15- Deep Mycoses

Question 1

Flulike illness
Lung changes on CXR- hilar adenopathy, infiltrate
Generalized maculopapular eruption

Pulmo sx subside within a few weeks
Erythema nodosum over shins then disappear after 3 weeks

Answer 1

Coccidiodomycosis (primary pulmonary)

Question 2

Treatment for coccidiomycosis

Answer 2

Fluconazole 400-800mg/day
Itraconazole 200mg TID

X 12-18 months

Question 3

Inhalation of airborne spores
Asymptomatic or limited lung disease

Immunocompromised/ systemic steroids

Ulcerations/ granulomas of the oronasopharynx

Answer 3

Histoplasmosis

Question 4

Painless, slightly pruritic dome shaped nodular granulomas
Erythema nodosum

Organism found in bat and bird feces

Answer 4

African histoplasmosis

Question 5

Treatment of choice for histoplasmosis

Answer 5

Amphotericin B

Question 6

Begins as a pulmonary infection and remains localized to the lung in 90% of cases

10%- disseminate to CNS and skin
Immunocompromised

Molluscum contagiosum like lesions-50% of px with HIV and disseminated

Answer 6

Cryptococcosis

Question 7

Most common cause of mycotic meningitis

Answer 7

Cryptococcosis

Question 8

4th leading cause of opportunistic infection and 2nd most common fungal opportunist

Answer 8

Cryptococcosis

Question 9

Treatment of cryptococcosis

Answer 9

Amphotericin B IV + oral fluconazole - seriously ill

Fluconazole 400-600mg/day x 8-10 weeks- less severely ill non -AIDS

Question 10

Result from dissemination from a primary pulmonary focus

Multiple Verrucous, granulomatous lesions with thick crusts, warty vegetations on exposed skin
-thick dirty brown or gray crusts

Answer 10

Blastomycosis (North American)

Question 11

Treatment of choice for North

American blastomycosis

Answer 11

Itraconazole 200-400mg/day x 6 months

Question 12

Blastomycosis with mucocutaneous involvement

Armadillos may harbor the disease

Answer 12

South American 
(Paracoccidiodomycosis)

Question 13

Treatment for south American blastomycosis

Answer 13

Itraconazole 200mg/day x 12 months

Question 14

Usually from direct inoculation by a thorn, cat’s claw

Small nodule that disappear before onset of other lesions

After few weeks- painless firm nodules along draining lymphatics

Answer 14

Sporotrichosis

Question 15

Treatment of sporotrichosis

Answer 15

Itraconazole 200mg/day x 2-4 weeks

Question 16

Affects one lower extremity
Occurs in farmers 75%
Direct inoculation
Small pink scaly papules or warty growth and soread through direct extension

Answer 16

Chromoblastomycosis

Question 17

Treatment for chromoblastomycosis

Answer 17

Small lesions- excision

Itraconazole 200-400mg/day x 6-12months

Question 18

Chronic, granulomatous, subcutaneous inflammatory disease

Triad: progressive subcutaneous swelling
Sinus tracts that discharge grains

Begin in instep or toe webs- nontender firm
Bone and fascia involved also

Answer 18

Mycetoma

Madura foot/maduromycosis

Question 19

Mycetoma triad

Answer 19

Tumefaction
Sinuses
Granules

Question 20

Treatment of mycetoma (maduromycosis)

Answer 20

Early stage- surgical removal

Penicillin- A.israelli
Sulfonamides- nocardia spp
Voriconazole- P. boydii

Question 21

Acute rapidly developing fatal infection

Infarction, gangrene, necrotic abscess
Black, necrotic purulent debris

Common in soil, decomposing plant and animal matter

Answer 21

Mucormycosis

Question 22

Treatment of mucormycosis

Answer 22

Excision + amphotericin B

Question 23

2nd to candidiasis
Opportunistic fungal disease in px with leukemia and other hema neoplasias

Neutropenia- risk factor
Pulmo involvement- invasive disease
Hemorrhagic bullae/ necrotic ulcers

Answer 23

Aspergillosis

Question 24

Treatment of choice for invasive aspergillosis

Answer 24

Voriconazole