7 - Mycotic Diseases Flashcards

1
Q

Mycotic diseases include:

A
Endemic mycotic mycotic illness 
- blastomycocsis
- coccidioidomycosis
- histoplasmosis
Cryptococcosis
Candiadiasis 
- superficial fungal
- systemic infections
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2
Q

Mycoses are?

A

Fungal infections

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3
Q

Mycoses transmission?

A

No evidence of transmission among humans or animals

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4
Q

Where is blastomycosis found

A

North America

  • mississippi and ohio rivers
  • midwest
  • great lakes
  • new york/canada
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5
Q

Who gets blasto (MC)

A

Males - “because they hunt and fish”

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6
Q

Environments where blasto is found?

A

Occupational and recreational activities

Along streams or rivers

Moist soil enriched w decaying vegetation

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7
Q

Blasto types of infection?

A

Asymptomatic (50%)

Primary - inhalation (pneumonia)

Cutaneous

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8
Q

Primary blastomycosis phases

A

Acute: similar to bacterial pneumonia

Chronic: looks like TB

Can resolve spontaneously

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9
Q

Cutaneous blasto presentation?

A

Verrucous, nodular, or ulcerative lesions

Face>extremities>neck>scalp

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10
Q

What organs/systems are involved with blastomycosis?

A

Almost any organ can be involved

  • Osteoarticular
  • Genitourinary
  • CNS
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11
Q

Test/studies for blasto?

A

Microscopic

  • KOH
  • culture

Serology

  • immunodiffusion test
  • ELISA

Skin test
- blastomycin antigen (useless)

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12
Q

Preferred blasto test?

A

Immunodiffusion test

ELISA

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13
Q

Temperatures for growing blastomyces?

A

Mold: 77*F

Yeast 98.6*F

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14
Q

Treatment modalities for blastomycosis?

A
Liposomal amphotericin B
- life threatening
Itraconazol (sporanox)
- mild-moderate
Fluconazole (diflucan)(6-12 mo)
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15
Q

Coccidiomycosis aka?

A

San Joaquine valley fever

Valley fever

Coccidioides immitis

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16
Q

Where do you find coccidiomycosis?

A

Arizona
Central cali
Southern NM
West Texas

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17
Q

Lab nerd concerns for coccidiomycosis?

A

It is highly infectious

- Hazard for the lab folks

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18
Q

Who is at the highest risk for coccidiomycosis?

A

Filipinos

Pregnant

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19
Q

CAP in arizona?

A

Coccidiomycosis accounts for 15-29% of cases of CAP in arizona

  • put it in your differential
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20
Q

Presentations for coccidiomycosis?

A

Pulmonary disease
- 60% asymptomatic

  • acute pneumona - look like pneumonia

Cnronic pneumona

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21
Q

Chronic pneumonia for coccidioidomycosis presentation?

A

TB-like disease

Thin walled cavities

Nodules

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22
Q

Disseminated/secondary coccidioidomycosis?

A
Fulminant disease
Skin
Bone
Vertebrae 
Meningeal
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23
Q

MC pts who get secondary/disseminated coccidiomycosis?

A

Immunocompromised

High risk

  • filipino
  • preggo
  • AA)
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24
Q

Coccidioidomycosis test and diagnostic procedures?

A

Direct - smear, tissue

Culture (biohazard)

Serology

  • complement fixation
  • IgG/IgM
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25
Q

Acute pulmonary vs severe/disseminated treatments?

A

Acute:

  • No antifungal therapy required
  • Symptomatic therapy only

Other/disseminated

  • severe - ampothericin B
  • fluconazole or itraconazole
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26
Q

Meningeal treatment?

A

Life-long fluconazole (not a long life though)

Intraventricular amphotericin B

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27
Q

Histoplasmosis aka??

A

Darling’s disease

Histoplasma capsulatum

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28
Q

Where do you find histoplasma capsulatum?

What spreads it?

A

World wide (molstly ohio/mississippi river valley)

Bats, chickens, birds

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29
Q

Who is at a higher risk for histoplasmosis?

A

Smokers

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30
Q

Skin tests for histoplasmosis?

A

80-90% of the endemic population will test positive

- not actually infected with it, just exposed

31
Q

Animinals who spread histoplasmosis?

A
  • Starlings
  • bats
  • chickens
  • other birds
32
Q

Acute pulmonary histoplasmosis presentation?

A
  • Mild - self limited
  • Flu like
  • Hilar or mediastinal lymphadenopathy
33
Q

Chronic pulmonary histoplasmosis presentation?

A
  • Male smokers
  • TB like
  • bullae
  • granulomas
  • cavitation
34
Q

Localized histoplasmosis is found?

A

Mediastinal disease - stable or progressive

Cutaneous

35
Q

Disseminated histoplasmosis presentation?

