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IOS 11 Exam 1

Treatment of Invasive Fungal Infections 2

QuestionAnswer
C.albicans charactericstics Most pathofenic via the ability adhere to host tissue and transform from yeast to hyphal phase
Risks for C, albican infections Preganancy, age, trauma, hematologic, endocrine, (DM, TSH), iatrigenic (steroid, chemotherapy, immunosuppressant, IVDA, malnutrution
Non-hematogenous types of C. albican infections Superficial (oral, vaginal) Deepseated(Esophageal, cystitis, peritonitis)
Hematogenous types of C. albican infections Candidiasis, Sndophthalmitis, osteomyelitis, infectious endocarditis, pyelonephritis, pulmonary, meningitis
Asperigillus Characterisitics Found in the soil, water, or near decaying vegetation
Risk factors for getting asperigillus infection Bone marrow transplant, hematologic disease, solid organ transplant, AIDS
Types of Aspergillus Invasive, pulmonary, and allerfic bronchopulmonary aspergillosis
Dimorphic fungi Sporotrichosis, Blastomycosis, Coccidiodes, Histoplasmosis
Amphotericin B spectrum of activity Candida spp (not lusitaniae), cryptococcus neoformans, Diphormorphic Blastomyces, Coccidiodes, Histoplasma, Molds-Aspergillus, Fusarium, Sporothris schenckii
Flucytosine Spectrium of activity is Candida spp, Cryptococcus neoformans, Saccharomyces cerevisiaw, Chromoycosis-off label use
Fluconazole spectrum of activity Yeast-Cryptococcus neoformans, C. albicans, C. tropicalis, C. parapsilosis- Dimorphic fungi-Histoplasma Blastomyces, Coccidides
Itraconazole Spectrum of Activity Yeast- Candida spp, Cryptococcus neoforms -Dimorphic fungi-Blastomyces, Histoplasma, Coccidiodes, Paracoccidodes, Paracoccidiodes brasilliensis and Filentous fungi- Asperigillus spp, Zygomycetes, Sporothrix
Voriconazole contraindications Absolute-Terfenadine, Astemizole, Cisapride, Pimozide, Quinidine, Ergot alkaloids, Long acting barbiturates, sirolimus, pregnancy D
Biofilms of Candidas can be treated with Caspofungin, Abelcet, Ambisome and Posaconazole
Empirical Treatment of Candidiasis Caspofungin IV 70mg Load x1 then 50mg IV q24hr, or Ambisome 5mg/kg IV Q24hr or AMB 0.5-1mg/kg IV QD if normal renal function
Candidiasis germ positive tube treatment FLuconazole IV/PO 6-12mg/kg/day which is about 400-800mg
Treatment of Candida Endocarditis or endovascular or prosthetic material Caspofungin 70mg x1 and 50mg IV QD or Ambisone 5mg/kg/day
Dx of invasive Aspergillosis/Pulmonary disease Histoplatholic evidence of acute-angle branching, septated non-pigmented hyphe measuring 2-4um or radiographic with pleural densities,or CT with halo (edema or bleeding) or + sputum
Treatment of invasive Aspergillosis IV voriconazole 6mg/kg Q12 hr x 2 doses then 4mg/kg IV q12hr only if CrCl>30ml/min accumulation of cyclodextran, if <30 PO voriconazole 400BID or Abelcet or ambisome
Symptoms of Non-HIV cryptococcus neoformans-Pulminary and non-CNS Cough, pneimonitis, fever, sputum production, pleura symptoms
Treatment for Pulmonary & Non-CNS Cryptococcus neoformans Asymptomatic Immunocompetent patientFluconazole 400mg QD for 3-6months, For Symptomatic patient 6-12 months of Fluconazole 400mg QD
Cryptococcus Neoformans with CNS component (NON-HIV) Ambisone + Flucytosine 100mg/kg/day 2 weeks then Fluconazole 400mg /day for 10 weeks then maintenance of Fluconazole 200-400mg PO QD for 8-10weeks if immunosuppressed 6-12 months and fluconasole 400-800mg***
Goal of Treating Cryptococcus neoformans CNS disease Cure the infection (CSF steriliazition) and prevntion of long-term CNS system sequele, such as cranial nerve palsies, hearing loss, and blindness
AIDS related Crytococcal Disease-Pulmonary and Meningitis Pulmonary- Fluconazole 200-400mg/d FOR LIFE CNS induction -Ambisome+Flucytosine 100mg/kg/day 2weeks, then Fluconasole 400mg for 10weeks then Fluconazole 200-400 FOR LIFE
Renal dysfunction patients Do not used Abelcet unless Mucormycosis, Do not us IV voriconazole if CrCl <30
Hepatic dysfunction remember Casopfungin in moderate liver impariment 50mg IV to 30mg IV for maintenance therapy
Caspofungin DI Cyclosporin
Caspofungin and Ambisome are better than azoles for infections for Biofilms
Created by: liza001
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