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IM - COMMON FUNGAL INFECTIONS

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tonystep1's version from 2017-08-12 19:38

COMMON FUNGAL INFECTIONS CLINICAL FEATURES

Question Answer
CandidiasisTypical presentation is the mucocutaneous growth // Vagina-"yeast infection" -- This results in a thick, white, "cottage cheese-like" vaginal discharge. // Mouth, oropharynx-"thrush" -- This causes thick, white plaques that adhere to the oral mucosa // Cutaneous candidiasis -- This causes erythematous, eroded patches with "satellite lesions" // GI tract-e.g., esophagus -- Candida esophagitis may cause significant odynophagia or asymptomatic
Candidiasis Disseminated or invasive diseaseManifestations include sepsis/septic shock, meningitis, and multiple abscesses in various organs.
Allergic bronchopulmonary aspergillosisA type I hypersensitivity reaction to Aspergillus // It presents with asthma and eosinophilia. Recurrent exacerbations are common.
Pulmonary aspergillomaPulmonary aspergilloma is caused by inhalation of spores into the lung. // Patients with a history of sarcoidosis, histoplasmosis, tuberculosis, and bronchiectasis are at risk. //.It presents with chronic cough; hemoptysis may be present as well.
Invasive aspergillosisThis occurs when hyphae invade the lung vasculature, resulting in thrombosis and infarction. // Hosts are typically at-risk patients with acute leukemia, transplant recipients, and patients with advanced AIDS // It usually presents with acute onset of fever, cough, respiratory distress, and diffuse, bilateral pulmonary infiltrates. // It is transmitted via hematogenous dissemination, and may invade the sinuses, orbits, and brain.
CryptococcosisCNS disease-meningitis or meningoencephalitis; brain abscess is also possible // It should always be on the differential diagnosis of an HIV-positive patient with a fever and headache // Isolated pulmonary infection may also occur.
BlastomycosisAcquired through inhalation of spores // Disseminated infection -- chronic indolent disease, constitutional symptoms, LAN , pneumonia
HistoplasmosisTransmitted through exposure to bird/bat droppings // Flu- like symptoms erythema nodosum, hepatosplenomegaly
CoccidiomycosisAcquired through inhalation of spores // Asymptomatic or nonspecific respiratory symptoms // Dissemination causes focal CNS findings
SporotrichosisAcquired from invasion of skin by thorn or other plant material // Lymphocutaneous form, hard subcutaneous nodules -- ulcerate and drain. // Disseminated form causes pneumonia and meningitis
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DIAGNOSIS OF COMMON FUNGAL INFECTIONS

Question Answer
CandidiasisMucocutaneous candidiasis diagnosis is primarily clinical; KOH preparation demonstrates yeast. // Invasive candidiasis is diagnosed by blood or tissue culture.
AspergillusCXR reveals a dense pulmonary consolidation and sometimes a fungus ball. // Definitive diagnosis of invasive aspergillosis is by tissue biopsy
CryptococcosisLP is absolutely essential if meningitis is suspected. // Latex agglutination detects cryptococcal antigen in the CSF. // India ink smear shows encapsulated yeasts // Tissue biopsy is characterized by lack of inflammatory response
SporotrichosisVisualization of yeast in tissue or body fluids or serology
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TREATMENT OF COMMON FUNGAL INFECTIONS

Question Answer
Oral CandidiasisClotrimazole troches (dissolve in the mouth) five times per day // Nystatin mouthwash ("swish and swallow") three to five times per day; only for oral candidiasis // Oral ketoconazole or fluconazole for esophagitis
Vaginal candidiasismiconazole or clotrimazole cream
Cutaneous candidiasisoral nystatin powder, keeping skin dry
Systemic candidiasisFor systemic candidiasis, use amphotericin B or fluconazole. New, alternative antifungal agents include voriconazole and caspofungin.
allergic bronchopulmonary aspergillosispatients should avoid exposure to Aspergillus; corticosteroids may be beneficial.
For pulmonary aspergillomapatients with massive hemoptysis may require a lung lobectomy.
invasive aspergillosistreat with IV amphotericin B, voriconazole, or caspofungin
CryptococcosisUse amphotericin B with flucytosine for approximately 2 weeks, followed by oral fluconazole.
BlastomycosisPO itraconazole // Amphotericin B for meningitis
HistoplasmosisPO itraconazole //amphotericin B for severe infection or immunocompromised host
CoccidioidomycosisPO fluconazole or itraconazole x 6 mo // IV amphotericin B for severe infection or immunocompromised host
SporotrichosisPotassium iodide x 1-2 mo or itraconazole x 3-6mo // Disseminated amphotericin B
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