Treatments for fungal infections

Question 1

TB

Answer 1

?

Question 2

disseminated Histoplasmosis

Answer 2

amphotericin B with itraconazole for 1yr

if meningitis, fluconazole

Question 3

Blastomycosis - Symptomatic but not severe:

Answer 3

itraconazole

Question 4

minor Coccidiomycosis

Answer 4

nothing if minor infection (flue like symptoms, mild pneumonia erythemia nodosa/multiforme) if disseminated or severe pneumonia or black/fillipino/immunosupressed/diabetes/cadiopulminary disease use oral itraconazole or Amphotericin B (for pregnancy!)

if memingitis - us fluconazole

Question 5

Severe Blastomycosis (including any CNS):

Answer 5

amphotericin B, may switch to itraconazole after improvement

Fluconazole also appropriate for meningitis

Surgical excision of loci

Question 6

Histoplasmosis Spreading in lung

Answer 6

oral itraconazole 6-12 weeks

Question 7

persisting lung lesions or disseminated Coccidiomycosis

Answer 7

Amphotericin B and long-term itraconazole, May require years of therapy to clear

Minimum of 6 months of drug therapy, followups for at least a year

Question 8

disseminated Coccidiomycosis meningitis

Answer 8

fluconazole, continue as a long-term suppressive, may add intrathecal amphotericin B if severe, may need to add corticosteroids to reduce immunogenic symptoms from amphotericin therapy

Minimum of 6 months of drug therapy, followups for at least a year

Question 9

Allergic bronchopulminary Aspergillosis

Answer 9

▪ Oral corticosteroids and itraconazole

▪ Consider sinus surgery and/or omalizumab (Xolair)

Question 10

Asperigilloma

Answer 10

Remove surgically if hemoptysis

▪ Oral itraconazole

Question 11

Invasive Aspergillosis or CNPA

Answer 11

▪ Voriconazole and/or amphotericin B, alt capsofungin, but may not work – high mortality.
▪ Decrease immunosuppression if possible.
▪ Surgical resection of diseased area may be considered.