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Respiratory > EXAM #2: PULMONARY FUNGAL INFECTIONS > Flashcards

EXAM #2: PULMONARY FUNGAL INFECTIONS Flashcards

1
Q

What is the most common endemic fungal infection in the US?

A

Histoplasmosis

*Along the Ohio/Mississippi rivers

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2
Q

What activities are Histplasmosis associated with?

A

1) Cave exploring
2) Excavation
3) Construction
4) Demolition

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3
Q

What type of organism is histoplasmosis?

A

Dimorphic fungus

Mold in the cold and a yeast in the heat

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4
Q

What cells does histoplasmosis infect?

A

Macrophages (alveolar)

*Mycelial infects and then yeast conversion occurs in the macrophage

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5
Q

Where does Histoplasmosis “live?”

A
  • Soil

- Bird and bat droppings

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6
Q

How is histoplasmosis transmitted?

A

Inhalation

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7
Q

Describe the clinical course of histoplasmosis.

A

1) Inhalation and phagocytosis of histoplasma in alveolar macrophages
2) Hematogenous dissemination
3) Cell-mediated containment

*Infection is typically asymptomatic and causes granulomas i.e. residual nodules in the lung and spleen.

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8
Q

In symptomatic cases of histoplasmosis, what do patients complain of?

A

Subacute non-specific respiratory symptoms, often cough or flu-like sx.

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9
Q

What are the physical exam findings associated with histoplasmosis?

A

Rales and possible consolidation

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10
Q

What are the CXR findings associated with histoplasmosis?

A
  • Hilar and mediastinal lymphadenopathy

- Calcified granulomas

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11
Q

What disease must you differentiate between prior to treatment of histoplasmosis?

A

Sarcoidosis

If you give a patient with histoplasmosis (not sarcoidosis) high dose steroids, you may kill them

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12
Q

In what patient populations is chronic pulmonary histoplasmosis most common?

A

Patients with underlying COPD

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13
Q

What are some of the clinical syndromes associated with histoplasmosis?

A

1) Broncholithiasis
2) Mediastinal granuloma
3) Fibrosing mediastinitis (precipitates SVC syndrome)
4) Pericarditis
5) RA

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14
Q

What skin findings are associated with histoplasmosis?

A

1) Erythema nodosum

2) Erythema multiforme

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15
Q

How is histoplasmosis diagnosed?

A

1) Antigen detection from blood, urine, or BAL fluid
2) Serology w/
- Complement fixation
- Immunodiffusion

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16
Q

How does the treatment plan for moderate to severe histoplasmosis differ from mild-moderate?

A

Moderate- severe:

1) Amphotericin B (2 weeks) followed by
2) Itraconazole

Mild-moderate:
- Itraconazole only

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17
Q

What type of organism is Coccdioides?

A

Dimorphic fungus

*Mold in the cold, yeast in the heat

18
Q

What are the two organisms that fall under the label of coccidioides? Where are these species endemic?

A
  • C. immitis= CA

- C. posadasii= other SW states

19
Q

Describe the morphological features of coccidioides outside the body, and inside the body.

A

Outside= barrel-shaped arthroconidia

Inside= large spherule containing endospores

20
Q

How is Coccidioides transmitted?

A

Inhalation of spores from dust exposure

*Think archaeological excavation and desert military maneuvers

21
Q

What is the most typical clinically significant manifestation of coccidioides called?

A

San Joaquin Valley Fever w/

  • Pneumonia
  • Fatigue
  • Arthralgias
22
Q

What is the primary manifestation of pulmonary coccidioides?

A

Community acquired pneumonia with erythema nodosum and erythema multiforme

23
Q

What organs/systems can disseminated coccidioides affect?

A

1) Skin or subcutaneous soft tissue
2) Meninges
3) Skeleton

24
Q

How is coccidioides diagnosed?

A

Serological testing w/

  • Immunodiffusion
  • Precipitin antibodies
  • Complement fixation
  • ELISA
25
Q

What types of coccidioides infection requires treatment? How is it treated?

A

1) Infections not affecting the CNS= itraconazole

2) Reticulonodular pneumonia or CNS manfiestations= amphotericin B

26
Q

What organism causes Blastomycosis?

A

Blastomyces dermatitidis

*Again, dimorphic fungi i.e. mold in the cold and a yeast in the heat

27
Q

What is the mnemonic to remember how Blastomycosis appears on wet smear?

A

Broad-based-budding

28
Q

How is Blastomycosis transmitted?

A

Inhalation of spores from moist soil

29
Q

Where is Blastomycosis endemic?

A
  • Southeastern and south-central states that border the Mississippi and Ohio River basins
  • Great Lakes
  • Small portion of New York and Canada
30
Q

What is Blastomycosis associated with?

A

Wooded areas and soil with decaying vegetation

31
Q

What is the mnemonic to remember the organs/ systems involved in Blatomycosis infection?

A

BLAS

  • Bone
  • Lung (pneumonia)
  • And Skin
32
Q

How are the cutaneous lesions associated with Blastomycosis described?

A

Verrucous lesion with irregular borders

M*may mimic squamous cell carcinoma.

33
Q

How does Blastomycosis treatment differ from Histoplasmosis?

A

Most patients with Blastomycosis require treatment

34
Q

How is Blastomycosis treated?

A

1) Amphotericin B

2) Itraconazole

35
Q

What type of organism is Pneumocystis jirovecii?

A

Pneumocystis jirovecii is an opportunistic fungi

36
Q

What patient population is classically associated with Pneumocystis pneumonia (PCP)?

A

HIV+ with CD4 counts under 200

37
Q

How is PCP diagnosed?

A

Silver stain of:

  • Induced sputum
  • Bronchoalveolar lavage
  • Lung biopsy
38
Q

Describe the appearance of PCP on CXR.

A

Diffuse, bilateral infiltrates extending from the perihilar region described as “ground-glass.”

Ground glass appearance is also seen on CT scan

39
Q

How is PCP treated?

A

TMP-SMX

*Maybe with inhaled Pentmadine

40
Q

What are alternative medications to TMP-SMX for PCP treatment?

A
  • Dapsone

- Atovaquone

Respiratory (35 decks)

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