Fungi

Front 1

amphotericin B and nystatin work by

Back 1

bind to ergosterol, punch holes in the fungal cell wall

Front 2

azoles work by

Back 2

interfering with ergosterol synthesis (fungi)

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fungi capsule can be visualized with

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india ink stain

Front 4

Malassezia furfur causes

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pityriasis versicolor

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une annonce

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a notice, an announcement

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Drug that binds to cell membrane sterols, especially ergosterol; form pores which irreversibly damage the membrane; intracellular ions (K, Mg) leak out.

Back 6

Polyene antifungal agents:

Amphotericin B
Nystatin,
Natamycin

Front 7

Which drug forms pores in fungal cell membranes

Back 7

Amphoterecin B

Front 8

drugs that inhibit ergosterol synthesis

Back 8

azole derivatives
terbinafine
naftifine

Front 9

Which drug disrupts microtubles

Back 9

griseofulvin

Front 10

Which drug inhibits thymidylate synthetase

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flucytosine

Front 11

Which drugs inhibits squalene epoxidase

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terbinafine
naftifine

Front 12

Adverse reactions of azole antifungal drugs include

Back 12

hepatotoxicity

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adverse reactions of Amphotericin B

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Hypersensitivity, flushing, chills, fever, headache, pain, hypotension, convulsions, thrombophlebitis, hypokalemia, vomiting, impairment of renal function, anemia

Front 14

Azoles decrease/increase P450 activity

Back 14

decrease P450 activity
(cause increased bleeding when given with warfarin)

Front 15

Griseofulvin increases/decreases P450

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increase P450
(the only antifungal drug that does this)

Front 16

What drug is used in conjunction with flucystosine

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amphotericin B

Front 17

drug for Candidal infections

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Amphotericin B (topical)

Front 18

drug for candidal infections of mucosa (mouth-oral monoliasis, esophagus, vaginal), skin, GI tract

(e.g.Candidis albicans)

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Nystatin

Front 19

not absorbed from the gut; too toxic to use systemically

(use topically)

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Nystatin

Front 20

Used topically as 5% ophthalmic suspension for fungal keratitis

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Natamycin

Front 21

Drug that is a primidine analog

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Flucytosine (5FC, Ancobon)

Front 22

Drug used to treat Candida, Cryptococcus, and some Aspergillus

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Flucytosine

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Drug that is toxic to bone marrow (anemia) and liver

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Flucytosine

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enterocolitis is an adverse reaction of

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Flucytosine

Front 25

ketoconazole
miconazole
clotrimazole

Class of drug?

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imidazole

Front 26

what are the triazoles

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fluconazole
itraconazole
voriconazole
posaconazole

Front 27

These agents inhibit sterol 14-alpha-demethylase, a P450-dependent enzyme essential for ergosterol synthesis

Back 27

imidazole and triazole derivatives

Front 28

Well absorbed from GI tract provided stomach contents remain acidic, though not used much for systemic infections.

Back 28

ketoconazole

Front 29

drug used to treat chronic mucocutaneous candidiasis, dermatophytes

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ketoconazole

Front 30

drug that Inhibits synthesis of adrenal and gonadal steroids (gynecomastia, infertility). Inhibits P450 enzymes.

Back 30

ketoconazole

Front 31

Hepatotoxic in 0.01%

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ketoconazole

Front 32

Clinical uses - Topical for a variety of cutaneous infections, cutaneous candidiasis and vulvovaginitis due to C. albicans

Back 32

miconazole (monistat)

(an imidazole)

Front 33

Used for oropharyngeal candidiasis

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clotrimazole

Front 34

Orally effective for several fungal infections; particularly dermatophytoses and onychomycosis.

Back 34

itraconazole

Front 35

a triazole analog approved for primary treatment of aspergillosis; also candidiasis and filamentous fungi.

Back 35

voriconazole

Front 36

Adverse reactions include rash, alteration in liver enzymes, visual disturbances

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voriconazole

Front 37

a triazole analog approved for prevention and treatment of aspergillosis and candidiasis

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posaconazole

Front 38

Inhibits fungal cell mitosis by disrupting mitotic spindles from interaction with microtubules (binds to tubulin and microtubule associated protein).

Back 38

griseofulvin

Front 39

Used topical in treatment of Tinea cruris and Tinea corporis. Reduces ergosterol synthesis by inhibiting squalene-2,3-epoxidase.

Back 39

naftifine
terbinifine

Front 40

these two drugs reduce ergosterol synthesis by inhibiting squalene-2,3-epoxidase.

Back 40

naftifine
terbinafine

Front 41

Acts by inhibiting the synthesis of Beta(1-3) glucan in fungal cell walls. This results in cell death

Back 41

caspofungin

Front 42

An echinocandin approved for intravenous treatment of candida and invasive aspergillosis in patients who do NOT respond to Amphotericin B or voriconazole

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caspofungin

Front 43

Mechanism of Action - Transported into sensitive fungi by permease. Converted to 5-fluorouracil (5-FU), then to 5-fluorodeoxyuridylate (FdUMP), a competitive inhibitor of thymidylate synthetase, which impairs DNA synthesis AND fluorouridine triphosphate (FUTP), an inhibitor of RNA synthesis.

Back 43

flucytosine

Front 44

drugs that are restrict to topical use due to toxicity

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the imidazoles
(ketoconazole, miconazole, clotrimazole)

Front 45

Only _____ can form germ tubes

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Candida albicans

Front 46

Aspergillis is feared in _____ patients

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cancer

Front 47

are dimorphic fungi contagious?

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Yes! Are contagious

Front 48

First line of defense against fungi?

