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Systemic Fungal Infections Flashcards

1
Q

What is the most common invasive fungal infection?

A

Candidiasis.

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2
Q

What is the most common Candida species?

A

Candida albicans.

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3
Q

What is the recommended test to rule out ocular involvement in candidemia?

A

Ophthalmology consult to assess for chorioretinitis.

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4
Q

What is the preferred initial treatment for candidemia?

A

An echinocandin.

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5
Q

When can fluconazole be used for candidemia?

A

When the patient is stable and susceptibilities confirm sensitivity.

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6
Q

What is the minimum treatment duration for candidemia?

A

14 days after the first negative blood culture.

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7
Q

Why should central lines be removed in candidemia?

A

To remove the source and reduce recurrence risk.

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8
Q

Why are echinocandins avoided in Candida UTIs?

A

They do not achieve adequate urinary concentrations.

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9
Q

How is asymptomatic candiduria managed?

A

Usually not treated unless the patient is high risk (e.g., neutropenic, low birth weight infant, or pre-urologic procedure).

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10
Q

What regions are endemic for Histoplasma capsulatum?

A

Ohio and Mississippi River valleys.

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11
Q

How is histoplasmosis acquired?

A

Inhalation of microconidia from disturbed soil.

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12
Q

What is the hallmark pathophysiology of histoplasmosis?

A

Granuloma formation with caseation and calcification.

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13
Q

What is the treatment for moderate to severe pulmonary histoplasmosis in immunocompetent patients?

A

Liposomal amphotericin B followed by itraconazole for a total of 12 weeks.

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14
Q

How long should itraconazole be continued in disseminated histoplasmosis?

A

At least 12 months.

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15
Q

What is used for antigen detection in histoplasmosis?

A

Blood, urine, BAL, and CSF samples.

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16
Q

What pathogen causes blastomycosis?

A

Blastomyces dermatitidis.

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17
Q

What are extrapulmonary sites of blastomycosis dissemination?

A

Skin, bone/joints, and genitourinary tract.

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18
Q

What is the treatment for mild-moderate pulmonary blastomycosis?

A

Itraconazole for 6 months.

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19
Q

How long is CNS blastomycosis treated?

A

At least 12 months.

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20
Q

What is the initial treatment for severe or CNS blastomycosis?

A

Liposomal amphotericin B followed by an azole.

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21
Q

What pathogen causes Valley Fever?

A

Coccidioides immitis.

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22
Q

Where is coccidioidomycosis endemic?

A

Southwestern and Western United States.

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23
Q

What are signs of severe pulmonary coccidioidomycosis?

A

Weight loss >10%, intense night sweats >3 weeks, extensive infiltrates, or high complement fixation titers.

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24
Q

What is the treatment for meningeal coccidioidomycosis?

A

Fluconazole 400–1200 mg daily, possibly lifelong.

