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30 Cards in this Set

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list three predisposing factors for a fungal infection
trauma especially with egeetable matter (EWCL),
immunosuppression
improper use of steroids
fungi are seperated into two main catagories what are they?
filamentous multi-cellular and non filamentous uni-cellular
what fungi is the most virulent and rapidly destructive in the filamentous multicellular fungi?
fusarium, it exists in warmer regions
what are the three main filamentous multicellular fungi tht infect normal eyes that have sustained damage?
fusarium (warmer regions)
aspergillus (warmer regions)
cephalosporiium - more indolent
what is the main nonfilamentous unicellular fungi (yeast)/ that causes opportunistic keratitis in compromised corneas?
candida (colder regions)
fusarium is a major corneal pathogen in what part of the united states
southern where it is warmer
the B and L fungal outbreak was due to what type of fungi?
fusarium
one of the filamentous fungi is commonly found in indoor air, which one?
aspergillus
what type of filamentous fungus commonly takes advantage of immunocompromised individuals
cephalosporium
what fungus is commonly found on inanimate objects, food, and hospital environments
candida
what fungus is the most common pathogenic cause for fungal endogenous endophthalmitis?
candida
you see a stromal grey-white opacity with elevation, that has indistinct feathery margins. Also present is hypopyon. what could it be?
fungal keratitis by a filamentous species like fusarium, if it was caused by a nonfilamentous species the opacity would be more yellow-grey and denser like a bacterial infection
is the epithelium in tact or not with a fungal keratitis infection
yes but it raised so it will show neg staining with flourocine
what must you DDx a fungal keratitis from?
bacterial keratitis/ ulcer. bacterial is not as feathery appearing but could still have hypopyon.
what is the only topical ocular drug available in the US for fungal infection?
natamycin 5%
what is the drug and dosage used for filamentous fungal keratitis
natamycin 5%, q1h even during sleep then taper slowly over weeks.
what is the treatment and dosage for nonfiamentous fungal keratitis
amphotericin B .15% q5min x 1 hour then q1h
daily debridement required
general guidlines for treating fungal infections
NO STEROIDS
tell the pt they will be on medication for months
consider hospitalization
refer to corneal special keratoplasty may be needed
contact instructionsw
what are the main systemic fungal drugs?
flucytoysine PO, or topical sln
keoconazole PO
what are some risk factors for acanthamoeba
any event that disrupts the epitheium
CL's, homemade sln
FB
non- sterile water. (resistant to chlorine)
co-infection with HSV or bacterial keratitis
acanthamoeba uses protolytic enzymes to attack what?
keratocyes
what are the steps to corneal infection by acanthamoeba?
compromised corneal epi
invasion of stroma
loss of keratocytes
inflammation
stromal vecrosis
what are the symptoms of acanthamoeba infection
severe pain
unilateral red eye
photophobia
blurry vision
waxing and waning of symptoms
what are the signs of early, late(3-8 weeks), and other signs of acanthamoeba?
early: PEE's, limbitis
late: stromal ring infiltrate, radial keratoneuritis (enlarged corneal nerves =pathoneumonic) and anterior uveitis with hypopyon
other: corneal microcysts, bullous keratopathy, disciform stromal keratitis, stromal necrosis--> corneal perforation
DDx for acanthamoeba
HSV, fungal keratitis, and bacterial keratitis
why is acanthamoeba laid on e coli to grow in the lab
it eats it. yum yum
what can be used for confocal microscopy in vivo of the cornea in the office?
the HRT because if you dont have one you are not cool.
how do you treat acanthamoeba?
no consensus, there are no commercially available agents some that are used are chlorhexadine, polyhexamethylene, propamidine, or brolene/PHMB
what does waxing and waning refer to in an acanthamoeba infection?
if you are treating say a co-existant bacterial or viral infection the acanthamoeba will go into cyst for and appear like it is not there anymore then when you let off of the drugs it will come back
on a side note what do you prescribe for an HSV infection
triflurodine