Fungal Infections

Yeast Infection No More

Natural Solution to get rid of Candida Overgrowth

Get Instant Access

Candida species

• Microbiology: C. albicans and nonalbicans species (consider imidazole resistance if prior treatment or nonalbicans species)

• Risk factors: neutropenia, immunosuppression, broad-spectrum abx. intravascular catheters (especially ifTPN). IVDA. abdominal surgery, renal failure

• Clinical manifestations

Mucocutaneous: cutaneous (eg. red. macerated lesions in intertriginous zones); oral thrush (if unexplained, r/o HIV); esophageal (odynophagia; • oral thrush); vulvovaginal Candiduria- typically colonization due to broad-spectrum abx and/or indwelling catheter;

failure to clear raises possibility of upper UTI Candidemia (4th or 5th leading cause of nosocomial blood stream infection): typically due to intravascular catheter: r/o retinal involvement; endocarditis rare (but more common w/ nonalbicans and if prosthetic valve) Hepatosplenic: intestinal seeding of portal & venous circulation; seen in acute leukemics Hematogenous dissemination lung, brain, meninges

Empiric Treatment


Clotrimazole, nystatin, fluconazole, itraconazole

Candidemia w/o neutropenia

Ampho B or fluconazole or caspofungin or [flue - ampho B]

Febrile neutropenia

Ampho B or caspofungin

Remove intravascular catheters (00 2004.38:161)


• Epidemiology: hyperendemic in central & SE U.S. (especially in areas w/ bird & bat droppings), present in river banks including northeast

• Clinical manifestations

Acute pulmonary: often subclinical

Chronic pulmonary: t productive cough, wt loss, night sweats, infiltrates, cavitation Disseminated (immunocompromised): fever, wt loss. HSM. LAN. oral ulcers, skin lesion

• Treatment: itraconazole; amphotericin if severe or disseminated (CiD 2000:30*88)


• Epidemiology: SW US. (San Joaquin or "Valley" fever)

• Clinical manifestations

Acute pulmonary: often subclinical; chest pain, cough, fever, arthralgias Chronic pulmonary: cough, hemoptysis, fever, night sweats, wt loss Chronic disseminated (in immunocompromised, pregnant. & diabetics): fever, malaise, diffuse pulmonary process, bone. skin. & meningeal involvement

• Treatment for disseminated or high-risk Y pulmonary: fluconazole or itraconazole, or amphotericin if severe (00 2005:41:1217)


• Epidemiology: south central. SE. and midwest U.S.

• Clinical manifestations

Often asymptomatic, acute pneumonia, chronic pneumonia Extrapulmonary: verrucous & ulcerated skin lesions, bone & GU involvement Disseminated: can involve CNS

• Treatment: itraconazole; amphotericin if severe (CiD 2000.30:679)

Aspergillus (Chest 2002:121 1988)

• ABPA: see "Interstitial Lung Disease"

• Hypersensitivity pneumonitis: see "Interstitial Lung Disease"

• Aspcrgilloma: usually in pre-existing cavity (from TB, etc.): most asx. but can lead to hemoptysis; sputum cx © in <50%; CT — mobile intracavitary mass with air crescent Rx: antifungals w/o benefit; embolization or surgery for persistent hemoptysis

• Necrotizing tracheitis: white necrotic pseudomembranes in Pts w/ AIDS or lung tx

• Chronic necrotizing (semi-invasive): seen in COPD or mild immunosuppression;

p/w sputum, fever, wt loss over months; CT shows infiltrate * nodule * pleural thickening; lung bx — invasion; Rx - amphotericin or voriconazole

• Invasive/disseminated: seen if immunocompromised (neutropenia, s/p transplant.

glucocorticoid Rx. AIDS); clinical: s/s pneumonia including chest pain and hemoptysis; CT shows nodules, halo sign, air crescent sign, lung bx if prior testing inconclusive Rx: amphotericin B or voriconazole



• Anatomic lower, urethritis, cystitis (superficial infection of bladder) upper pyelonephritis (inflammatory process of the renal parenchyma), renal or perinephric abscess, prostatitis

