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Skin/MSk > Exam2 fungal infections > Flashcards

Exam2 fungal infections Flashcards

1
Q

Adverse effects of nystatin

A

80% of patients are nephrotoxic if given orally

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2
Q

Distribution of azoles

A

Orally available; cola/acid helps absorption of itraconazole

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3
Q

Distribution of griseofulvin

A

Lipids increase oral absorption, concentrates in dead keratinized layer of the skin

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4
Q

How to treat diaper rash (Candida albicans)

A

Keep skin dry, azole creams, clotrimazole

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5
Q

In ergosterol production, where do allylamines (terbinafine, tolnaftate) and azoles act, respectively?

A

Squalene epoxidase (squalene –> 2,3-oxidosqualene); C14-a-demethylase (Lanosterol–> ergosterol and cholesterol)

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6
Q

Mechanism of Nystatin?

A

Fungicidal; Binds ergosterol and opens a pore to make membrane leaky

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7
Q

Mechanisms of benzalamine (butenafine) and allyamine (tervinafine, tolnaftate)

A

Fungicidal; Inhibits squalene epoxidase leading to a toxic accumulation of squalene

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8
Q

Mechanisms of griseofulvin

A

Fungistatic; Binds microtubules to inhibit spindles leading to multinucleate effects

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9
Q

Name cutaneous fungal infections

A

Malassezia, Dermatophytes (microsporum, epidermophyton, trichophyton)

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10
Q

Name different skin mycoses

A

Cutaneous fungal infections, subcutatneous infections, opportunistic mycoses

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11
Q

Name mechanism of azoles (Fluconazole, Itraconazole, Clotrimazole, Miconazole, Ketoconazole

A

Fungistatic; Binds fungal p450 (Erg11, C14-a-demethylase) blocking production of ergosterol

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12
Q

Name opportunistic mycoses

A

Candida albicans part of normal flora

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13
Q

Name subcutaneous fungal infections and how they infect

A

Enter through skin followed by subcutaneous or lymphatic spread; Sporothrix

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14
Q

Pathogenesis of dermatophytes

A

Monomorphic molds secrete proteases and keratinases, fungal antigens cause inflammation, grow best in cooler temps (not 37C)

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15
Q

Resistance of nystatin

A

acquired is rare, fungi can reduce ergosterol on membrane

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16
Q

Resistance to azoles

A

Altered cytochrome p450, increased efflux

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17
Q

Resistance to butenafine, terbinafine, tolnaftate

A

rare

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18
Q

Spectrum of azoles

A

Most widely used antifungal and spectrum varies by agent

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19
Q

Spectrum of butenafine, terbinafine, tolnaftate

A

Broad, dermatophytes, Candida, Sporothrix

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20
Q

Spectrum of griseofulvin

A

Dermatophytes

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21
Q

Spectrum of nystatin

A

Active against yeast and molds, dermatophytes are intrinsically resistant

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22
Q

Three major genuses of dermatophytes: ring worm, tinea jock itch, athlete’s foot

A

Trichophyton, Microsporum, Epidermophyton

23
Q

Three modes of dermatophyte transmission

A

Anthropophillic (persion to person fomite), Zoophilic (animal to human), Geophilic (soil)

24
Q

Toxicity of azoles

A

Drug-drug interactions, hepatotoxicity, neurotoxicity, alters hormone synthesis (avoid during pregnancy)

25
Q

toxicity of griseofulvin

A

TERATOGENIC, DISULFIRAM-LIKE REACTION, monitor hematology, renal and hepatic fxn

26
Q

Toxicity to butenafine, terbinafine, tolnaftate

A

Topical, severe hepatitits if given orally, and drug-drug interactions; avoid giving to pts with liver disease

27
Q

Treatment of dermatophytes

A

Topical griseofulvin, terbinafine, itraconazole for 1 month; Oral for hair and nail infections (monitor for hepatotoxicity)

28
Q

Treatment of cradle cap?

A

Selenium sulfide shampoo

29
Q

What can also lead to infection with Candida

A

Immune difficiencies and prior antibiotic use (opportunistic infection)

30
Q

What causes cradle cap?

A

Inflammatory reaction to Malassezia

31
Q

What causes diaper rash?

A

Candida albicans, usually a secondary infection with an antibiotic treatment

32
Q

What causes rose gardener’s disease? Pathogensis? Treatment?

A

A puncture wound with Sporothrix schenckii; spread along lymphatic channels forming nodular lesions, need to biopsy a lymph node to diagnose; Oral itraconazole for 3-6 months, heat for pregnant women

33
Q

What causes tinea pedis (ringworm), and tinea capitis?

A

Trichophyton rubrum (transfers at swimming pools); Trichopyton tonsurans (child to child)

34
Q

What causes tinea versicolor?

A

Malassezia furfur: yest converts to mold and requires lipids for growth, grows in areas rich with sebaceous glands. Looks hypopigmented or hyperpigmented.

35
Q

What is a less common cause of tinea pedis and cruris?

A

Epidermophyton floccosum

36
Q

What is the main way to diagnose a fungal infection? Others?

A

10% KOH test and collect the skin on to a slide to look under a microscope; Wood’s lamp, can culture on Sabouraud media, skin biopsy w/ periodic acid-schiff stain

37
Q

What is the resistance to griseofulvin

A

change in beta-tubulin

38
Q

What to dermatophytes require for growth?

A

Keratin

39
Q

Where does Microsporum grow? Diagnosis?

A

Hair (ectothrix) and skin; Wood’s light blue-green

40
Q

Why is compliance a problem with griseofulvin?

A

Patient has a hard time taking drug for 4-6 weeks.

41
Q

T/F: Candida albicans is an opportunistic infections

A

True

42
Q

How do you diagnose a Candida albicans infection?

A

typically based on clinical appearance

43
Q

Name three genera of dermatophytes

A

Trichophyton, Microsporum, Epidermophyton

44
Q

most common cause of tinea capitis in US

A

Trichophyton tonsurans

45
Q

most common cause of tinea pedis

A

Trichophyton rubrum

46
Q

What microsporum is zoophilic that transfers through cats and dogs?

A

Microsporum canis

47
Q

What microsporum is geophilic?

A

Microsporum fulvum

48
Q

How should you treat a pregnant pt who has Sporothrix schenckii?

A

Apply heat to affected are (itraconazole is harmful during pregnancy)

49
Q

What is this disease? What typically causes it? What does its KOH test look like? What’s the treatment?

A

Tinea versicolor; Malassezi furfur; Spaghetti and meatballs; Salenium sulfide shampoo

50
Q

What organism is identified by the KOH test below (macro and microconidia)

A

Trichophyton rubrum

51
Q

What organism if identifiable by its KOH test below (spindle shaped macroconidia)

A

Microsporum

52
Q

What organism is identifiable by it’s KOH test below? (Dumbell shaped macrosporidum)

A

Epidermophyton floccosum

53
Q

What organism is identifiable by its KOH test below? (rosette formation)

A

Sporothrix schenckii

Skin/MSk (31 decks)

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