Invasive fungal infections: case-based presentation in pediatric patients (CME/ Questionnaire)

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Continuing Medical Education Questionnaire

Please enter the correct response to each question on the Answer Key provided on the Evaluation Form. A minimum passing score of 70% must be achieved to receive CME credit. A certificate of completion will be issued only upon receipt of your completed program evaluation form and the post-test answers.

1. Which of the following medications has been associated with an increased risk of invasive Candida infections in neonates?

   1. Broad-spectrum antibiotics

   2. Acid inhibitors

   3. Postnatal steroids

   4. All of the above

2. Which of the following appears to be the optimal fluconazole dosing regimen for pediatric patients with invasive candidiasis?

   1. 3 mg/kg/day

   2. 6 mg/kg/day

   3. 9 mg/kg/day

   4. 12 mg/kg/day

3. In neonates, when treating with amphotericin B deoxycholate, dosing can begin at 1 mg/kg without the need for subtherapeutic test doses.

   1. True

   2. False

4. Which of the following antifungal agents provides the best coverage for the most common neonatal Candida species, thus the best therapeutic choices pending speciation?

   1. Amphotericin B

   2. Nystatin

   3. Echinocandins

   4. Voriconazole

5. Which of the following has been shown in randomized placebo controlled trials of antifungal prophylaxis with fluconazole?

   1. Increased colonization

   2. Increased resistance

   3. Decreased Candida colonization

   4. Decreased Candida colonization and invasive infections

6. Which of the following is NOT a widely recognized risk factor for invasive candidiasis/candidemia in pediatric patients?

   1. Prior antiviral therapy

   2. Total parenteral nutrition

   3. Prolonged stay in an ICU

   4. Use of a central venous catheter

7. Based on the 2004 study by Zaoutis et al., immunosuppression and which of the following were independent risk factors for disseminated disease in children with candidemia?

   1. Prolonged antibiotic therapy

   2. Mechanical ventilation

   3. Candidemia >3 days with a CVC in place

   4. ICU stay ≥5 days

8. Candida albicans is the most common species causing invasive candidemia in pediatric children. Which of the following is the second most common species?

   1. C glabrata

   2. C parapsilosis

   3. C tropicalis

   4. C krusei

9. According to the 2009 Infectious Diseases Society of America (IDSA) guidelines, which of the following is recommended for empiric therapy in suspected invasive candidiasis in non-neutropenic pediatric patients?

   1. An echinocandin

   2. Fluconazole

   3. A or B

   4. Lipid formulation of amphotericin B

10. According to the 2009 IDSA guidelines, which of the following would be preferred treatment for a pediatric patient with neutropenic candidemia due to C glabrata?

    1. Fluconazole

    2. A lipid formulation of amphotericin B

    3. Caspofungin

    4. Voriconazole

11. Which of the following is NOT a major risk factor for invasive aspergillosis in pediatric patients?

    1. Acute myeloid leukemia

    2. Graft-versus-host disease

    3. Allogeneic bone marrow transplantation

    4. Candidiasis

12. In the largest pediatric analysis by Burgos and colleagues of 139 cases of pediatric invasive aspergillosis diagnosed at six major medical centers in the United States between January 1, 2000, and July 1, 2005, the overall mortality rate was:

    1. <30%

    2. 35–40%

    3. >50%

    4. 75%

13. Which of the following is a diagnostic test for invasive aspergillosis more commonly used in the research setting than in clinical practice at this time?

    1. Positron emission tomography

    2. Bronchoalveolar lavage

    3. Serum galactomannan assay

    4. Serum cytomegalovirus assay

14. The galactomannan enzyme immunoassay (EIA) has been approved by the FDA for the diagnosis of invasive aspergillosis in adults but as of this date not in pediatric patients because of limited data.

    1. True

    2. False

15. Once a diagnosis of invasive pulmonary aspergillosis is made, the 2008 IDSA guidelines for aspergillosis treatment recommend primary treatment with which of the following for most pediatric and adult patients

    1. Caspofungin

    2. A lipid formulation of amphotericin B

    3. Voriconazole

    4. Itraconazole

16. In conjunction with other clinical or host factors, the presence of which of the following radiographic findings is suggestive of invasive pulmonary aspergillosis?

    1. Halo sign

    2. Nodule

    3. Cavitation

    4. All of the above