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PHARMACOLOGIC MANAGEMENT OF VIRAL AND FUNGAL INFECTIONS IN THE IMMUNOCOMPROMISED HOST Ngoc-Yen Nguyen, PharmD February, 2014. The Triazoles ? MOA: inhibition of cytochrome P-450-dependent ergosterol synthesis and inhibition of cell membrane formation. Fluconazole ? Place in therapy: Most often used as prophylaxis or treatment agent against C. Voriconazole ? Place in therapy ? Drug of choice for invasive aspergillosis ? Used in treatment of infections caused by Scedosporium apiospermum and Fusarium spp in patients intolerant of, or refractory to other therapy ? More active than fluconazole against Candida sp and has more activity than amphotericin B, except C.
Host factors ? Presence of target receptors on host cells ? Availability of enzymes essential for viral entry and replication ? Specific immunity against certain viral epitopes ? State of immunocompetence, i.e.


To avoid missing serious causes, Vesicular and Bullous lesions must be approached systemically. Primarily, the decision as to whether lesions are focal or diffuse is made, lesion history is taken, system review, and a focused physical exam. HSV, poxviruses ? Persistent Infection ? Virions are released continuously ? Host cell may not be lysed ? causes little adverse effect ? E.g. Based on work by Jacki Buros (bot), Cafer Zorkun and Heather Mangan and wikidoc user WikiBot. Most common invasive fungal infection in critically-ill nonneutropenic patients Portals of entry Gastrointestinal tract Intravascular catheters Types of Candida spp.


Lassa, retroviruses, rubella ? Latent Infection ? Delay between infection and appearance of symptoms ? E.g.
Candida albicans- most common Candida non-albicans ? Candida glabrata – most common non-albicans Candida spp.
Second most frequent cause of invasive mycotic infections in the severely immunocompromised population Found in the soil known to cause localized skin infections in immunocompetent persons Common species: F.



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