Funal Diseases

Question 1

Are fungal diseases restrictive or obstructive?

Answer 1

restrictive

Question 2

What anatomical alterations occur with fungal infections?

Answer 2

alveolar consolidation
alveolar capillary destruction
formation of cavities and caseous tubercles
fibrosis of the lung parenchyma w/ secondary calcification
increased broncial airway secrections

Question 3

When spores are inhaled they reach the lungs and ______, producing a frothy yeast-like substance that leads to ___________ response.

Answer 3

germinate; inflammatory response

Question 4

Anatomical changes in severe fungal infection mostly commonly involve which lung segments?

Answer 4

apical and posterior segments

Question 5

T/F Humans have a relatively high resistance to fungal infections

Answer 5

true

Question 6

What is the most common fungal infection in the U.S.?

Answer 6

histoplasmosis

Question 7

Ohio Valley Fever is also known as

Answer 7

histoplasmosis

Question 8

H cpsulatum is commonly found in what type of soil?

Answer 8

soil enriched with bird droppings

Question 9

T/F Birds carry histoplasmosis

Answer 9

false. (however bats DO carry the spore)

Question 10

The incubation period for histoplasmosis is

Answer 10

about 17 days

Question 11

Only ____% of those infected demonstrate symptoms and only ___% are ill enough to seek medical treatment

Answer 11

40% develop symptoms; 10% are severe enough to seek medical attention

Question 12

What factors effect the patient response to the infection?

Answer 12

The individual’s immune system, the exposure (concentration, time exposed, # of spores inhaled)

Question 13

The most common form of Ohio Valley Fever is

Answer 13

asymptomatic primary histoplasmosis

Question 14

Signs and symptoms of asymptomatic primary histoplasmosis

Answer 14

no signs and symptoms

residual sign of infection may be seen as small healed lesion of the lung parenchyma and/or calcified hilar lymph nodes

Question 15

Signs and symptoms of acute symptomatic histoplasmosis infection

Answer 15

MILD/SEVERE CASES- fever, muscle and joint pain, chills, sweats, headache, dry hacking cough, chest pain, weight loss

Question 16

Severe actue histoplasmosis pulmonary is also called _____________

Answer 16

spelunker’s lung - acquired from excessive exposure to bat guano it is a serious and potential life threatening condition

Question 17

Chronic pulmonary histoplasmosis is characterized by _____________ and is often self limiting (reaching an equilibrium)

Answer 17

cavity formation in the upper lobes;

Question 18

What patient population is most likely to suffer from chronic pulmonary histoplasmosis?

Answer 18

middle aged men who smoke and/or those who already have comorbidity of emphysema or COPD

Question 19

Disseminated histoplasmosis primarily affects what patient population?

Answer 19

very young or very old patients with compromised immune systems

Question 20

T/F If untreated, disseminated histoplasmosis is usually fatal

Answer 20

true

Question 21

The gold standard test for detecting histoplasmosis is _____

Answer 21

fungal culture

Question 22

T/F Fungal culture is the test of choice to diagnose disseminated histoplasmosis

Answer 22

FALSE. Test takes 4 weeks or longer for fungus to grow and could cause fatal treatment delays-
also requires invasive procedure to obtain sample from lymph node, lung or bone marrow

Question 23

What are advantages and disadvantages of fungal stain for diagnostic testing?

Answer 23

advantage: 100% accurate

disadvanges- requires invasive procedure such as bronchoscopy for sputum or invasive tissue sampling

Question 24

What are the advantages/disadvantages of serology testing?

Answer 24

advantage- blood sample easy to obtain, test for antigen/antibody reaction are relatively fast and fairly accuracte
disadvantage- false negatives may occur in people who have compromised immune systems or who are infectived with other types of fungi

Question 25

What organism causes Valley Fever?

Answer 25

coccidioidomycosis

Question 26

Coccidioides immitis are _____ shaped fungi that are spread how?

Answer 26

sphere shaped; | carried by windborne dust particles

Question 27

Coccidiodomycosis is also known as

Answer 27

California Disease, Desert Fever, San Joaquin Valley Disease, Valley Fever

Question 28

T/F The fungus coccidioidomycosis is found in soils, plants, mammals, birds, reptiles and amphipians

Answer 28

true

Question 29

When C. immitis spores are inhaled they germinate in the lungs and form ____

Answer 29

thin-walled cells called spherules. The spherules produce endospores that make more spherules

Question 30

What ____ % of patients infected with coccidioidomycosis produce clinical symptoms? What are the s/s?

