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Clinical Medicine II > Fungal and Parasitic Infections > Flashcards

Fungal and Parasitic Infections Flashcards

1
Q

T of F

Fungal infections are hard to treat?

A
  • True
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2
Q

What are the three types of fungal infections?

A

1) Superficial
2) Systemic
3) Opportunistic

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3
Q

T of F

Candidiasis can causes both Superficial and Systemic infections?

A
  • True

- Both Superficial and Systemic

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4
Q

What are some examples of Superficial Candidiasis infections?

A
  • Candidal Dermatitis
  • Candidal Folliculitis
  • Mucosal Cadidiasis
  • Vaginal Candidiasis
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5
Q

What are some examples of systemic Candidiasis infections?

A
  • Candidemia
  • Endocarditis
  • UTI
  • Osteoarticular infections
  • Meningitis
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6
Q

Most common pathogenic Candida species?

A
  • Candida Albicans
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7
Q

Mucosal Candidiasis is also know as?

A
  • Thrush
  • White plaques (Can be scraped off)
  • Esophageal Candidiasis S&S resemble GERD
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8
Q

Treatment for Thrush?

A

PO Antifungals

  • Nystatin
  • Fluconazole
  • Itraconazole
  • Amphotericin B for recurrent infections
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9
Q

Vulvovaginal Candidiasis prevalence and risk factors?

A
  • High prevalence
- RF 
Infants
Elderly 
Prego
Corticosteroids 
Antibiotics

Uncontrolled DM & HIV

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10
Q

Vulvovaginal Candidiasis S&S?

A
  • Pruritus
  • Vaginal burning
  • Pain with intercourse
  • White cottage cheese appearing discharge
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11
Q

Vulvovaginal Candidiasis treatment?

A
  • Topical Azoles
  • Fluconazole
    Diflucan
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12
Q

Invasive Candidiasis systemic risk factors include?

A
  • Neutropenia
  • Cancer chemotherapy
  • Steroids
  • Broad spectrum antibiotics
  • Uncontrolled DM & HIV
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13
Q

Dx of Invasive Candidiasis?

A
  • Blood cultures
  • Tissue site culture
- Cell count +
Sterile fluid (CSF, joint fluid)
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14
Q

Treatment of Invasive Candidiasis?

A
  • Systemic antifungals (Azoles, AMP B)
  • May require surgery for
  • Osteomyelitis
  • Septic arthritis
  • Endocarditis
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15
Q

T or F

You need a high index of suspicion to Dx systemic Candidiasis?

A
  • True
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16
Q

What is the most common endemic mycosis in the US and what part of the US?

A
  • Histoplasmosis

- Midwest (Ohio, Kansas, N/S Dakota, Michigan etc..)

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17
Q

Where is Histoplasmosis usually found in?

A
  • Fungus in Soil, Bird or Bat droppings
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18
Q

How is histoplasmosis transmitted?

A
  • Respiratory inhalation

- T Cell mediated defense

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19
Q

True of False

Pt’s with Histoplasmosis are usually asymptomatic if
they have an intact immune system?

A
  • True

- But ImmunoComp pt’s might develop S&S weeks later also (Higher Risk)

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20
Q

Histoplasmosis S&S ?

A
  • Fever
  • Chills
  • Fatigue
  • Nonproductive cough
  • Myalgia
  • Patchy lobar or multilobar nodular infiltrate on CXR
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21
Q

What is the hallmark sign for Histoplasmosis ?

A
  • Enlarged Hilar or Mediastinal lymph nodes

- Strongly consider histoplasmosis

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22
Q

When dose Progressive Histoplasmosis occur?

A
  • Immunosuppressed Pt’s
  • AIDS CD4 < 150
  • Infants
  • Organ transplant
  • Long-term steroids
  • Hematologic malignancy
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23
Q

Symptoms of Progressive Disseminated Histoplasmosis ?

