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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
Q

Test of choice for diagnosis of sinonasal Asper

A

Galactomannan urine antigen ELISA - Very good sensitivity for disseminated infx

26
Q

What can cause a false positive on the Galactomannan urine antigen ELISA?

A

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
Q

What antifungal is Asper resistant to

A

FLUCONAZOLE

28
Q

2 main species of Cryptococcus in SA

A

C. neoformans → immunocompromised dogs

C. gattii → immunocompetent animals (mostly cats)

29
Q

Primary site of infection in dogs and cat with Crypto

A

: nasal cavity

30
Q

Most common neuro location for Crypto

A

forebrain

31
Q

Nasal aspergillus tx

A

topical clotrimazole

32
Q

Most common presentation in dog with Crypto

A

Neuro signs

33
Q

Describe the cytology of Crypto

A

Cytology: thick walled organisms - polysaccharide capsule (dont confuse with fat droplets)

34
Q

Gold standard for diagnosis of Crypto

A

Latex agglutination Crypto GMX
No cross reactivity with Histo or Blasto
Serum or CSF

35
Q

Tx of Crypto

A

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
Q

Distribution of Coccidiomycosis

A

Southwest

37
Q

Clinical signs of Valley Fever

A

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
Q

Almost all infected animals with valley fever have what change on bloodwork

A

HYPOALBUMINEMIA

uncommonly hypercalcemia

39
Q

Most sensitive test for Coccidiomycosis

A

Antibody serology (IgG and IgM)

Most sensitive biomarker (almost 100%)– antibody testing - the one fungal pathogen that this is the choice

40
Q

Unique adverse effect of itraconazole

A

Unique adverse effect: vasculitis - skin ulcerations/abscesses

41
Q

What anti fungal causes neurotoxicity in cats

A

voriconszole

42
Q

Medications that affect absorption of azoles (separate them)

A

PPI, cyclosporine, plavix

43
Q

Which antigunfal is not a cytochrome p450 substrate

A

Fluconazole
70% excreted in urine

44
Q

MOA azoles

A

MOA: inhibit fungal ergosterol synthesis
Lanosterol 14a-demethylase = cyp450

45
Q

Drug that interact with azoles

A

Ivermectin, benzodiazepines, cyclosporine, macrolide abx, corticosteroids, amitriptyline, digoxin

46
Q

Which fungal diseases use itraconazole as first option

A

Histo, blasto

47
Q

What’s the first choice tx for Cryptococcosis and coccidiomycosis

A

Fluconazole

48
Q

MOA terbinafine

A

**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
Q
A

ACVIM General - Imp stuff (11 decks)

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