Answer 30

40% | coldlike symptoms such as fever, cough chest pain, headache and malaise

Question 31

One in ____ cases of coccidioidomycosis will not resolve and progresses to a chronic state

Answer 31

1 in 200

Question 32

The chronic progressive state of c. immitis is characterized by nodular growths called ___ and formation of what in the lungs?

Answer 32

fungomas; | cavities

Question 33

Disseminated coccidioidomycosis occurs in about ________

Answer 33

1 in 6000 exposed persons

Question 34

What are some of the characteristics of disseminated coccidioidomycosis

Answer 34

``` involvement of the lymph nodes, meninges, spleen, liver, kidney, skin, and adrenals Skin lesions (bumbs on face and chest) are commonly accompanied by arthralgia or arthritis in the knees and ankles (desert rheumatism) ```

Question 35

If untreated, disseminated coccidioidomycosis can lead to what?

Answer 35

meningitis and death

Question 36

Chicago disease aka Gilchrist's disease is also called ____ and caused by ____

Answer 36

blastomycosis caused by blastomyces dermatitidis

Question 37

Blastomycosis inhabits areas high in ____

Answer 37

organic matter (forest soil, decaying wood, animal manure, abandoned buildings

Question 38

Blastomycosis is most common among what patient population?

Answer 38

pregnant women and middle aged african american men (also found in dogs, cats and horses)

Question 39

How does blastomycosis differ from histoplasmosis in clinical presentation?

Answer 39

blastomycosis requently results in productive cough with purulent sputum

Question 40

What are the first signs of blastomycosis infection?

Answer 40

subcutaneous nodules and skin lesions

Question 41

T/F Actute pulmonary blastomycosis may be self- limiting or progressive

Answer 41

true

Question 42

Progressive blastomycosis - clinical progression

Answer 42

nodules and abscesses develop in the lungs. Extrapulmonarye lesions involve skin, bones, reproductive tract, spleen liver kidney or prostate (skin lesions / subcutaneous nodes may be first signs of disease)

Question 43

T/F Standardized testing procedures for blastomycosis include cultures and skin tests

Answer 43

False- there are no standardized tests however cultures can be performed The diagnosis is made from direct visualization of the yeast in sputum smears

Question 44

Name 3 opportunistic yeast pathogens

Answer 44

candida albicans, cryptococcus neoformans aspergillus

Question 45

Cryptococcus neoformans proliferates in the high nitrogen content of pigeon droppings and is proliferated _____

Answer 45

dried droppings scatter in the air and in dust

Question 46

Which patient populations are most likely to be infected with cryptococcus neoformans?

Answer 46

patients with HIV and those undergoing steroid therapy

Question 47

What is the most pervasive of all fungi?

Answer 47

aspergillus fumigatus

Question 48

What population is at a higher risk of being infected with aspergillus fumigatus?

Answer 48

persons breathing the air of granaries, barns, and silos

Question 49

General management of fungal disease (drug therapy)?

Answer 49

IV amphotericin B (Fungizone);ketoconazole, fluconazole,itraconazole and echinocandins

Question 50

What are the RT care treatment protocols for fungal infections?

Answer 50

O2 therapy to treat hypoxemia and decrease WOB and myocardial work AND bronchopulmonary hygiene therapy to enhance mobilizxation of secretions

Question 51

What is the most common fungal infection in the US?

Answer 51

histoplasmosis

Question 52

``` Incidence of Histoplasmosis is especially high in which of the following areas? 1 Arizona 2 Mississippi 3 Nevada 4 Texas ```

Answer 52

MISSISSIPPI only

Question 53

Desert bumps, desert arthritis is associated with wich fungal disorder?

Answer 53

coccidioidomycosis

Question 54

Which of the following forms of histoplasmosis is characterized by healed lesions in the hilar lymph nodes as well as a positive skin test response? a. disseminated infection b. latent asymptomatic disease c. chronic histoplasmosis d. self limiting primary disease

Answer 54

b- latent asymptomatic disease