A
  • Fever
  • Dyspnea
  • Cough
  • Weight loss
  • Oral Ulcers
  • Pharynx
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24
Q

Signs of Progressive Disseminated Histoplasmosis ?

A

Signs similar to other causes of Sepsis

  • Hypotension
  • Acute respiratory failure
  • Pancytopenia
  • Diffuse infiltrates on CXR/CT
  • Disseminated intravascular coagulation
  • Multi-organ failure
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25
Q

Most definitive Dx method of Histoplasmosis which is used as a back up?

A
  • Culture of sputum / Fluid

- But Takes to LONG

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26
Q

Most common fastest method to Dx Acute Histoplasmosis?

A
  • Tissue biopsy

- Methenamine Silver
Special stain

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27
Q

Most common fastest method to Dx Dessiminated Histoplasmosis?

A
  • Bone marrow, Liver, Skin lesion Bx or Smear

– Methenamine Silver
(Special stain)

  • Look for Yeast/Buds
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28
Q

Histoplasmosis treatment for pulmonary disease > 4 weeks duration:

A

Mild/moderate
- Itraconazole
(Check serum levels after 2 weeks!)

Severe
- Amphotericin B + Itraconazole

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29
Q

Histoplasmosis treatment for Chronic disease?

A
  • Itraconazole

12-24 months

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30
Q

Histoplasmosis treatment for Disseminated disease ?

A

Mild/moderate
- Iitraconazole
12 months

Severe
- Amphotericin B
Until response 
3 weeks 
\+
- Itraconazole 
12 months

For AIDS patients, must have 12 months therapy, be on antiretroviral therapy, CD4 >150

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31
Q

Histoplasmosis treatment for Disseminated disease for Aids pt’s?

A 
Severe
- Amphotericin B
Until response 
3 weeks 
\+
- Itraconazole 
12 months
\+
Antiretroviral

CD4 > 150

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32
Q

T or F

You can add Methylprednisolone if a Histoplasmosis pt is in respiratory distress?

A
  • True
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33
Q

How to Immuno comp pt’s avoid histoplasmosis?

A
  • No demolition areas
  • No Spelunking (Cave Diving)
  • No Cleaning of farm buildings
  • No cleaning of Attics
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34
Q

The only indication for Prophylaxis Tx of Histoplasmosis is in what immuno comp pt?

A
  • AIDS Pts
  • CD4 < 150
  • Midwest high endemic areas
  • Itraconazole daily
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35
Q

T of F

Acute pulmonary histoplasmosis is self limited, no Tx needed in healthy pts?

A
  • True
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36
Q

T or F

Disseminated histoplasmosis usually responds quickly to anti-fungals, even in pts with AIDS unless diagnosis is delayed?

A
  • True
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37
Q

T of F

When antifungals must be used, usually patients respond quickly?

A
  • True
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38
Q

Where is the opportunistic fungus Crytococcus usually found?

A
  • Encapsulated budding yeast

- Soil w/ pigeon dung

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39
Q

What is the most common opportunistic Crytococcus fungus that affects humans?

A
  • Cryptococcus Neoformans
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40
Q

How is Cryptococcus Neoformans transmitted?

A
  • Inhalation

- Causes diseases in Immuno Comp Pt’s

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41
Q

Cryptococcus Neoformans can develop in pt’s with NON HIV ?

A

1 COPD

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42
Q

Who can contract Cryptococcal Neoformans in the CNS?

A
  • Aids Pts CD4 < 50
  • HA
  • Meningealoencephalitis
  • Nuchal Rigidity
  • Lethargy
  • Confusion
  • Fever 50% of Pt’s
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43
Q

What are the different stains that can be used for Cryptococcus Neoformans?

A
  • Mucicarmine Stain (Most Common)
  • GMS Stain
  • PAS Stain
  • Gram Stain
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44
Q

What is the most important defense against a Cryptococcus infection?

A
  • T Cell Immunity
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45
Q

Where does Cryptococcus infection start ?

