enzymes (generally)
takes years of exposure and circulation to develop resistance
rarely pass resistance mechs to each other

51
Q

how is antifungal resistance developed

A

antifungal pressure can select for specific drug resistant species

often involves drug efflux pumps or target enzyme mod mechs

52
Q

antifungals should be assessed on day _______ and again on day ____ for appropriateness

A

day of prescription
again on day 3

53
Q

why do pts will have increased mortality rate despite adequate antifungal tx

A

antifungal tx is only one component of tx
most importantly - effective source control of index source + hematogenous metastatic sites
ongoing immunodef may make CL difficult
(5 causes of apparent clinical failure)

54
Q

what are 5 causes of apparent clinical failure

A

lack of source control
immunodef
wrong dx
other diseases/ infxns
delayed improvement

55
Q

T or F: tx failure infers antifungal drug failure

A

F- may be due to lack of source control, immunodef, wrong dx, other diseases, delayed improvement

56
Q

cryotpococcus is an _________ associated endemically with ___________. it is a ___ (opportunist/ primary pathogen)

A

encapsulated yeast
vancouver island
opportunist

57
Q

how is cryptococcosis acquired

A

inhalation of airborne yeast
typically only in immunocomp pts

58
Q

what is the clinical presentation of cryotococcosis

A

pulmonary diseases (uncommon)- usually sequestered into granulomas in lung and dies
subacute meningitis
umbilicated skin lesions

59
Q

how is cryotococcosis dx

A

CrAG

60
Q

cryotococcosis tx includes

A

amp B + flucytosine (induction)
fluconazole (maintenance)

61
Q

histoplasmosis acquisition

A

inhalation of airborne microconidia- bat droppings

62
Q

clinical presentation of hsitoplasmosis

A

asymp in 90% pts
passess as CAP in most cases
some may develop pulmonary nodules/ cavitation (TB/ cancer), mediastinal fibrosis + disseminate if immunocomp to CNS, bone marrow, spleen (higher risk if on TNF-a inhibitors)

63
Q

how is histoplasmosis dx

A

serology testing, urinary histoplasma Ag, culture

64
Q

histoplasmosis tx

A

initially amp B then step down to itraconazole

65
Q

blastomycosis is a _______ with characteristic ___________ yeast phenotype

A

dimorphic fungi
broad based budding

66
Q

acquisition of blastomycosis is from

A

INH airborne conidia
traumatic inoculation rare

67
Q

what is the clinical presentation of blastomycosis

A

asymp in 50% pts, sometimes constitutional illness
pulmonary blastomycosis, but often combo wtih cutaneous
recurrent, extrapulmonary, cutaneous, joint, GU/prostate, CNS disease (chronic meningitis)

68
Q

how is blastmycosis dx

A

serology testing first, EIA from urine/serum, culture

69
Q

how is blastomycosis tx

A

ampho B, then step down to itraconazole

70
Q

mucormycosis group molds are rapidly growing _______ molds that are relatively _____

A

hyphal molds
relatively aseptate

71
Q

mucormycosis comes from

A

bread molds

72
Q

mucormycosis acquisiton

A

INH

73
Q

mucormycosis is classically assocaited with

A

DKA and uncontrolled diabetes

(also causes prolonged neutropenia >14 days), heme malignancy, iron overload sx- hemochromatosis)

74
Q

what is the clinical presentation of mucormycosis

A

Rhinocerebral mucormycosis – destructive soft-palate eschar/nasal/sinuses disease which can extend into the CNS/skull
Pulmonary mucormycosis – rapidly progressive lung-necrotizing disease in neutropenic patients, tough to parse from aspergillosis; can disseminate; is angioinvasive and has HIGH mortality rate
Cutaneous mucormycosis – involving necrotic skin lesions

75
Q

tx for mucormycosis

A

SURGERY/DEBRIDEMENT MOST IMPORTANT. Initially Amphotericin B but possibly isavuconazole as first-line with salvage options, prolonged treatment

76
Q

what are 3 antifungal stewardship jobs for pharmacists

A

de-escalation with final culture reports
IV-PO step down (most are highly bioavailable)
duration of tx (limit)

446- ID and transplant (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions