Treatment of Fungal Infection of the Lung Flashcards
How does candida albicans infection present?
fever, tachycardia, patchy infiltrates on chest film
Is candida albicans a common cause of pneumonia?
No, seen more in immunocompromised patients
How does cryptococcus neoformans infection present?
Often asymptomatic; may have productive cough, fever and weight loss
What is cryptococcus neoformans commonly associated with?
pigeon droppings
How does aspergillus (mold) infection present?
Wheezing, dyspnea and cough with allergic broncho-pulmonary
aspergillosis:
fever, cough,
dyspnea, pleuritic chest pain, and hemoptysis seen in invasive forms, usually in immuno-compromised patients
What is aspergillomas?
fungal ‘balls’ that can form in pre-existing cavities and can spread via blood
How does blastomyces dermatitidis infection present?
-fever, chills, productive cough and possibly skin or bone lesions
How is candida albicans treated?
ampho B IV and fluconazole
How is CNS cryptococcus neoformans treated?
Ampho B IV + flucytosine PO (because they are fungicidal)
How is non-CNS cryptococcus neoformans treated?
Fluconazole PO
How is aspergillus treated?
-Voriconazole IV Ampho B
For Aspergillus there is a move to employ one of the newer azole drugs, which are
effective against these species, rather than amphotericin B.
How is blastomyces dermatitidis treated?
Fluconazole IV or Ampho B IV if severe
How is Histoplasma capsulate treated in severe cases or immunocompromised cases?
Ampho B IV followed by Itra PO
How is mild Histoplasma capsulate treated?
Itra PO
How is Ampho B given?
Most physicians now employ lipid formulations of amphotericin B to try and avoid the
nephrotoxicity associated with the deoxycholate form of the drug
HYDRATION helps
Aspergillus is beginning to show resistance to what drug?
AZOLES, due to increased use to agriculture
How is aspergillus evolving against AZOLES?
Mutations in the promotor region of CYP51A, which
encodes lanosterol-14a-sterol demethylase activity
Note There is a trend towards moving away from itraconazole to the other newer azole
drugs. Why?
Oral absorption of itraconazole is low and variable from patient to
patient.
Which AZOLE can pass the BBB?
Fluconazole
How are AZOLES metabolized?
hepatic CYP metabolism
Possible DD interactions of AZOLES?
Concurrent drugs
metabolized via CYP2C9, 2C19 & 3A4.
Which anti-fungal don’t undergo hepatic metabolism?
Ampho B or fluctyosine
DD interactions of Ampho B?
Other nephrotoxic agents and with drugs producing
hypokelmia.
DD interactions of Flucytosine?
Other hematotoxic drugs because flucytosine can itself produce anemia, and blood dyscrasias, including agranulocytosis
Which anti fungals are fungicidal?
- Ampho B
- Alylamines (naftafine)
- Echinocandins
- Flucytosine
Which anti fungals are fungistatic?
- AZOLES
- Griseofulvin
