Systemic Fungal Infections

Question 1

Why is antfungal resistance much less likely than abx resistance?

Answer 1

1) fungus dont make hydrolysin genzyme slike EXBLS.
2) If a fungus generates resistance, it has to do it over YEARS OF EXPOSURE.
3) They don’t PARTIICPATE IN HORIZONTAL GENE TRANSFER (can’t get esbl genes from other e.coli).
* So GENERALLY, we assume resistance unlikely.

However, if a pt had recurrent candidemia, it’ s “possible” to have a drug resistant yeast.

Question 2

Which candida spp. hs intrinsic resistance agianst Amphotericine B?

Answer 2

Candida lusitaniae

Question 3

Waht is the 2nd most common candida sp in canad?

Answer 3

Glabrata after albicans.

Question 4

Waht is the spec of activiyt for fluconazole?
actiivty agianst galbrata and aspergillus?

Answer 4

c albicans, lustantiae, crypto.

med activity: galbrata
no actiivyt: aspergillus

Question 5

What is the broadest spec antifungal?

Answer 5

ampho B - only ones it doesnt cover: C. lustantiae, and trichosporon.

Question 6

What does Itraconazole cover?

Answer 6

Same as Fluconazole but more of the less common spp.

Question 7

What do the Echinocandins (Micafungin, capsofungin) cover?

Answer 7

albicans, lustantiae, galbrata, asspergillus but NOT crypto

Question 8

Waht is the go to for galbrata or aspergillus?

Answer 8

Echniocandins- micafingun.

Question 9

Waht would you use for crypto?

Answer 9

Amphotericin B IV + Flucytosine followed by fluconazole MTrx.

Question 10

clinical presentation of hsitoplasmosis

asymp in ___% pts

passess as ____ in most cases

some may develop pulmonary__________, mediastinal fibrosis + disseminate if immunocomp to _____, bone marrow, spleen (higher risk if on _____ inhibitors)

Answer 10

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)

Answer 11

Mucomycosis : think yucky bread = carbs= diabetes.