ENT Fungal Infections Flashcards
Describe the etiology/RF of candidiasis
candida albicans, opportunistic, found in mouth, vagina, feces
RF immunosuppression, hormonal fluctuation, augmentin
Describe the etiology of mucous candidiasis
- oral (thrush)
- angular cheilitis
- esophagitis (AIDS defining disease)
- vaginitis
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
Describe the clinical presentation of candida esophagitis
- substernal odynophagia
- gastroesophageal reflux
- nausea
- fever
- oral involvement
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
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
Describe the treatment for oral candidiasis
Mild: clotrimazole troche, nystatin suspension
Mod-Severe: Fluconazole
Describe the treatment for vaginal candidiasis
miconazole 2% cream, Clotrimazole 1-2% cream, Terconazole cream/suppository, Fluconazole PO
Describe the treatment for candida esophagitis
Fluconazole PO, Itraconazole PO tablet/solution
Describe the treatment for invasive candidiasis
refer to ID for echinocandins
What is the most common opportunistic infection in HIV
oral candidiasis
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
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
Describe the clinical presentation of cryptococcal meningitis
insidious onset, headache (1st sx), progressive confusion, AMS, fever, seizure, stiff neck, photophobia
Describe the clinical presentation of pulmonary cryptococcosis
may be asymptomatic, simple nodules, cough, dyspnea, hemoptysis, fever, respiratory issues
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
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
