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217 Pathogenesis, Diagnosis, and Treatment of Fungal Infections covers and a face shield and/or goggles. If available, N-95 or N-100 respi­ rators may be used to further limit infection risk. Positive-air-pressure respirators should be considered for high-risk...

218 Histoplasmosis to fluconazole or itraconazole. Posaconazole has been reported to be effective salvage therapy for aspergillosis, mucormycosis, fusariosis, cryptococcosis, histoplasmosis, and coccidioidomycosis, although controlled clinical trials are lacki...

219 Coccidioidomycosis for PDH. Stable or rising antigen levels suggest treatment failure or relapse and should raise concerns regarding proper intake of itraconazole (capsule formulation with food), adherence to treat­ ment, drug absorption, itraconazole seru...

220 Blastomycosis profoundly hypoxemic and critically ill, many clinicians favor beginning therapy with an amphotericin B formulation combined with an oral triazole antifungal. The triazole antifungal therapy is continued alone once clinical improvement occurs...

221 Cryptococcosis TABLE 220-1  Treatment of Blastomycosis SEVERITY OF INFECTION SITE OF INFECTION THERAPY PATIENT POPULATION Immunocompetent Mild to moderatea Lung Itraconazole for 6–12 monthsb     Disseminated Itraconazole for 6–12 monthsb (≥12 months for os...

222 Candidiasis The goal of maintenance is to prevent recurrent disease, and its duration depends on the immune status of the patient. Individu­ als who remain deeply immunocompromised, such as those with HIV whose CD4+ T lymphocyte counts remain <200/μL or ha...

223 Aspergillosis David W. Denning Aspergillosis Aspergillosis is the collective term used to describe all disease enti­ ties caused by any one of ~50 pathogenic and allergenic species of Aspergillus. Only those species that grow at 37°C can cause invasive inf...

224 Mucormycosis TABLE 223-3  Treatment of Aspergillosisa INDICATION PRIMARY TREATMENT PRECAUTIONS SECONDARY TREATMENT COMMENTS Invasive diseaseb Voriconazole, isavuconazole, posaconazole Drug interactions (especially with voriconazole)c AmB, caspofungin, mica...

225 Superficial Fungal Infections therapy with deferasirox (plus LAmB) documented excess mortality among patients treated with deferasirox. Of note, the study popula­ tion included primarily patients with active malignancy, and few patients in the study had di...

226 Uncommon Disseminated Fungal Infections tolerated because of adverse reactions, including metallic taste, salivary gland swelling, rash, and fever. High-dose terbinafine may be effective for lymphocutaneous infection. Treatment for lymphocutaneous spo­ rot...

133 Infective Endocarditis study suggested that moxifloxacin (400 mg/d PO) is as effective and well tolerated as ampicillin-sulbactam. Notably, metronidazole is not effective as a single agent: it covers anaerobic organisms but not the microaerophilic streptoc...

227 Pneumocystis Infections Treatment and Prognosis  Scedosporium and Lomentospora species are intrinsically resistant to AmB, echinocandins, and some azoles. Voriconazole has been the agent of choice for S. apiospermum, and posaconazole has been increasingly ...

SECTION 17 Protozoal and Helminthic Infections: General Considerations appear to be particularly susceptible to PCP. The glucocorticoid exposure threshold that warrants chemoprophylaxis is ill-defined, but such preventive therapy should be strongly considered ...

228 Introduction to Parasitic Infections appear to be particularly susceptible to PCP. The glucocorticoid exposure threshold that warrants chemoprophylaxis is ill-defined, but such preventive therapy should be strongly considered for any patient who is receivi...

229 Agents Used to Treat Parasitic Infections TABLE 228-1  Parasitic Infections, by Organ System and Signs/Symptomsa ORGAN SYSTEM, MAJOR SIGN(S)/SYMPTOM(S) PARASITE(S) GEOGRAPHIC DISTRIBUTION COMMENTS Muscular System Myalgias, myositis Trichinella Worldwide Pa...

SECTION 18 Protozoal Infections serum levels of theophylline should be monitored closely in this situation. Tinidazole  This nitroimidazole is effective for the treatment of amebiasis, giardiasis, and trichomoniasis. Like metronidazole, tini­ dazole must under...

230 Amebiasis and Infection with Free-Living Amebae serum levels of theophylline should be monitored closely in this situation. Tinidazole  This nitroimidazole is effective for the treatment of amebiasis, giardiasis, and trichomoniasis. Like metronidazole, tin...

231 Malaria sulfadiazine, and macrolides. The CDC recommends that miltefosine now be included, as for treatment of other free-living amebae. Clini­ cians should contact the CDC Emergency Operations Center at (770)-488-7100 for assistance in diagnosis and treat...