Fingal & Viral Infections Flashcards
How is CMV pneumonia best diagnosed? How about in lung transplants?
Usually, diagnosed by identifying CMV inclusion cells from BAL or lung biopsy. In lung transplants, PCR from BAL is acceptable.
How does aspergillus lung disease present in:
- Normal lungs?
- Cavitary lung lesions?
- Chronic lung dz or mild immunosuppression?
- Immunocompromised?
- Asthma
- Normal = no sequelae
- Cavitary = aspergilloma
- Chronic lung dz / mild immunosupp = Chronic necrotizing aspergillosis
- Immunocompromised = invasive pulmonary aspergillosis
- Asthma = ABPA
What are symptoms of invasive pulmonary aspergillosis?
- fever, cough, sputum, dyspnea
- vascular invasion: hemoptysis, pleurisy, infarcts
- hematogenous spread to brain
What is a typical CT finding for invasive pulmonary aspergillosis?
Halo sign, air-crescent sign (aspergilloma), multiple nodules
What is the treatment for invasive pulmonary aspergillosis?
Voriconazole
What is the prophylaxis against invasive pulmonary aspergillosis? Who needs it?
- Posaconazole.
- AML, MDS, GVHD
Patient has chronic lung disease or mild immunosuppression, and CAP that “just won’t go away”. What do they have?
Chronic necrotizing pulmonary aspergillosis.
What are the treatment options for chronic necrotizing pulmonary aspergillosis?
Voriconazole, amphotericin B, itraconazole, caspofungin.
What is the typical imaging finding of an aspergilloma?
Fungus ball that moves w/in a cavity
What are the treatment options for aspergilloma?
- Asymptomatic: observation
- Itraconazole (60% effective)
- Surgical resection
- Bronchial artery embolization if hemoptysis
What underlying diseases are required to have ABPA?
Asthma or CF
What is the treatment of ABPA?
Steroids, +/- itraconazole
What is the diagnosis for ABPA?
Hint: Major/minor diagnostic criteria
- Must have asthma or CF
- Major criteria (must have both)
- IgE > 1,000
- Aspergillus skin test or Anti-Fumagitus IgE - Minor criteria (2 of 3)
- Fumigatus IgE
- Radiographic pulmonary opacities
- Eosinophils >500
Where is blastomycosis found?
Mississippi valley, eastern US
What is the first and second most common symptom of blastomycosis?
1st: recurrent pneumonia
2nd: skin lesion (verrucous, ulcerative)
How is blastomycosis diagnosed?
Antigen detection from urine, serum, or BAL.
False positive with histo or other fungi
Dogs can get what pulmonary pathogen and share with humans?
Blastomycosis
What does blastomycosis look like on microscopy?
broad-based budding
What is the treatment of blastomycosis?
- Severe: amphotericin B for 1-2 weeks, then itraconazole
- Mild-moderate: itraconazole for 6-12 months
- CNS Dz: Amphotericin B
- Pregnant: Amphotericin B (avoid azoles)
What Candida species is usually resistant to antifungals?
Candida Glabrata
What Candida species is usually catheter related?
Candida Parapsilosis
What Candida species is seen in neutropenics & what is the resistance pattern?
Candida Krusei.
Intrinsic azole resistance, but also resistant to Amphotericin B.
What is the treatment for systemic candida infections in general?
Echinocandins first, the ntransition to azoles if susceptible. Treat for 2 weeks.
-Remove catheters.
What are the skin manifestations of coccidiomycosis?
Erythema Nodosum
How is coccidiomycosis diagnosed?
Antibody ELISA testing, or culture
What is treatment for coccidiomycosis?
If immunocompetent, observe for first 6 weeks.
If immunocompromised, use fluconazole or amphotericin B.
What body systems to cryptococcus infect?
Lungs & CNS
What is the treatment of cryptococcus neoformans infections?
If pneumonia, fluconazole.
If CNS infection, flucytosine + amphotericin B
Where is histoplasmosis found? What is the reservoir?
Soil, bird/bat droppings in eastern US (Indiana)
What fungal infections can be PET (+) on imaging?
Histoplasmosis
HIV (+) patients get what advanced disease from histoplasmosis?
Broncholithiasis, fibrosis mediastinitis, dissiminated histo.
What is the treatment for histoplasmosis?
Mild or chronic: observation
Moderate: Itraconazole
Severe: Amphotericin B
What are the imaging findings of mucormycosis pneumonia?
multiple pulmonary nodules, pleural effusion
vs invasive pulmonary aspergillosis, which does nto have effusion
What is the histology of mucormycosis?
filamentous, ribbon, pauci-septated hypae, branching at 90 degrees
what is gold standard for diagnosis of mucormycosis?
culture
What is treatment for mucormycosis?
- Amphotericin B is first line. Posaconazole and isovuconazole also approved.
- Combo of antifungals, surgical resection/debridement, immune reconstitution
- Stop deferoxamine, it is siderophore for mucor.
Does HIV (+) or (-) patients have more acute PJP?
HIV negative have more severe disease.
What is treatment for PJP pneumonia?
3 weeks of bactrim
-Add steroids if A-a > 35.
What is morphology of aspergillus?
Acute, branching hyphae