A

Acute, progressive

Usually in AIDS pts

  • low fever
  • wt loss
  • anemia
  • oral lesions
  • cutaneous lesions
36
Q

Disseminated histoplasmosis clinical manifestation

A
Lymph nodes
- lymphadenitis
Bone marrow
- anemia
- leukopenia
- thrombocytopenia
Heart
- endocarditis
Adrenal
- enlargement
- addisons
CNS
- chronic meningitis
- cerebritis
- Mass
GI tract
- oral ulcers
- small bowel micro/macro ulcers
Eyes
- Uveitis
- choroiditis
Skin
- Uveitis
- choroiditis
GU tract
- hydronephrosis
- bladder ulcers
- penile ulcers
- prostatitis
37
Q

Tests/diagnosis studies for histoplasmosis?

A

Direct - smears of samples

Culture - temp depenent

Serology

  • immunodiffusion
  • complement fixation
  • antigen testing
38
Q

Acute pulmonary histoplasmosis tx?

A

Not usually required

- Unless they have hypoxemia or lasts > 1 mo

39
Q

Severe/life threatening and moderate histoplasmosis infection treatment?

A

Severe
- Liposomal amphotericin B
Mild-moderate
- Itraconazole

40
Q

AIDS histoplasmosis tx?

A

Life-ling itraconazole

41
Q

Who gets treated for histoplasmosis?

A

Acute pulmonary - only if last >1mo

Chronic pulmonary

Disseminated - aids/non-aids

Fibrosing mediastinitis

42
Q

Cryptococcosis (neoformans) is found?

A

World wide
Immunocompromised
Men>women

43
Q

What spreads cryptococcus neoformans?

A

Pidgeon droppings

44
Q

When in the AIDS progression do you see cryptococcus?

A

CD4<200

45
Q

MC manifestation of cryptococcosis?

A

Meningitis

46
Q

Cryptococcosis meinigitis/meningoencephalitis s/s?

A
  • Subacute or chronic
  • HA
  • personality changes
  • lethargy
  • coma
  • N/V
  • Fever and stiff neck (less common)
  • altered mental
  • confusion
  • obtundation
47
Q

Pulmonary cryptococcosis s/s?

A

Extremely variable
- subacute - ARDS

Clinically similar to acute pneumonia

48
Q

Cutaneous manifestations fo cryptococcosis?

A
Papules
Pustules
Nodules
Ulcers
Draining sinuses
49
Q

Other sites of infection with cryptococcosis?

A

Prostate

Medullary cavity of bones

50
Q

Tests for cryptococcosis?

A

Culture
- urease-producing yeast

Direct microscopic- smear

Serology - antigen

Radiology (not diagnostic)
- CT -> LP

51
Q

What test is most useful for cryptococcosis induced meningitis?

A

The serology antigen test

52
Q

Treatment for cryptococcosis?

A

Immunocompetent

  • pulmonary - fluconazole
  • CNS - amphotericin B

AIDS - the same except its lifelong

53
Q

List of other systemic mycotic illness?

A

Aspergillosis - AIDS

Zygomycosis - Diseases

Paracoccidioidomycosis - south america

Penicillosis - SE asia/southern CHINA (HIV)

54
Q

MC candidiasis?

A

Candida albicans

55
Q

Non-albicans candidal yeasts?

A
Candida tropicalis
Candida kruesi
Candida paraposilosis
Candida lustaniae
Candida glabrata
56
Q

Fluconazole resistant candida?

A

Candida krusei

Candida glabrata

57
Q

Candida amphoterican B resistant?

A

Candida lusitaniae

58
Q

Candida of malignancy?

A

Candida tropicalis

59
Q

Superficial and systemic candidiasis presentation?

A

Superficial

  • thrush
  • vaginitis
  • onychomycosis
  • esophangitis
  • intertrigo

Systemic

  • funguria
  • candidemia
60
Q

Thrush in a young adult?

A

AIDS

61
Q

Thrush is usually found on?

A
Neonates
Diabetics on Abx
AIDS
Inhaled steroids
Esophageal diesase
62
Q

Vaginal candidiasis candidates?

A

Sexually active
Pregnant
Diabetic
Following abx

63
Q

Diagnosis of vaginal candidiasis?

A

Usually empiric

64
Q

Tx for candidiasis?

A

Vaginal
- creams/fluconazole

Skin folds

  • diaper rash cream
  • nystatin powders
65
Q

Satellite lesions?

A

Found in candidiasis

- differentiates from tinea

66
Q

Where does candiduria (funguria) come from?

A

Usually its nosocomial

67
Q

What is candiduria (funguria)?

A

Its a nosocomial candida that colonizes the bladder

68
Q

Risk factors for candidiasis?

A
  • Immunosupression (nutropenia)
  • hematologic malignancy
  • steroid exposure
  • disruption of skin/mucuous/GI
  • indwelling devices
  • surgery
  • antibiotic therapy
  • TPN
  • Diseases
69
Q

Survival for blood stream candida?

A

35% survive hospitalization

30% die of underlying disease

35% die of candidal infection

70
Q

Systemic deep and disseminated candidiasis?

A

High mortality

Difficult to diagnosis

71
Q

Test and procedures for candidiasis

A

Direct

  • lesions
  • smears (gram stain, KOH)
  • tissue (gram, GMS, PAS)

Culture
- yeast, germ-tube formation

Serology (no good ones)

72
Q

Deep/systemic candidiasis treatment?

A

IV voriconazole

73
Q

All fungi are edible

A

But some are only edible once