ENT Fungal Infections Flashcards by Elizabeth Sager

Describe the etiology/RF of candidiasis

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

RF immunosuppression, hormonal fluctuation, augmentin

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Describe the etiology of mucous candidiasis

oral (thrush)
angular cheilitis
esophagitis (AIDS defining disease)
vaginitis

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Describe the etiology/RF for invasive candidiasis

Candida in the bloodstream

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

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Describe the clinical presentation of candida esophagitis

substernal odynophagia
gastroesophageal reflux
nausea
fever
oral involvement

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Describe the clinical presentation of invasive candidiasis

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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Describe the diagnostic testing for candidiasis

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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Describe the treatment for oral candidiasis

Mild: clotrimazole troche, nystatin suspension

Mod-Severe: Fluconazole

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Describe the treatment for vaginal candidiasis

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

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Describe the treatment for candida esophagitis

Fluconazole PO, Itraconazole PO tablet/solution

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Describe the treatment for invasive candidiasis

refer to ID for echinocandins

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What is the most common opportunistic infection in HIV

oral candidiasis

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Describe the etiology/RF of cryptococcosis

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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Describe the clinical presentation of cryptococcosis

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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Describe the clinical presentation of cryptococcal meningitis

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

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Describe the clinical presentation of pulmonary cryptococcosis

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

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Describe the diagnostic testing for cryptococcosis

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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Describe the treatment for cryptococcosis

Consult ID

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

Avoid steroids

Describe the etiology/RF of histoplasmosis

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

Describe the clinical presentation of histoplasmosis

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

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

Describe the clinical presentation of acute pulmonary histoplasmosis

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

Describe the diagnostic testing for histoplasmosis

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

Describe the treatment for histoplasmosis

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

Describe the complications of pulmonary histoplasmosis

granulomatous mediastinitis

Describe the etiology of pneumocystosis

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)

Describe the clinical presentation of pneumocystosis in pts with HIV

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

Describe the clinical presentation of pneumocystosis in pts without HIV

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

Describe the diagnostic testing for pneumocystosis

CXR: normal or diffuse interstitial infiltrates Cannot be cultured Can diagnose via stains or PCR on resp specimens

Describe the treatment for pneumocystosis

PO TMP-SMX (Bactrim) QID-QID Add prednisone for moderate to severe disease

Describe the prognosis for pneumocystosis

100% fatality in immunodeficient pts if tx is not early 30% recurrence in pts with AIDS who don’t receive prophylaxis

Describe the etiology of blastomycosis

Blastomyces dermatitidis Inhaling spores through outdoor activities, occupational exposure Affects immunocompetent individuals most commonly as a chronic pulmonary infection Dissemination: skin, bones, urogenital system

Describe the clinical presentation of blastomycosis

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

Describe the diagnostic testing for blastomycosis

grows on culture

Describe the treatment for blastomycosis

Itraconazole PO 6-12 mos IV amphotericin B for severe disease, CNS involvement, or tx failure

Describe the etiology of coccidioidomycosis

2 species of coccidioides Inhalation of spores from dry soil (SW US, central america, south america) Aka Valley Fever

Describe the clinical presentation of coccidioidomycosis

Erythema nodosum, flu like symptoms (malaise, fever, arthralgia, HA, cough) Can disseminate to CNS, bones, skin

Describe the diagnostic testing for coccidioidomycosis

CXR findings vary Serologic testing

Describe the treatment for coccidioidomycosis

Itraconazole QD-BID 6mos+ IV amphotericin B or fluconazole for severe/meningitis

Describe the complications of coccidioidomycosis

high mortality if it disseminates (especially to the CNS)

Describe the structure of fungi

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

Describe some common superficial fungal infections

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

Describe some cutaneous fungal infections

- 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