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EENT/ID > ENT Fungal Infections > Flashcards

ENT Fungal Infections Flashcards

1
Q

Describe the etiology/RF of candidiasis

A

candida albicans, opportunistic, found in mouth, vagina, feces

RF immunosuppression, hormonal fluctuation, augmentin

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2
Q

Describe the etiology of mucous candidiasis

A
  • oral (thrush)
  • angular cheilitis
  • esophagitis (AIDS defining disease)
  • vaginitis
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3
Q

Describe the etiology/RF for invasive candidiasis

A

Candida in the bloodstream

Risk factors
- immunocompromised
- infection
- broad spectrum abx use
- recent chemo (neutropenia)
- recent surgery/ICU stay

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4
Q

Describe the clinical presentation of candida esophagitis

A
  • substernal odynophagia
  • gastroesophageal reflux
  • nausea
  • fever
  • oral involvement
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5
Q

Describe the clinical presentation of invasive candidiasis

A

several days of fever unresponsive to board spectrum abx, hx risk factors,
- organ dysfunction, malaise, fever, tachy, hypotension, AMS, hepatosplenomegaly, maculopapular/nodular rash, resembles bacterial sepsis

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6
Q

Describe the diagnostic testing for candidiasis

A

KOH (wet prep) or fungal culture

Candida esophagitis: endoscopy w/ biopsy & culture

Invasive candidiasis: blood cultures positive only 50% of the time

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7
Q

Describe the treatment for oral candidiasis

A

Mild: clotrimazole troche, nystatin suspension

Mod-Severe: Fluconazole

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8
Q

Describe the treatment for vaginal candidiasis

A

miconazole 2% cream, Clotrimazole 1-2% cream, Terconazole cream/suppository, Fluconazole PO

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9
Q

Describe the treatment for candida esophagitis

A

Fluconazole PO, Itraconazole PO tablet/solution

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10
Q

Describe the treatment for invasive candidiasis

A

refer to ID for echinocandins

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11
Q

What is the most common opportunistic infection in HIV

A

oral candidiasis

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12
Q

Describe the etiology/RF of cryptococcosis

A

Cryptococcus neoformans (pigeon poop, soil)

Transmitted through contaminated vegetation, inhalation of spores, dissemination from lungs

RF immunosuppressed, disease burden in South Asia & Africa

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13
Q

Describe the clinical presentation of cryptococcosis

A

Painless skin nodules mimicking molluscum contagiosum, cutaneous erythematous papules, vesicles, macules, ulcers

Skeletal involvement, infection can harbor in heart, bone, liver, kidney, adrenals, eyes, prostate, lymph nodes

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14
Q

Describe the clinical presentation of cryptococcal meningitis

A

insidious onset, headache (1st sx), progressive confusion, AMS, fever, seizure, stiff neck, photophobia

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15
Q

Describe the clinical presentation of pulmonary cryptococcosis

A

may be asymptomatic, simple nodules, cough, dyspnea, hemoptysis, fever, respiratory issues

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16
Q

Describe the diagnostic testing for cryptococcosis

A

LP for suspected meningitis
- CSF gram stain: budding, encapsulated yeast
- CSF crypto antigen
- CSF culture
- india ink prep

Serum crypto antigen: usually positive in pts with AIDS

Chest x-ray may appear with diffuse interstitial pneumonia

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17
Q

Describe the treatment for cryptococcosis

A

Consult ID

IV amphotericin B x14 days then 8 weeks fluconazole PO, +/- flucytosine (toxic, $$$)

Avoid steroids

18
Q

Describe the etiology/RF of histoplasmosis

A

Histoplasma Capsulatum (mold in environment, yeast at body temp)

Soil contaminated with bird/bat droppings & spores carried by air & inhaled

Spores active for 10 years

RF: farmers, endemic areas, Ohio river valley, spelunking, immunosuppression

19
Q

Describe the clinical presentation of histoplasmosis

A

Vary d/t extent of exposure, immune response, underlying lung disease

Most cases asymptomatic or mild, pneumonia: fever, cough, mild central chest pain

20
Q

Describe the clinical presentation of acute pulmonary histoplasmosis

A

mild flu-like to severe pneumonia, long term (progressive disseminated histo in HIV - multiple organ involvement, fulminant, rapidly fatal)

21
Q

Describe the diagnostic testing for histoplasmosis

A

Pulm: sputum culture rarely positive, histoplasmosis antigen in urine & serum

Disseminated: pancytopenia, blood/bone marrow culture positive 80%, histo antigen in urine 90% sensitive

Chronic: anemia

Chest x-ray with hilar LAD

22
Q

Describe the treatment for histoplasmosis

A

Oral itraconazole BID weeks to months depending on severity

IV amphotericin B for severe illness with CNS involvement

AIDS-related histo: lifelong suppressive therapy with itraconazole PO qd

23
Q

Describe the complications of pulmonary histoplasmosis

A

granulomatous mediastinitis

24
Q

Describe the etiology of pneumocystosis

A

Pneumocystis jirovecii (worldwide distribution w/ airborne transmission)

Opportunistic: occurs in 80% of pts with AIDS who are not receiving prophylaxis

Most kids exposed by age 4 (asymptomatic - latent)

25
Q

Describe the clinical presentation of pneumocystosis in pts with HIV

A

subacute onset over weeks, pneumonia sxs with progressively worsening dyspnea, tachypnea, cough, fever, chills, weakness, fatigue

26
Q

Describe the clinical presentation of pneumocystosis in pts without HIV

A

more acute onset & fulminant resp failure, abrupt tachypnea, dyspnea, fever, cough

27
Q

Describe the diagnostic testing for pneumocystosis

A

CXR: normal or diffuse interstitial infiltrates

Cannot be cultured

Can diagnose via stains or PCR on resp specimens

28
Q

Describe the treatment for pneumocystosis

A

PO TMP-SMX (Bactrim) QID-QID

Add prednisone for moderate to severe disease

29
Q

Describe the prognosis for pneumocystosis

A

100% fatality in immunodeficient pts if tx is not early

30% recurrence in pts with AIDS who don’t receive prophylaxis

30
Q

Describe the etiology of blastomycosis

A

Blastomyces dermatitidis

Inhaling spores through outdoor activities, occupational exposure

Affects immunocompetent individuals most commonly as a chronic pulmonary infection

Dissemination: skin, bones, urogenital system

31
Q

Describe the clinical presentation of blastomycosis

A

Cough, fever, dyspnea, chest pain, purulent cough, weight loss, extreme exhaustion, ARDS

32
Q

Describe the diagnostic testing for blastomycosis

A

grows on culture

33
Q

Describe the treatment for blastomycosis

A

Itraconazole PO 6-12 mos

IV amphotericin B for severe disease, CNS involvement, or tx failure

34
Q

Describe the etiology of coccidioidomycosis

A

2 species of coccidioides

Inhalation of spores from dry soil (SW US, central america, south america)

Aka Valley Fever

35
Q

Describe the clinical presentation of coccidioidomycosis

A

Erythema nodosum, flu like symptoms (malaise, fever, arthralgia, HA, cough)

Can disseminate to CNS, bones, skin

36
Q

Describe the diagnostic testing for coccidioidomycosis

A

CXR findings vary

Serologic testing

37
Q

Describe the treatment for coccidioidomycosis

A

Itraconazole QD-BID 6mos+

IV amphotericin B or fluconazole for severe/meningitis

38
Q

Describe the complications of coccidioidomycosis

A

high mortality if it disseminates (especially to the CNS)

39
Q

Describe the structure of fungi

A
  • polysaccharide coating (india ink stain test)
  • cell wall with carbs & proteins
  • 2 layer membranes (ergesterol in fungi, cholesterol in human cells) - target for meds
40
Q

Describe some common superficial fungal infections

A

affect only the top layer of skin
- tinea/pityriasis versicolor
- typically diagnosed with KOH
- typically treated with topicals

41
Q

Describe some cutaneous fungal infections

A
  • can be 30+ species
  • fungi secrete keratinase (scaling, brittling, loss of hair)
  • tinea corporis, cruris, pedis, capitis, unguium
  • diagnosed with KOH or culture
  • treated with -azoles, griseofluvin, terbinafine

EENT/ID (15 decks)

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