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HDID 2 > 60. Opportunistic Mycoses > Flashcards

60. Opportunistic Mycoses Flashcards

1
Q

opportunistic mycoses w/altered phagocytes (neutropenia)?

A

invasive candidiasis

aspergillus

zygomycosis

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2
Q

opportunistic mycoses w/altered T-cell function?

A

mucocutaneous candidiasis

cryptococcosis

pneumocystosis/pneumocystis carinii

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3
Q

likely pts to get mucocutaneous candidiasis?

A

Altered T-cell function

  • underlying diseases (HIV, DM)
  • corticosteroids
  • pregnancy (progesterone)
  • age (waning cell-mediated immunity)
  • antibacterial antibiotics
  • postpartum risk for cutaneous candidiasis
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4
Q

clinical disease of mucocutaneous candidiasis?

A
  • oropharyngeal candidiasis (thrush)
  • esophageal candidiasis (burning, dysphagia, good localization)
  • candida epiglottitis
  • cutaneous candidiasis (skin folds like groin or under breast, diaper dermatitis)
  • onychomycosis (occasionally)
  • vulvovaginal candidiasis
  • mucocutaneous candidiasis = diabetes
  • chronic mucocutaneous candidiasis (inherited disorder of cellular immunity w/ concomitant adrenal insufficiency and hypoarathyroidism, IDDM, hypothyroidism, hypogonadism = autoimmune polyendocrinopathy-candidosis-ectodermal dystrophy/APECED = autosomal recessive)
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5
Q

pathology of mucocutaneous candidiasis?

A
  • lesions on oral, esophageal, epiglottal, GI, and vaginal mucosal surfaces w/white pseudomembranous plaque of Candida hyphae, pseudohyphae, and budding yeast cells
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6
Q

treatment of mucocutaneous candidiasis?

A
  • keep diaper dry
  • topical clotrimazole, miconazole, or nystatin
  • PO fluconazole
  • IV echinocandin for severe cases
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7
Q

invasive candidiasis susceptible patients?

A

Altered phagocytes (neutropenia) – major problem w/host defense : mucosal disruption, catheters, GI surgery, trauma, transplant and immune-suppressed

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8
Q

invasive candidiasis pathogenesis?

A
  • adherence and colonization
  • penetration through mucosal barriers and angioinvasion or access to vascular catheters
  • hematogenous dissemination
  • replicaoitn in tissue causes necrosis +/- abscess formation w/budding yeast and hyphae
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9
Q

invasive candidiasis clinical disease?

A
  • candidemia
  • endocarditis
  • hepatosplenic candidiasis
  • acute disseminated candidiasis (septic shock)
  • renal candidiasis
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10
Q

invasive candidiasis treatment?

A
  • echinocandins – esp if in eyes, need to QUICKLY KILL the fungi
  • fluconazole
  • AmB
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11
Q

candida albicans?

A

most virulent and common member of candida

germ tube w/chitin on the end

virulence:
surface receptors, cell wall can act as immunomodulator, hydrolytic enzymes, and host mimicry

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12
Q

aspergillus biology?

A
  • filamentous fungi ubiquitous in the env’t
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13
Q

aspergillus pts at risk?

A

Altered phagocytes (Neurtopenia)

  • CGD
  • post-engraftment BMT
  • organ transplant recipients
  • corticosteroids
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14
Q

aspergillus pathogenesis?

A
  • inhalation of conidia reach alveoli
  • phagocytosis but no killing if compromised host
  • germination w/hyphal invasion of lung parenchyma
  • angioinvasion w/thrombosis, ischemia and infarction
  • +/- hematogenous dissemination
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15
Q

aspergillis virulence factors?

A
  • aflatoxins
  • adherence receptors
  • hydrolytic enzymes
  • C’inhibitor
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16
Q

aspergillis clinical disesae?

A
  • toxins re: aflatoxins
  • allergic syndromes in atopic indivs
  • fungal ball in old TB cavity
  • keratitis following corneal trauma
  • invasive disease (pulmonary +/- dissemination)
17
Q

aspergillis pathology?

A
  • angular dichotomously branching septate hyphae

halo sign or crescent sign

18
Q

aspergillis treatment?

