7 - Mycotic Diseases Flashcards
Mycotic diseases include:
Endemic mycotic mycotic illness - blastomycocsis - coccidioidomycosis - histoplasmosis Cryptococcosis Candiadiasis - superficial fungal - systemic infections
Mycoses are?
Fungal infections
Mycoses transmission?
No evidence of transmission among humans or animals
Where is blastomycosis found
North America
- mississippi and ohio rivers
- midwest
- great lakes
- new york/canada
Who gets blasto (MC)
Males - “because they hunt and fish”
Environments where blasto is found?
Occupational and recreational activities
Along streams or rivers
Moist soil enriched w decaying vegetation
Blasto types of infection?
Asymptomatic (50%)
Primary - inhalation (pneumonia)
Cutaneous
Primary blastomycosis phases
Acute: similar to bacterial pneumonia
Chronic: looks like TB
Can resolve spontaneously
Cutaneous blasto presentation?
Verrucous, nodular, or ulcerative lesions
Face>extremities>neck>scalp
What organs/systems are involved with blastomycosis?
Almost any organ can be involved
- Osteoarticular
- Genitourinary
- CNS
Test/studies for blasto?
Microscopic
- KOH
- culture
Serology
- immunodiffusion test
- ELISA
Skin test
- blastomycin antigen (useless)
Preferred blasto test?
Immunodiffusion test
ELISA
Temperatures for growing blastomyces?
Mold: 77*F
Yeast 98.6*F
Treatment modalities for blastomycosis?
Liposomal amphotericin B - life threatening Itraconazol (sporanox) - mild-moderate Fluconazole (diflucan)(6-12 mo)
Coccidiomycosis aka?
San Joaquine valley fever
Valley fever
Coccidioides immitis
Where do you find coccidiomycosis?
Arizona
Central cali
Southern NM
West Texas
Lab nerd concerns for coccidiomycosis?
It is highly infectious
- Hazard for the lab folks
Who is at the highest risk for coccidiomycosis?
Filipinos
Pregnant
CAP in arizona?
Coccidiomycosis accounts for 15-29% of cases of CAP in arizona
- put it in your differential
Presentations for coccidiomycosis?
Pulmonary disease
- 60% asymptomatic
- acute pneumona - look like pneumonia
Cnronic pneumona
Chronic pneumonia for coccidioidomycosis presentation?
TB-like disease
Thin walled cavities
Nodules
Disseminated/secondary coccidioidomycosis?
Fulminant disease Skin Bone Vertebrae Meningeal
MC pts who get secondary/disseminated coccidiomycosis?
Immunocompromised
High risk
- filipino
- preggo
- AA)
Coccidioidomycosis test and diagnostic procedures?
Direct - smear, tissue
Culture (biohazard)
Serology
- complement fixation
- IgG/IgM
Acute pulmonary vs severe/disseminated treatments?
Acute:
- No antifungal therapy required
- Symptomatic therapy only
Other/disseminated
- severe - ampothericin B
- fluconazole or itraconazole
Meningeal treatment?
Life-long fluconazole (not a long life though)
Intraventricular amphotericin B
Histoplasmosis aka??
Darling’s disease
Histoplasma capsulatum
Where do you find histoplasma capsulatum?
What spreads it?
World wide (molstly ohio/mississippi river valley)
Bats, chickens, birds
Who is at a higher risk for histoplasmosis?
Smokers
Skin tests for histoplasmosis?
80-90% of the endemic population will test positive
- not actually infected with it, just exposed
Animinals who spread histoplasmosis?
- Starlings
- bats
- chickens
- other birds
Acute pulmonary histoplasmosis presentation?
- Mild - self limited
- Flu like
- Hilar or mediastinal lymphadenopathy
Chronic pulmonary histoplasmosis presentation?
- Male smokers
- TB like
- bullae
- granulomas
- cavitation
Localized histoplasmosis is found?
Mediastinal disease - stable or progressive
Cutaneous
Disseminated histoplasmosis presentation?
Acute, progressive
Usually in AIDS pts
- low fever
- wt loss
- anemia
- oral lesions
- cutaneous lesions
Disseminated histoplasmosis clinical manifestation
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
Tests/diagnosis studies for histoplasmosis?
