242.2 📚 國考版

242.2.0.1 必背 — Major Candida Species

  • C. albicans — most common
  • C. glabrata — fluconazole resistance (often need higher dose or echinocandin)
  • C. krusei — intrinsic fluconazole resistance
  • C. parapsilosis — neonatal + line; some echinocandin variable
  • C. auris — multi-drug resistant (Ch 252)

242.2.0.2 必背 — Risk Factors Invasive

  • Central line + broad antibiotics + ICU + abdominal surgery + neutropenia + DM + TPN + dialysis

242.2.0.3 必背 — Mucocutaneous Forms

  • Oral thrush (HIV CD4 < 200, inhaled steroids, dentures, DM)
  • Esophagitis (HIV CD4 < 100, AIDS-defining)
  • VVC (pruritus + “cottage cheese” discharge)
  • Cutaneous intertrigo (skin folds)
  • Chronic mucocutaneous (CMC, immune defects)

242.2.0.4 必背 — Invasive Treatment

  • Echinocandin first-line (caspofungin/micafungin/anidulafungin/rezafungin)
  • Step-down to fluconazole if azole-sensitive species + stable + neg cultures
  • 14 days after first negative blood culture for uncomplicated candidemia
  • Source control essential (line removal, debridement)
  • Ophthalmologic exam within 1 wk for all candidemia
  • TEE for persistent / endocarditis suspicion

242.2.0.5 必背 — Mucocutaneous Treatment

  • Oral thrush: clotrimazole troches / nystatin / fluconazole 100-200 mg × 7-14 d
  • Esophageal: fluconazole 200-400 mg × 14-21 d
  • VVC: fluconazole 150 mg PO × 1 or topical azoles
  • Recurrent VVC: fluconazole weekly × 6 months or ibrexafungerp

242.2.0.6 必背 — Ibrexafungerp (Brexafemme, FDA 2021)

  • Oral triterpenoid (similar to echinocandins)
  • VVC + recurrent VVC
  • Alternative to fluconazole

242.2.0.7 必背 — Species-Specific

  • C. krusei + C. glabrata: echinocandin (not fluconazole)
  • C. parapsilosis: fluconazole or echinocandin (variable echinocandin susceptibility)
  • C. auris: echinocandin (but AST required)

242.2.0.8 必背 — β-D-Glucan

  • Elevated in invasive candidiasis (+ PJP + Aspergillus)
  • Not specific
  • Useful for early diagnosis + monitoring response

242.2.0.9 必背 — Ophthalmology in Candidemia

  • All candidemia → ophth exam within 1 week
  • Chorioretinitis 9-37%
  • Sight-threatening
  • Intravitreal antifungal if active disease

242.2.0.10 必背 — Rezafungin

  • Once-weekly IV echinocandin (FDA 2023)
  • Convenience for outpatient OPAT

242.2.0.11 必背 — Diaper Rash Treatment

  • Topical antifungal (clotrimazole, miconazole, nystatin)
  • Keep area dry
  • Diaper change frequently