30 - Opportunistic Fungal Infections (Klutts)

Question 1

leading cause of opportunistic fungal infections

Answer 1

candida

normal human commensals

Question 2

cadida spectrum of disease

Answer 2

localized (skin and nails)
mucosal (vaginitis, oral thrush, esophagitis)
invasive (bloodstream)

Question 3

invasive candidiasis blood stream infections

Answer 3

usually catheter related
CLABSI (central line associated blood stream infection)
40% mortality rate

Question 4

hepatosplenic candidiasis

Answer 4

type of invasive candidiasis unique to CA patients with prolonged neutropenia
micro abscesses in liver and spleen

Question 5

sequelae from bloodstream infections

Answer 5

bone, joint, peritoneum involvement

Question 6

risk factors for invasive candidiasis

Answer 6

ABX use
candida colonization
CVC use
Hemodialysis
abdominal surgery (GI commensal)
TPN (plastic+nutrition)
ICU stay
Hospital stay
neutropenia (hepatosplenic disease)

Question 7

most common candida species

Answer 7

c. albicans

Question 8

candida species that is resistant to fluconazole

Answer 8

c. krusei

Question 9

diagnosis of candidiasis

Answer 9

budding yeast
pseudohyphae
grows readily
antigen testing for Beta 1, 3 glucan

Question 10

why is early diagnosis of opportunistic mycoses hard

Answer 10

lack of inflammatory response
risky invasive diagnostic procedures
lack of non invasive procedures

Question 11

treatment of localized candidiasis

Answer 11

topical azoles

Question 12

treatment of invasive candidiasis

Answer 12

azoles (fluconazole)
echinocandins
polyenes (amphotericin B)
PULL CATHETERS

Question 13

most common cause of invasive mold infection

Answer 13

aspergillus

not a normal colonizer of healthy people

Question 14

most common aspergillus species

Answer 14

a. fumigatus
a. flavis
a. niger

Question 15

aspergillosis clinical syndromes

Answer 15

allergic bronchopulmonary aspergillosis
apergilloma
semi invasive
invasive

Question 16

allergic bronchopulmonary aspergillosis

Answer 16

colonization of airways with allergic reaction
bronchospasm
bronchietasis
segmental collapse

Question 17

aspergilloma in pre existing cavity

Answer 17

secondary colonization

fungus ball

Question 18

semi invasive aspergillosis

Answer 18

chronic cavitary, chronic fibrosing, chronic invasive

Question 19

invasive aspergillosis

Answer 19

life threatening

angioinvasive with rapid spread and dissemination

Question 20

risk factors for invasive aspergillosis

Answer 20

neutropenia
corticosteroids
immunosuppressives
transplant (graft vs. host)

Question 21

aspergillosis diagnosis

Answer 21

branching segmented hyphae

antigen detecion of galactomannan

Question 22

galactomannan

Answer 22

polysaccharide cell wall component

not useful if pt on antifungal therapy or certain ABX

Question 23

allergic aspergillosis treatment

Answer 23

corticosteroids

Question 24

aspergilloma treatment

Answer 24

observation

surgical and medical therapy

Question 25

semi invasive and invasive treatment

Answer 25

voriconazole

amphotericin B

Question 26

species of zygomycosis

Answer 26

rhizopus
mucor
rhizomucor

Question 27

risk factors for zygomycosis

Answer 27

diabetes/DKA
malignancies
deferoxamine therapy (iron chelator)
steroids
voriconazole prophylaxis
acidosis

Question 28

zygomycosis infections

Answer 28

cause rhinocerebral or pulmonary disease

Question 29

zygomycosis treatment

Answer 29

amphotericin B

surgical debridement

Question 30

zygomycosis diagnosis

Answer 30

cultures are often negative
not detected by Beta d glucan or galactomannan
grow rapidly
nonseptate hyphae with sproangia

Question 31

what is changing the epidemiology of fungal infections

Answer 31

more aggressive antifungal use

more immunocompromised patients

Question 32

pneumocystis jiroveci

Answer 32

used to be a protozoan

Opportunistic mycotic infections (AIDS, transplant, corticosteroids, immunodeficiencies, CA)

Question 33

what has caused decline in pneumocystis jiroveci

Answer 33

HAART therapy for HIV

Question 34

pneumocystosis diagnosis

Answer 34

microscopic examination with GMS or DFA

Question 35

pneumocystosis treatment

Answer 35

trimethoprim sulfamethoxazole - for prophylaxis and treatment
corticosteroids for hypoxic patients to reduce inflammatory response

Question 36

why can patients worsen for a few days from pneumocystosis treatment

Answer 36

lysing of organisms and releasing antigens into lungs