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25
How long is treatment for chronic cavitary pneumonia due to coccidioidomycosis?
12 months.
26
What pathogens cause cryptococcosis?
Cryptococcus neoformans and Cryptococcus gattii.
27
What is the most common site of cryptococcosis dissemination?
CNS – leading to meningitis.
28
What is the hallmark diagnostic test for cryptococcal meningitis?
Positive cryptococcal antigen in CSF or serum.
29
What is the induction therapy for cryptococcal meningitis in HIV patients?
Liposomal amphotericin B + flucytosine for 2 weeks.
30
When can ART be withheld in cryptococcal meningitis?
If the patient is newly diagnosed with HIV or not yet on ART.
31
What is the most common site of invasive aspergillosis?
Lungs.
32
What is the diagnostic hallmark of invasive aspergillosis on CT?
Halo sign or air crescent sign.
33
What is the first-line treatment for invasive aspergillosis?
Voriconazole.
34
What is the role of galactomannan testing?
Detects Aspergillus antigen in serum or BAL.
35
What is a major risk factor for invasive aspergillosis?
Prolonged neutropenia.
36
What is the standard dose of liposomal amphotericin B?
3–5 mg/kg IV daily.
37
What is the MOA of amphotericin B?
Binds ergosterol and forms membrane pores.
38
What is the spectrum of amphotericin B?
Broad: Candida, Cryptococcus, Aspergillus, Histoplasma, Blastomyces, Coccidioides.
39
What are key toxicities of amphotericin B?
Nephrotoxicity, hypokalemia, infusion reactions.
40
What is a benefit of liposomal amphotericin B over conventional?
Less nephrotoxicity and fewer infusion reactions.
41
What is the typical dose of fluconazole for cryptococcal meningitis maintenance?
400 mg PO daily.
42
What is the dose of fluconazole for coccidioidal meningitis?
400–1200 mg PO daily.
43
What is fluconazole's MOA?
Inhibits 14α-demethylase, blocking ergosterol synthesis.
44
What is fluconazole's spectrum?
Candida spp. (not C. krusei or C. glabrata), Cryptococcus, Coccidioides.
45
Is fluconazole renally adjusted?
Yes.
46
What is the MOA of itraconazole?
Inhibits fungal CYP450, blocking ergosterol synthesis.
47
What is the dose of itraconazole for histoplasmosis or blastomycosis?
200 mg PO BID or TID, depending on formulation.
48
What is the key counseling point for itraconazole capsules?
Take with acidic beverage and food.
49
What formulation of itraconazole has better bioavailability?
Solution (take on empty stomach).
50
What is the target serum concentration of itraconazole?
>1 mcg/mL.
51
What is the loading dose of voriconazole?
6 mg/kg IV q12h x 2 doses.
52
What is the maintenance dose of voriconazole?
4 mg/kg IV q12h or 200 mg PO BID.
53
What is the MOA of voriconazole?
Inhibits 14α-demethylase.
54
What is the spectrum of voriconazole?
Aspergillus, Candida, Fusarium.
55
What are key adverse effects of voriconazole?
Visual changes, hepatotoxicity, phototoxicity.
56
What is the therapeutic range for voriconazole?
1–5.5 mcg/mL.
57
What is the loading dose of posaconazole DR tablets?
300 mg PO BID on day 1.
58
What is the maintenance dose of posaconazole DR tablets?
300 mg PO daily.
59
What is the spectrum of posaconazole?
Candida, Aspergillus, Mucorales.
60
What is the key absorption tip for posaconazole oral suspension?
Take with high-fat meal.
61
What is the target trough level of posaconazole?
>0.7 mcg/mL (prophylaxis), >1.0 mcg/mL (treatment).
62
What is the loading dose of isavuconazonium?
372 mg IV/PO q8h x 6 doses.
63
What is the maintenance dose of isavuconazonium?
372 mg IV/PO daily.
64
What is the spectrum of isavuconazole?
Aspergillus, Mucorales.
65
What is a unique feature of isavuconazole?
Shortens QT interval; no cyclodextrin needed.
66
Is therapeutic drug monitoring required for isavuconazole?
No.
67
What is the dose of flucytosine in cryptococcal meningitis?
100 mg/kg/day PO divided Q6h.
68
What is the MOA of flucytosine?
Converted to 5-FU → inhibits DNA/RNA synthesis.
69
What are key toxicities of flucytosine?
Bone marrow suppression, GI upset.
70
What is the target peak concentration of flucytosine?
30–80 mcg/mL.
71
What must be co-administered with flucytosine in cryptococcal meningitis?
Amphotericin B.
72
What is the dose of caspofungin for candidemia?
Loading: 70 mg IV x1, then 50 mg IV daily.
73
What is the MOA of echinocandins?
Inhibit β-1,3-glucan synthase.
74
What is the spectrum of echinocandins?
Candida spp., some Aspergillus activity.
75
Do echinocandins penetrate the urine well?
No.
76
What are adverse effects of echinocandins?
Histamine-mediated reactions, elevated LFTs.
77
What is the most common invasive fungal infection?
Candidiasis.
78
What fungal infection is associated with bird/bat droppings in the Ohio/Mississippi River Valley?
Histoplasmosis.
79
Which fungi can cause meningitis?
Cryptococcus and Coccidioides.
80
What is the most common site of invasive aspergillosis?
Lungs.
81
What is the first-line treatment for invasive aspergillosis?
Voriconazole.
82
What is the preferred initial treatment for candidemia?
Echinocandin.
83
What is the first-line treatment for cryptococcal meningitis in HIV?
Liposomal amphotericin B + flucytosine.
84
What is the treatment for moderate to severe pulmonary histoplasmosis?
Liposomal amphotericin B followed by itraconazole.
85
What is used for CNS blastomycosis?
Liposomal amphotericin B followed by itraconazole for ≥12 months.
86
How long should candidemia be treated?
At least 14 days after negative blood cultures.
87
How long is treatment for CNS histoplasmosis?
At least 12 months.
88
How long is treatment for chronic cavitary coccidioidomycosis?
12 months.
89
How long is fluconazole continued after cryptococcal meningitis induction/consolidation?
At least 1 year.
90
What is the hallmark of cryptococcal meningitis diagnosis?
Positive CSF cryptococcal antigen.
91
What is a hallmark radiologic finding in aspergillosis?
Halo sign or air crescent sign on chest CT.
92
What test detects Aspergillus antigen in BAL or serum?
Galactomannan.
93
What fungal infection may show calcified granulomas on imaging?
Histoplasmosis.
94
What antifungal requires weekly CBC monitoring due to delayed anemia?
IV artesunate (for malaria, relevant in co-infection).
95
What antifungal requires drug level monitoring and has phototoxicity risk?
Voriconazole.
96
What antifungal is best avoided in urinary tract infections?
Echinocandins.
97
Which antifungal shortens QT interval?
Isavuconazole.

therapeutics V (29 decks)

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