Fungal Infections and treatment only

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The most common causative agent of Aspergillosis

The most common causative agent of Aspergillosis

A. flavus

Clinical manifestations of pulmonary aspergillosis

Wheezing, pulmonary infiltrates, bronchiectasis & fibrosis. Associated with increased blood eosinophils, increased serum IgE levels, and increased serum antibodies.

Primary treatment for aspergillosis

Corticosteroids

Causative agent of Blastomycosis

Blastomyces dermatidis

Primary treatment for blastomycosis

Ampho B for 1-2 weeks, then Itra oral for 3 days

Causative agent of bloodstream Candidiasis

C. albicans & C. glabrata

Main treatment options for bloodstream Candidiasis

Caspofungen or Micacafungen (echinocandins) and Fluconazole

Main treatment for vaginal Candidiasis (vaginitis)

Topical azole therapy or oral azole therapy

Causative agent of of Coccidioidomycosis

Coccidioides immitis

Most common disseminted complication associated with Coccidioidomycosis

Meningitis

Primary treatment of Coccidioidmycosis in low risk patient

Antifungal rx no generally recommended

Primary treatment of Coccidioidmycosis in high risk patient with mild to moderate severity

Itra or Fluconazole

Primary treatment of Coccidioidmycosis in high risk patient with high severity or disseminated disease

Ampho B

Causative agent of Cryptococcosis (very common form)

Cryptococcus neoformans

Primary treatment for Cryptococcosis

Flu or Ampho B (non-meningeal) or Ampho B (meningeal)

Causative agent of Tinea Versicolor (as discussed in lecture)

Malassezia furfur

Primary treatment for Tinea Versicolor

Ketoconazole

Causative agent of Histoplasmosis

Histoplasma capsulatum

Primary treatment for moderately severe or severe Histoplasmosis

Ampho B

Causative agent of paracoccidioidomycosis

P. brasiliensis

Primary treatment for mild-moderate Paracoccidioidomycosis

Itraconazole

Primary treatment for severe Paracoccidioidomycosis

Ampho B

Causative agent of Pneumocystis pneumonia

Pneumocystis jirovecii

Primary treatment of acutely ill Pneumocystis pneumonia patient

Prednisone/trimethoprim-sulfamethoxazole according to lecture

Primary treatment of cutaneous Sporotrichosis

Itraconazole

Primary treatment of pulmonary or meningeal/disseminated Sporotrichosis

Ampho B

This normally suppresses the growth of Candida species

Other microorganisms

Common locations of Candida

GI, upper respiratory, buccal cavity, and vagina

Candida species exibits resistance to this

Azoles

Can cause candida disease

Alterations to flora, broad-spectrum antibiotics or mucosal injury

Is candida considered to be part of normal flora?

Yes

Risk factors for candidiasis

Post-operative status, cancer, chemotherapy, antibiotic therapy, burns, drug abuse, GI damage, diabetes, diapers

Main cause of oral thrush candidiasis

Antibiotic and steriod use & HIV

Main cause of vaginal candidiasis

Antibiotic use

Main cause of bloodstream candidiasis infections

Neutropenia, surgery, catheters

Cryptococcosis

Caused by C. neoformans and transmitted via pigeon droppings

Most commonly disseminated manifestation of cryptococcosis

Cryptococcal meningitis

Incidence of cryptococcosis in US

2-3% incidence in HIV patients & 5% in transplant patients

Global deaths associated with cryptococcosis

>600,000 deaths globally each year

Histoplasmosis

Dimorphic/soil saprophyte; transmitted through bat/bird droppings; most prevalent fungal infection, grows inside dust cells; granulomatous reactions in tissues

Coccidioidomycosis

Transmitted through inhalation of conidia; 40% valley fever, assymptomnatic in 60%; in 15% of valley fever patients rash, erythema nodosum, and erythrma multiforme may be present

Blastomycosis

Dimorphic/soil saprophyte; spread through inhalation; granulomatous infection that mainly involves lungs; can spread to skin and bone; not common in IS patients

Aspergillosis

Ubiquitous saprophytes; abundant conidia that aerosolize; outbreak in hospitals during construction; causes severe allergies

Risk factors for major aspergillosis disease

Neutropenia, corticosteroids, CGD, leukemia or lymphoma, and AIDS (<50 CD4= cells/microL)

Pneumocystic jirovecii

Cell mediated deficiency; <400 CD4+ cells/microL; causes pneumonia in patients with AIDS; may be part of normal flora but unsure; most are infected at a young age