Fungal Infection

AntiFungal Drugs
Candida
Cryptococcus
Aspergillus
Histoplasmosis
Blastomycosis
Coccidiodycosis
Sporotrichosis
Zygomycocic
Pneumocystis Carinii

Prepared by Dr. Amr Malash

 Fungal infections
Anti-fungal drugs:
1. Nystatin (mycostatin, nystastatin, fungistatin) 100,000 units /
ml dose 1 ml. / 6 hours / 7-10 days.
2. Miconazole (Daktarin oral gel, miconaz, micazol oral gel)
¼ spoon infant ½ spoon child / 6 hours / 7-10 days, micoban
oral gel (Add Lidocaine) same dose.\
3. Fluconozole (Diflucan syrup 25 mg/5 ml., Diflucan I.V.
infusion (100 mg./ 50 ml)
(Single dose or every 12 hours) 3-6 mg/Kg/day up to 12
mg/Kg/day in serious infection for 1-3 weeks.
Not indication in aspergillius, mucor, scedosporium.
Use in oropharyngeal candida, cutaneous tinea pedis, tinea
corporis.
4. Amphotericin B: 0.5-1 mg/Kg/day slow I.V. infusion
Serious drug – nephrotoxicity, anaphylaxis, ↓ platelet
Fungizone vial (50 mg./20 ml) add to 500 ml. glucose (1
ml.=0.1 mg)
Dose 5-10 ml. /Kg protect from light and no added Electrolyte
in separate line.
5. Griseofulvin: (Ultragrisofulvin susp. 125 mg/5 ml.)
Mycotic infection of hair, nail, skin esp. fungal infection of
scalp (ringworm & favus) and tinea capitis.
Side effect: GIT $ and allergy.
Dose: 10 mg/Kg/day2-3 times / day.

1. Candida: Neonatal infection

Systemic candidiasis: Same as sepsis C/P.
Skin: ½ patient erythroderma or vesiculo pustules
Renal: Candidurea, flankmass, hypertension, renal failure,
renal abscess
CNS: 1/3 of cases meningitis
Prepared by Dr. Amr Malash
 Endophalmitis: so retinal must ex in syst candidiasis
Endocarditis: Esp. in catheter infection in right otrium.

Diagnosis:
1. Histological ex. Of skin scrapping, blood smear
2. Cult. Of blood or CSF but must be multiple cult. as
result usually intermitten +ve.
3. Candida antigen detection in blood
4. PCR
NB.: If fever and neutropenia persist > 7 days in immunocaprimise
patient → Diflucan or amphecain B infusion started.

Treatment:
1. Fluconozol treatment
If catheter infusion removal of catheter + treatment
2. Amphotencin B infusion

Flucanozol (Diflucan): Susp. Tab. I.V.

Oral candidiasis: 6 mg./Kg/day 1st day 1 then 3 mg./Kg/ day
Esophageal candida: 6 mg./Kg/day day 1st then 3-12 mg/Kg/day
Systemic candidiasis: 6-12 mg. /Kg./ day for 28 days (1month)

NB: Paronychia esp. finger nail (Tinea toe nail mainly)

Treatment: Keep dry + topical antifungal or oral diflucan
treatment.

Topical anti-fungal:
Nystatin: Mycostatin cream
Miconozol: Daktarine cream, miconaz cream.
Clotrimazol: Canestene cream, candistan cream

NB.: Cream for wet lesion

Ointment for chronic dry lesion.
For napkin dermatitis mainly wet cream are the only suitable.

Prepared by Dr. Amr Malash

( Fluorinated steroid): Hydrocortisone + micazol: Daktacort cream
(fluorinated steroid): Betamethazone + clotrimazol: Lotriderm
(fluorinated steroid): Betamethazone + clioquinal + Gentamycin +
chlorocresal: quadriderm cream
(fluorinated steroid): triamcinolon + mystatin + neomycin +
gramicidine: Kenacomb or pandermal.

NB.: Systemic candidiasis in immunocompromise patient

Fever & neutropenia > 7 days → start amphotercin B or Diflucan
infusion.

II. Cryptococcus: Pneumonia pigeon breeder bird most commonest

manifestation disseminated form with meningitis.

III. Aspergillus:
1. Farmer lung: Steroid treatment
2. Exacerbate asthma: Elevation of total IgE to higher level than
before in stable asthmatic patient.
Treatment: Cotricosteroid 0.5 mg/Kg/day for 7 days
(Prednisolone) then every otherday till $ controlled or inhalation
steroid.
3. Otomycosis: Clearly of Ear + topical Nystatin drops
4. Skin
5. Disseminated infection

Diagnosis:
1. Histological ex. Of tissue
2. Culture

IV. Histoplasmosis: Acute pulmonary, chronic pulmonary,

disseminated
Diag.: Culture, direct antigen, detection, histological ex. of tissue
Sero conversion titre > 1/32
Treatment: Amphotericin B infusion

Prepared by Dr. Amr Malash

V. Blastomycosis: Acute pulmonary, chronic pulmonary
disseminated
Same diag. same treatment + Diflucan treatment

NB.: Fungal infection of lung: Cavity, granuloma, hemoptysis,

necrotizing pneumonia or mediastinum granuloma

VI. Coccidiodomycosis: Pulmonary acute, chronic, disseminated

VII. Sporotrichosis: Papule on skin → ulcerate → satellite lesion

from lymphngitis spread (lymphocutaneous lesion). Treatment: Dflucan

VIII. Zygomycosis: Sinus / Rhinocerebral with dark bloody with

necrotic tissue may spread to eye or destruct bones around pulmonary or
disseminated fever.

Treatment: Ampheteacin B infusion.

IX. pneumocystits carinii: Only in immunocampromise patient

cong. Or acquired lead to fatal disease if not treatment.

Diagnosis: Histological ex. and demonest of P. carrini in lung + clinical

signs.
Treatment:
1. Trimethaphin – Sulfanethexozole (TMP – SMz)
(15-20 mg/Kg/day.) (75-100 mg/Kg/day)
I.V or oral for 2-3 weeks
2. Steroid treatment + (TMP-SMZ)
Prednisolone 1-2 mg./Kg/day for 7-10 days.

NB.: Prophylaxis to infant bone to HIV AIDS mother or patient with

severe combined immunodeficiency, patient receive immunosupprise
treatment.

Prepared by Dr. Amr Malash

TMP-SMZ 5 mg of TMP/Kg/day given 3 succeive day / week
or alternative day manner as prophylaxis.

Prepared by Dr. Amr Malash