Fungi

OVERVIEW

• Best empiric treatment for life-threatening fungal infection is amphotericin B (all fungi are susceptible)
• fungal infection is termed mycosis

TYPES OF INFECTIONS

• superficial, cutaneous and subcutaneous infections (e.g. oral thrush)
• endemic mycosis (e.g. histoplasmosis, blastomycosis, coccidioidomycosis, sporotrichosis)
• opportunistic infections (most important in ICU)

EXAMPLES OF PATHOGENIC FUNGI

Yeast

• Candida spp
• Cryptococcus spp
• Pneumocystis spp (“a yeast-like fungus”)

Molds

• Aspergillus
• Zygomycetes (Mucor, Rhizopus)
• Other (Scedosporium, Fusarium)

YEAST

Candida

• C. albicans: fluconazole
• voriconazole
• flucytosine
• echinocandins: caspofungin, micafungin, anidulafungin (first line for invasive candidemia)

Cryptococcus

• triazoles: fluconazole, itraconazole
• flucytosine

Pneumocystis

• co-trimoxazole 10mg/kg of sulfamethoxazole
• pentamidine isethionate
• dapsone

MOLDS

Rhizopus (causes mucormycosis)

• amphotericin B
• (surgery!)

Aspergillus

• itraconazole
• voriconazole
• echinocandins: caspofungin, micafungin, anidulafungin

References and Links

LITFL

• CCC — Aspergillosis
• CCC — Candidiasis
• CCC — Cryptococcosis
• CCC — Pneumocystis Jiroveci
• CCC — Rhinocerebral Mucormycosis

Journal articles

• Enoch DA, Ludlam HA, Brown NM. Invasive fungal infections: a review of epidemiology and management options. J Med Microbiol. 2006 Jul;55(Pt 7):809-18. PMID: 16772406.
• Pappas PG, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD; Infectious Diseases Society of America. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009 Mar 1;48(5):503-35. PMID 19191635.
• Van Thiel DH, George M, Moore CM. Fungal infections: their diagnosis and treatment in transplant recipients. Int J Hepatol. 2012;2012:106923. PMC3433127.

FOAM and web resources

• ICN Podcast — 69. Janin on Fungal Infections (2012)
• Maryland CC Project — Fungal Invasion of the ICU: A catastrophe waiting to happen (2014)