A
  • first line therapy: voriconazole (isavuconazole, liposomal AmB)
  • Second Line therapy: posaconazole, echinocandins, AmBLC
19
Q

zygomycoses general biology?

A
  • wide, ribbon-like, nonseptate hyphae that branch infrequently at right angles
  • medical emergency! Can overwhelm the patient w/in hours
  • rapid growing
  • sporangiophores which bear a large sac-like structures called sporangia filled w/ sporangiospores produces internally
20
Q

zygomycoses pts at risk?

A

Altered phagocytes (neutropenia)

  • DM w/DKA -> rhinocerebral zygomycosis
  • neutropenic -> pulmonary +/- dissemination
21
Q

zygomycoses pathogenesis?

A
  • inhalation/ contact w/asexual spores from env’t
    Rhinocerebral zygomycosis:
  • infec begins in paranasal insuses (or nasal/oral mucosa)
  • tissue invasion w/frequent invasion of nerves and BVs (cranial nerve palsies, thrombosis, and necrosis)
  • invasion of orbit and eye
  • direct extension to brain
    Pulm: angioinvasion and hemorrhagic infarction
22
Q

zygomycoses clinical disease/pathology?

A
  • Saprophytic/Colonization: old TB lung cavity, no invasion of lung parenchyma
  • Invasive: rhinocerebral zygomycosis
  • invasive: pulmonary +/- dissemination
  • easily spreads through lamina papyracea
  • medial rectus affected = diplopia
  • CN III, IV, V1, V2, V6, internal carotid (hemispheric infarction) affected if spreads to cavernous sinus
  • invasion of BV walls and nerves w/extensive necrosis in advance of the fungus
23
Q

zygomycoses treatement?

A
  • First line therapy: AmB, recently approved isavuconazole

- adjunctive therapy: surgery, restitution of host defenses

24
Q

cryptococcus neoformans general/biology?

A
  • Encapsulated yeast
  • neurotropic
  • visualize capsule w/india ink stain
25
Q

cryptococcus neoformans pts at risk?

A

Altered T-cell function:

  • high dose corticosteroids
  • organ transplant w/ immunusupp.
  • HIV+**AIDS-defining infection
26
Q

cryptococcus neoformans pathogenesis and virulence factors?

A
  • inhalation of yeast from env’t
  • replication in the lung
  • recruitment of CD4 and CD8 cells
  • clearance of pulm infection in most concomitant w/ development of specific cellular immune response OR progressive pulm infection in compromised pts
  • +/- hematogenous dissemination or crossing of BBB
  • replication of yeast w/gelatinous lesion due to capsule: tremendous pressue in CNS
  • hetero-polysaccharide capsule: glucuronoxylomannan -> inhibits intracellular phagocytosis
  • melanin inhibits oxygen dependent killing mechanisms
27
Q

cryptococcus neoformans clinical disease/pathology?

A
  • meningoencephalitis: memory impaired/confused
  • pulmonary: asymptomatic to mild to progressive, depending on the pt and inoculum size…then spreads to the brain
  • disseminated disease
  • increased ICP can cause herniation and blindness so if see nothing on ophthalmic exam and pt experiencing blindness…think this.
  • normal host: chronic inflammation and granulomatous responses, resolution w/out calcification
  • compromised host = mild to non-inflammatory reaction
  • gelatinous lesions (excess capsule)
  • spherical yeasts: spherules
  • stain w/PAS, GMS, or mucicarmine
28
Q

cryptococcus neoformans treatment?

A
  • first line therapy: Amb + 5FC then fluconazole maintenance

- Adjunctive therapy: relief of increased ICP

29
Q

pneumocystis jirovecii general/biology?

A
  • obligate parasite-fungus
30
Q

pneumocystis jirovecii pts at risk?

A

Altered T-cell function

  • immunosupp
  • corticosteroid
  • HIV
  • age
31
Q

pneumocystis jirovecii pathogenesis?

A
  • proliferates w/in capillaries along alveolar epithelium and produces delicate proteinacious material that blocks capillary and prevents oxygenation of tissue
32
Q

pneumocystis jirovecii clinical disease?

A

-alveolar-interstitial pna presents w/fever, dyspnea, and non-productive cough
- extrapulmonary disease rare
-

33
Q

pneumocystis jirovecii tx?

A
  • first line therapy: TMP-SMX

HDID 2 (32 decks)

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