Direct - smears of samples
Culture - temp depenent
Serology
- immunodiffusion
- complement fixation
- antigen testing
Acute pulmonary histoplasmosis tx?
Not usually required
- Unless they have hypoxemia or lasts > 1 mo
Severe/life threatening and moderate histoplasmosis infection treatment?
Severe
- Liposomal amphotericin B
Mild-moderate
- Itraconazole
AIDS histoplasmosis tx?
Life-ling itraconazole
Who gets treated for histoplasmosis?
Acute pulmonary - only if last >1mo
Chronic pulmonary
Disseminated - aids/non-aids
Fibrosing mediastinitis
Cryptococcosis (neoformans) is found?
World wide
Immunocompromised
Men>women
What spreads cryptococcus neoformans?
Pidgeon droppings
When in the AIDS progression do you see cryptococcus?
CD4<200
MC manifestation of cryptococcosis?
Meningitis
Cryptococcosis meinigitis/meningoencephalitis s/s?
- Subacute or chronic
- HA
- personality changes
- lethargy
- coma
- N/V
- Fever and stiff neck (less common)
- altered mental
- confusion
- obtundation
Pulmonary cryptococcosis s/s?
Extremely variable
- subacute - ARDS
Clinically similar to acute pneumonia
Cutaneous manifestations fo cryptococcosis?
Papules Pustules Nodules Ulcers Draining sinuses
Other sites of infection with cryptococcosis?
Prostate
Medullary cavity of bones
Tests for cryptococcosis?
Culture
- urease-producing yeast
Direct microscopic- smear
Serology - antigen
Radiology (not diagnostic)
- CT -> LP
What test is most useful for cryptococcosis induced meningitis?
The serology antigen test
Treatment for cryptococcosis?
Immunocompetent
- pulmonary - fluconazole
- CNS - amphotericin B
AIDS - the same except its lifelong
List of other systemic mycotic illness?
Aspergillosis - AIDS
Zygomycosis - Diseases
Paracoccidioidomycosis - south america
Penicillosis - SE asia/southern CHINA (HIV)
MC candidiasis?
Candida albicans
Non-albicans candidal yeasts?
Candida tropicalis Candida kruesi Candida paraposilosis Candida lustaniae Candida glabrata
Fluconazole resistant candida?
Candida krusei
Candida glabrata
Candida amphoterican B resistant?
Candida lusitaniae
Candida of malignancy?
Candida tropicalis
Superficial and systemic candidiasis presentation?
Superficial
- thrush
- vaginitis
- onychomycosis
- esophangitis
- intertrigo
Systemic
- funguria
- candidemia
Thrush in a young adult?
AIDS
Thrush is usually found on?
Neonates Diabetics on Abx AIDS Inhaled steroids Esophageal diesase
Vaginal candidiasis candidates?
Sexually active
Pregnant
Diabetic
Following abx
Diagnosis of vaginal candidiasis?
Usually empiric
Tx for candidiasis?
Vaginal
- creams/fluconazole
Skin folds
- diaper rash cream
- nystatin powders
Satellite lesions?
Found in candidiasis
- differentiates from tinea
Where does candiduria (funguria) come from?
Usually its nosocomial
What is candiduria (funguria)?
Its a nosocomial candida that colonizes the bladder
Risk factors for candidiasis?
- Immunosupression (nutropenia)
- hematologic malignancy
- steroid exposure
- disruption of skin/mucuous/GI
- indwelling devices
- surgery
- antibiotic therapy
- TPN
- Diseases
Survival for blood stream candida?
35% survive hospitalization
30% die of underlying disease
35% die of candidal infection
Systemic deep and disseminated candidiasis?
High mortality
Difficult to diagnosis
Test and procedures for candidiasis
Direct
- lesions
- smears (gram stain, KOH)
- tissue (gram, GMS, PAS)
Culture
- yeast, germ-tube formation
Serology (no good ones)
Deep/systemic candidiasis treatment?
IV voriconazole
All fungi are edible
But some are only edible once
