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ACVIM General - Imp stuff > Fungal > Flashcards

Fungal Flashcards

1
Q

MOA Itraconazole

A

Itraconazole- inhibits lanosterol 14-a-demethylase which interrupts conversion of lanosterol into ergosterol

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2
Q

MOA Terbinafine

A

Terbinafine- squalene epoxidase inhibitor- allows accumulation of squalene prompting ergosterol depletion

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3
Q

Distribution of Histo

A

SW

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4
Q

Mode transmission Histoplasmosis

A

Mode of transmission: inhaled or ingested microconidia by host → replication in ALVEOLAR MACROPHAGES

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5
Q

Dog most common CS Histoplasmosis

A

GI signs seen in 50-60% of cases - most commonly in small/toy breeds
Respiratory signs seen in 10%

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6
Q

CS cat Histo

A

Persians overrepresented
Respiratory signs - 40%
Don’t cough when they have respiratory involvement
Ocular manifestations - 25%
Bone involvement - 20%
FeLV co-infection in up to 28% of cases
Bone marrow involvement
Skin involvement

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7
Q

What does Histo bind to on the host

A

CD11-CD18 integrins on alveolar macrophages → granulomatous inflammatory response in lungs

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8
Q

Common BW changes with Histoplasmosis

A

CBC: reflects presence of systemic inflammation, non-regenerative anemia common, +/- other cytopenias
>75% hypoalbuminemic (mild to severe)
Cats with liver involvement can have elevated ALT and AST

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9
Q

Most common GI CS in dogs with Histo

A

Proctitis

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10
Q

How do you dx Histoplasmosis

A

Organisms occasionally found in blood (20%)
Colonic scrapes can often be diagnostic

Galactomannan test (antigen)
-Similar test to blastomycosis
-*BLASTO AND HISTO CAN CROSS REACT
-Very sensitive (>90%) – urine > serum

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11
Q

Tx of Histo? What if ocular and CNS involvement?

A

Itraconazole - tx of choice
Fluconazole - Excellent for ocular and CNS penetration

Treat for at LEAST 6 months - decision based on lesion resolution, negative antigen test, clinical signs

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12
Q

Distribution Blastomycosis

A

Distribution: Midwest to south central

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13
Q

Whos at high risk for Blasto

A

Young (2-4YO), large breed (>15kg) hunting dogs (Hounds, Labs, Goldens, Pointers), slight male predisposition

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14
Q

Most common CS for blasto

A

Respiratory signs (common - 85%): tachypnea, harsh lung sounds, cough

Ocular manifestations - anterior uveitis common
Granulomas
Draining tracts
Lameness (osteomyelitis)
Neuro signs (uncommon)
Testicular involvement

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15
Q

What’s the main virulence factor associated with Blasto

A

BAD-1: cell surface glycoprotein that binds on cell receptor of macrophage

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16
Q

Most sensitive screening test for Blasto

A

Urine antigen test

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17
Q

Cytology of Blasto

A

Cytology (FNA, impression smears, lung wash, CSF) - YEAST IN HOST

Broad based budding yeast - thick double refractile wall

Pyogranulomatous inflammation - concurrent presence of neutrophils with activated macrophages, lymphocytes, plasma cells

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18
Q

How to diagnose Blasto

A

Galactomannan cell wall antigen test
Some cross reactivity with Histoplasma - need cyto to confirm dx

Tracheobronchial enlargement - 25%
Also see with Valley Fever and Histo

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19
Q

Tx Blasto

A

Itraconazole

Fluconazole and voriconazole - better CNS/ocular than itra
Amphotericin B - warranted if more aggressive/disseminated dz, fail to respond to azoles, do not tolerate azoles

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20
Q

Most common organism for sinonasal Asper? Most common organism for systemic asper?

A

Sinonasal: Aspergillus fumigatus
Systemic: Aspergillus tereus, deflectus

21
Q

Most common type of Asper in cats

A

SINORBITAL

22
Q

What would you find that is unique to Asper on work-up diagnostics

A

Renal changes (only fungal disease that goes to kidney)

23
Q

Findings in radiographs of dogs with Asper

A

Osteolytic lesions, discospondylitis (20-25% of all cases)

24
Q

Test of choice for diagnosis of systemic Asper

A

Aspergillus antigen

25
Test of choice for diagnosis of sinonasal Asper
Galactomannan urine antigen ELISA - Very good sensitivity for disseminated infx
26
What can cause a false positive on the Galactomannan urine antigen ELISA?
False positives: other fungal infx, concurrent plasmalyte and vetivex pHlyte (both serum and urine will have false positive - uses fermentation of sorghum by aspergillum)
27
What antifungal is Asper resistant to
FLUCONAZOLE
28
2 main species of Cryptococcus in SA
C. neoformans → immunocompromised dogs C. gattii → immunocompetent animals (mostly cats)
29
Primary site of infection in dogs and cat with Crypto
: nasal cavity
30
Most common neuro location for Crypto
forebrain
31
Nasal aspergillus tx
topical clotrimazole
32
Most common presentation in dog with Crypto
Neuro signs
33
Describe the cytology of Crypto
Cytology: thick walled organisms - polysaccharide capsule (dont confuse with fat droplets)
34
Gold standard for diagnosis of Crypto
Latex agglutination Crypto GMX No cross reactivity with Histo or Blasto Serum or CSF
35
Tx of Crypto
Fluconazole (excellent eye and CNS penetration) Amphotericin B + 5-flucytosine (most effective but nephrotoxic) 5-flycytosine - contraindicated in dogs Surgical debridement if large granuloma
36
Distribution of Coccidiomycosis
Southwest
37
Clinical signs of Valley Fever
Fever is common (>60%) Respiratory signs Coughing - can be secondary to pericardial thickening, pericardial effusion, tracheobronchial lymphadenopathy, pulmonary infiltrates Testicular abnormalities CNS signs (>50% seizures) Non Healing wound (50% of cats) Hilar lymphadenopathy Ocular (immune mediated uveitis) Bone involvement
38
Almost all infected animals with valley fever have what change on bloodwork
HYPOALBUMINEMIA uncommonly hypercalcemia
39
Most sensitive test for Coccidiomycosis
Antibody serology (IgG and IgM) Most sensitive biomarker (almost 100%)– antibody testing - the one fungal pathogen that this is the choice
40
Unique adverse effect of itraconazole
Unique adverse effect: vasculitis - skin ulcerations/abscesses
41
What anti fungal causes neurotoxicity in cats
voriconszole
42
Medications that affect absorption of azoles (separate them)
PPI, cyclosporine, plavix
43
Which antigunfal is not a cytochrome p450 substrate
Fluconazole 70% excreted in urine
44
MOA azoles
MOA: inhibit fungal ergosterol synthesis Lanosterol 14a-demethylase = cyp450
45
Drug that interact with azoles
Ivermectin, benzodiazepines, cyclosporine, macrolide abx, corticosteroids, amitriptyline, digoxin
46
Which fungal diseases use itraconazole as first option
Histo, blasto
47
What's the first choice tx for Cryptococcosis and coccidiomycosis
Fluconazole
48
MOA terbinafine
**Terbinafine - affects ergosterol synthesis - fungal cell membrane = fungus died - Inhibits squalene epoxide reductase --> builds up in cell - Well tolerated but GI, hepatotoxicity Used in combination therapy for pythium
49

ACVIM General - Imp stuff (11 decks)

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