• Clinical uncomplicated: cystitis in nonpregnant women w/o underlying structural or neurological disease complicated: upper tract infection in women or any UTI in men or pregnant women or UTI with underlying structural disease or immunosuppression


• Uncomplicated UTI: L co/i (80%). Proteus. Klebsiella. S. saprophyttcus (QD 2004:3975)

• Complicated UTI: £ co/i (30%). enterococci (20%). Pseudomonos (20%). S. epidermidis

• Catheter-associated UTI: yeast (30%). £ coli (25%). other GNR. enterococci. S. epi

• Urethritis: Chlamydia trachomatis. Neisseria gonorrhoeae. Ureaplasma urealyticum.

Trichomonas vaginalis. Mycoplasma genitalium, HSV

Clinical manifestations

• Cystitis: dysuria. urgency, frequency. A in urine color/odor, suprapubic pain;

fever generally absent

• Urethritis: may be identical to cystitis except urethral discharge is present

• Prostatitis chronic: similar to cystitis except symptoms of obstruction (hesitancy, weak stream) acute: perineal pain, fever, tenderness on prostate exam

• Pyelonephritis: fever, shaking chills, flank or back pain, nausea, vomiting, diarrhea

• Renal abscess (intrarenal or perinephric): identical to pyelonephritis except persistent fever despite appropriate antibiotics

Diagnostic studies

• Urinalysis: pyuria * bacteriuria - hematuria significant bacterial counts: ^10s CFU/ml in asx women. -10J CFU/ml in men.

CFU/ml in sx or catheterized Pts sterile pyuria — urethritis, renal tuberculosis, foreign body

• Urine Gram stain and cx (from dean-catch midstream or straight-cath specimen)

• Pregnant women & those undergoing urologic surgery screen for asymptomatic bacteriuria

• Blood cultures: in febrile and possibly complicated UTIs

• DNA detection/cx for C. trachomatis/N. gonorrhoeae in sexually active Pts or sterile pyuria

• First-void and midstream urine specimens, prostatic expressate. and post-prostatic massage urine specimens in cases of suspected prostatitis

• Abdominal CT to r/o abscess in Pts with pyelo who fail to defervesce after 72 h

• Urologic workup (renal U/S. abd CT. voiding cystography) if recurrent UTIs in men

Treatment of UTIs

Clinical scenario Cystitis

Empiric treatment guidelines*

FQ or TMP-SMX PO ■ 3 d (uncomplic.) or • 10-14 d (complicated) Asx bacteriuria in pregnant women or prior to urologic surgery abx x 3 d

Urethritis Prostatitis

Treat for both Neisseria and Chlamydia

Neisseria: ceftriaxone 125 mg IM x 1 or levofloxacin 250 mg PO x 1 Chlamydia: doxy 100 mg PO bid x 7 d or azithromycin 1 g PO x 1 FQ or TMP-SMX PO 14-28 d (acute) or 6-12 wks (chronic)


Outpatient: FQ or amoxicillin/clav or oral ceph. PO x 14 d Inpatient: ceftriaxone IV or FQ PO or [amp IV t gent] or ampicillin/sulbactam x 14 d (A IV - PO when Pt improved clinically and afebrile x 24-48 h and then complete 14 d course)

Renal abscess

Drainage • antibiotics as for pyelonephritis

•When possible, organism-directed therapy, guided by in vitro susceptibilities or local patterns of drug resistance should be utilized.

•When possible, organism-directed therapy, guided by in vitro susceptibilities or local patterns of drug resistance should be utilized.


Was this article helpful?

0 0
How To Get Rid Of Yeast Infections Once And For All

How To Get Rid Of Yeast Infections Once And For All

No more itching, odor or pain or your money is refunded! Safe and DRUG FREE Natural Yeast Infection Solutions Are you looking for a safe, fast and permanent cure for your chronic yeast infection? Get Rid of that Yeast Infection Right Now and For Good!

Get My Free Ebook

Post a comment