CHAPTER 15: FUNGI AND YEASTS ( DEEP MYCOSES) Flashcards
Flulike illness
Lung changes on CXR- hilar adenopathy, infiltrate
Generalized maculopapular eruption
Pulmo sx subside within a few weeks
Erythema nodosum over shins then disappear after 3 weeks
Coccidiodomycosis (primary pulmonary coccidioidomycosis)
how to diagnose Coccidiodomycosis?
culture ( grown at room air)
PCR test
Treatment for coccidiomycosis
Fluconazole 400-800mg/day
Itraconazole 200mg TID
X 12-18 months
Inhalation of airborne spores
Asymptomatic or limited lung disease
Immunocompromised/ systemic steroids
Ulcerations/ granulomas of the oronasopharynx
Histoplasmosis
Painless, slightly pruritic dome shaped nodular granulomas
Erythema nodosum
Organism found in bat and bird feces
African histoplasmosis
Treatment of choice for histoplasmosis
Amphotericin B
Begins as a pulmonary infection and remains localized to the lung in 90% of cases
10%- disseminate to CNS and skin
Immunocompromised
Molluscum contagiosum like lesions-50% of px with HIV and disseminated
Cryptococcosis
Most common cause of mycotic meningitis
Cryptococcosis
4th leading cause of opportunistic infection and 2nd most common fungal opportunist
Cryptococcosis
Treatment of cryptococcosis
Amphotericin B IV + oral fluconazole - seriously ill
Fluconazole 400-600mg/day x 8-10 weeks- less severely ill non -AIDS
Result from dissemination from a primary pulmonary focus ( upper or middle lobe of the lungs)
Multiple Verrucous, granulomatous lesions with thick crusts, warty vegetations on exposed skin
-thick dirty brown or gray crusts
Blastomycosis (North American)
Treatment of choice for North
American blastomycosis
Itraconazole 200-400mg/day x 6 months
causative agent of North american balstomycosis
Bastomyces dermatitides
Blastomycosis with mucocutaneous involvement
Armadillos may harbor the disease
South American
(Paracoccidiodomycosis)
causative agent of South American
(Paracoccidiodomycosis)
Paracoccidiodes braciliences
Treatment for south American blastomycosis
Itraconazole 200mg/day x 12 months
Usually from direct inoculation by a thorn, cat’s claw
(occupational dse of gardeners, florists and laborers)
Small nodule that disappear before onset of other lesions
After few weeks- painless firm nodules along draining lymphatics
Sporotrichosis
Treatment of sporotrichosis
cutaneous and lymphocutaneous: Itraconazole 200mg/day x 2-4 weeks;
cutaneous form when Itraconazole fails: Potassium iodide 3-6 g/day
cutaneous form when Itraconazole fails: Potassium iodide 3-6 g/day
chromoblastomycosis
Mycetoma triad
- subcutaneous swelling
- discharging sinuses / sinus trats
- granules in sinuses
Treatment of mycetoma (maduromycosis)
A. israelii infection: penicillin
N. asteroides or N. brasiliensis: sul- fonamides.
P. boydii: Voriconazole alone or combined with surgical excision
Acute rapidly developing fatal infection
Infarction, gangrene, necrotic abscess
Black, necrotic purulent debris
Common in soil, decomposing plant and animal matter
mucormycosis
Treatment of mucormycosis
- surgical excision + liposomal Amphoterin B
TOC of Pneumocystosis ( P. jirovecci infection )
TMP-SMX for 3 wks
2nd to candidiasis
Opportunistic fungal disease in px with leukemia and other hema neoplasias
Neutropenia- risk factor
Pulmo involvement- invasive disease
Hemorrhagic bullae/ necrotic ulcers
aspergillosis
Treatment for chromoblastomycosis
- cryosurgery
- itraconazole 200-400 mg/day x 6-12 months
- terbinafine 500-1000 mg/day +/- itraconazole 200-400 mg/day
Treatment of choice for invasive aspergillosis
voriconazole
Chronic, granulomatous, subcutaneous inflammatory disease
Triad: progressive subcutaneous swelling
Sinus tracts that discharge grains
Begin in instep or toe webs- nontender firm
Bone and fascia involved also
mycetoma aka madura foot and maduromycosis