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Neutrophils

Front 49

Candida albicans can interfere with

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complement binding

Front 50

dimorphic fungi evade

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phagocyte killing

Front 51

Histoplasma multiplies inside

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phagocytes (macrophages, neutrophils)

Front 52

Important in HIV infected patients in Southeast Asia and China

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penicillium marneffei

Front 53

Histoplasma is a dimorphic fungus growing in the yeast phase in tissues and in temps over

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37 celsius

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epidemiological links of Histoplasma

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Puerto Rico
Bats
Spelunkers
Ohio and mississippi river

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Histoplasmas grown within

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mACROPHAGES AND NEUTROPHILS

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grow in the lung leading to lesions similar to tuberculosis

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Histoplasmas

Front 57

Histoplasma drug of choice

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Itraconazole

Front 58

present in the southwestern US and Northern Mexico deserts

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Coccidioides

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Valley Fever associated with

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Coccidioides

Front 60

dissemination leads to meningitis or osteomyelitis

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Coccidiodies

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Coccidioides drug of choice

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fluconazole

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Geographic distribution includes the middle (Ohio and Mississippi valley)and south east part of the US (Virginia and the Carolinas)


Also southeastern Canada (Quebec and Nova Scotia)

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Blastomyces

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Histoplasma : intracellular / extracellular

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intracellular

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Blastomyces: intracellular / extracellular

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extracellular

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Complement is not effective at opsonizing

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Coccidiodes

Front 66

Complement, antibody and cell mediated immunity are all involved

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Blastomyces

Front 67

It is geographically limited to Central and South America
80% of all cases world wide are found in Brazil

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Paracoccidioides brasiliensis

Front 68

Paracoccidioides brasiliensis drug of choice

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trimethoprim/sulfamethoxazole

Front 69

Smooth colonies form over night resembling Staphylococci

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Candida

Front 70

procedure to differentiate C. albicans from the other Candida species

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germ tube production

Front 71

first line defense against Candida

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neutrophils

Front 72

Seen in people with T-cell mediated immune defects

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Chronic mucocutaneous candidiasis

Front 73

Candida drug of choice

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Fluconazole

Front 74

can produce melanin which protects them from oxidation by phagocytes

Back 74

Cryptococcus

Front 75

has a strong affinity for the central nervous system

Back 75

Cryptococcus

Front 76

The capsule binds mucicarmine and appears red

Back 76

cryptococcus

Front 77

stain for cryptococcus

Back 77

india ink
mucicarmine stain

Front 78

Cryptococcus treatment

Back 78

Meningitis
Amphotericin B + flucytosine until asymptomatic
Followed by fluconazole indefinitely
Repeat lumbar punctures to decrease the intracranial pressure may be beneficial
All other forms of Cryptococcosis
Fluconazole is drug of choice

Front 79

exists as a sporocyte

Back 79

Pneumocystis jiroveci (carnii)

Front 80

The major surface glycoprotein (MSG) functions as an attachment ligand

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Pneumocystis jiroveci

Front 81

extracellular existence within the alveoli

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Pneumocystic jiroveci

Front 82

first line of defense against Pneumocystic jiroveci

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alveolar macrophages

Front 83

Pneumocystic jiroveci causes

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Pneumonia which is slowly progressive over 3-4 weeks
Non productive cough, dyspnea
Extrapulmonary findings are extremely rare

Front 84

diagnosis of Pneumocystic jiroveci

Back 84

The organism cannot be cultured
Can stain the bronchoalveolar lavage fluid (BAL)
Usually stained by methenamine silver

Front 85

Pneumocystic jiroveci treatment of choice

Back 85

trimethoprim/sulfamethoxazole

Front 86

Apergillus

Septate / Non-septate

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septate

Front 87

zygomycetes

Septate / Non-septate

Back 87

Non-septate

Front 88

are angioinvasive

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Aspergillus

The hyphae have a tendency to invade vasculature and can lead to infarction of tissue

Front 89

first line of defense against Aspergillus

Back 89

Alveolar macrophages

Front 90

treatment of Aspergilloma

Back 90

sclerosis of the bleeding vessel or surgical removal of the cavity and aspergilloma


*Antifungal therapy is not indicated

Front 91

treatment of Allergic Bronchopulmonary Aspergillosis

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steroids, albuterol
*antifungals contraindicated

Front 92

treatment of Invasive Aspergillosis

Back 92

The drug of choice is voriconazole
Alternatives include itraconazole or a lipid formulation of amphotericin B
Surgical debulking is almost always necessary

Front 93

zygomycetes include

Back 93

Rhizopus and Mucor

Front 94

Aseptate, irregular 90o branching, broad, ribbon-like hyphae

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zygomycetes (Rhizopus and Mucor)

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45o Angle Branching & Septate Hyphae

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Aspergillus

Front 96

zygomycetes found in

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soil, bread and other food

Front 97

have a predilection for low pH and are seen in patients with acidosis, either from diabetes or other organic acids (lactate)

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zygomycetes (Rhizopus and mucor)

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sequester iron which is a major virulence factor for this organism

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zygomycetes (Rhizopus and mucor)

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zygomycetes (Rhizopus and mucor) causes

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rhinocerebral infection or pulmonary infection

cutaneous infection and is followed by dissemination

rapidly invades tissue and can lead to destruction of blood vessels that lead to tissue necrosis (fatal)

Front 100

Headache
Orbital cellulitis/hemorrhage
Cranial nerve palsy
Vascular thrombosis
Coma
Death

clinical manifestations of

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zygomycetes (Rhizopus and mucor)

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treatment of zygomycetes

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Amphotericin B

posaconazole

Front 102

treatment of Hyalohyphomycoses & Phaeohyphomycoses

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surgical debulking
Amphotericin B

Front 103

rarely cause disease but When a patient gets one of these infections, it is almost always lethal

Back 103

Hyalohyphomycoses & Phaeohyphomycoses