30 Lung fungi

Question 0

Histoplasma disease

Answer 0

Flu-like illness
10 days after exposure
Can look like miliary TB on xray

Testing: Skin response may not be activve disease but previous exposure.

Treatment:
Often no treatment or itraconazole for mild
Amphoteracin B added for more severe or disseminated infection

Question 1

Histoplasma

Answer 1

3-17 days after innoculation Spores (micro and macroconidia) and Hyphae in soil (where birds and bats are.)
Become budding yeast in lungs.
Microconidia get into deep alveoli and are endocytozed by macrophaes, where they transform into yeast

Question 2

Histoplasma distribution

Answer 2

Mississippi valley below wisconsin

Question 3

Histoplasma clinical features

Answer 3

• Multiple calcified lesions on CXR
• Granulomatous response in the lung
• Can get fibrosing mediastinitis

Question 4

Blastomyces dermatitidis

Answer 4

*hyphae with mitcroconidia that becomes LARGE budding yeast in host. EXTRACELLULAR. Broad neck bud.
*Grow in places with moist soil and rotting vegitation
Wide distribution from Mississippi river- great lakes and minnesota

Question 5

Blastomyces Disease

Answer 5

• 4-6 week incubation
• usuallly self limiting disease, but you can get chronic granulomas within the lungs
• NOT ASSOCIATED WITH IMMUNOCOMPROMISED STATE
• Can quickly become severe in the lung.
• can become disseminated wiith multiple lesons

Diag: can be seen in sputum and biopsy
Sometimes cutaneous lesions

Treatment:
Itraconazole for mild disease (prevvent dissemination
Amphoteracin B added for moderate oor disseminated disease

Question 6

Coccidioides immitis

Answer 6

*Dry arid climates in soil!!!
Will not see disease out of those areas (excepting post travel)
*Multicellular septate hyphae with arthroconidia- In lung become large spherules with endospores
*late summer and early fall- when its dry or windy
*disturbing of groundsoil can cause outbreak

Question 7

Coccioides Disease

Answer 7

• Mild flu-like 7-21 days after exposure
• AIDS Associated
• Dangerous for pregnancy
• VERY VIRULENT- infective with 1-2organisms

Diag- PAS +
Skin test
Late cavitary lesions on CXR

Treatment:
None for mild
Flucontazole or ampphoteracin B for moderate resp disease
Fluc or itra for mild disseminated
Amphoteracin B and Itra for severe disseminated disease