A
  • Lungs
  • Fever
  • Cough
  • Dyspnea
  • CXR = Pleural based nodular lesion
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46
Q

In disseminated disease, Cryptococcus tends to infect most organs what are they?

A
  • Skin lesions: Acneiform rash / nodules / ulcers / plaques
  • Prostate
  • Genitourinary tract
  • Breasts
  • Eyes
  • Larynx
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47
Q

T of F

Cryptococcus is an Opportunistic infection?

A
  • True
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48
Q

What is the gold standard to Dx Cryptococcus?

A
  • Culture
  • CSF
  • Blood
  • Skin Lesion
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49
Q

What does the CSF of a pt with Cryptococcus usually show?

A
  • High WBC
  • High lymphocytes
  • High protein
  • Low glucose
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50
Q

T of F

PT with AIDS, CSF may be normal in a Cryptococcus infection because CD4 T cells are low already

A
  • True

- Low lymphocytes as is

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51
Q

Treatment of Mild, isolated pulmonary Cryptococcus infection?

A
  • Oral fluconazole
  • 400mg daily
  • 6-12 months
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52
Q

Treatment of severe Cryptococcus infection in Aids Pt?

A 
Amphotericin B 
\+
Flucytosine PO
2 to 4 weeks
                                                               Followed by

Fluconazole PO
400mg daily
8 weeks
Followed by
Suppressive Fluconazole
200mg daily
6 to 12 months

53
Q

T of F

Prognosis of death in disseminated Cryptococcus is high in the US ?

A
  • True

- 10%

54
Q

Africa mortality rate is 100% with Cryptococcal + Aids?

T of F

A
  • True
  • Even with the cure
  • Permanent Neurological damage
55
Q

What is the primary prophylaxsis in pts with HIV and CD4 < 200

A
  • Fluconazole
    200mg
    3x week
56
Q

What is important before you lower the dose in the treatment of severe Cryptococcus infection in Aids Pt’s?

A
  • Make sure CD4 count is high before lowering to the suppressive dose of Fluconazole
57
Q

What is the first and MOST dangerous opportunistic infection described in AIDS?

A
  • Pneumocystis

- Fungus, Infects through inhalation (Person to Person, Environment)

58
Q

Most cases of Pneumocystis occur in patients who are either:

A
  • Not on ART
  • Don’t take their PCP prophylaxis
  • Unaware of HIV status
59
Q

What cells are critical in defending from Pneumocystis ?

A
  • CD4 T Lymphocytes
60
Q

What are the symptoms of Pnemocystis?

A
  • Fever
  • Nonproductive cough
  • Dyspnea on exertion

(LESS pleuritic chest pain & purulent sputum than in bacterial pneumonia)

61
Q

T or F

In Pnemocystis pt has LESS pleuritic chest pain & purulent sputum than in bacterial pneumonia

A
  • True
62
Q

Labs for Pneumocystis often show?

A
  • CD4 < 200

- High LDH Lactate dehydrogenase

63
Q

What are classic CXR signs in Pneumocysitis?

A
  • Bilateral reticular or granular infiltrates
  • Start in perihilar region
  • Extend toward periphery as disease progresses.

Usually bilateral

  • Pneumatoceles
    (thin-walled cysts)
  • Pneumothoraces
64
Q

If CXR is normal but still suspect Pneumocystis what is the next test to order?

A
  • CT (Can catch what CXR misses)
  • If Normal CT
  • No PCP
65
Q

How do you test for Pneumocysitis?

A

1 Staining induced sputum

#3 Proceed to do a Bronchoscopy with bronchoalveolar lavage 
>90% sensitivity
66
Q

T or F

You can repeat the staining of the induced sputum in a pt with possible Pnumocysitis?

A
  • False

- Instead do a Bronchoscopy with bronchoalveolar lavage (>90% sensitivity)

67
Q

What is the treatment of Pneumocysitis?

A
  • Trimethoprim sulfamethoxazole (Bactrim)

If severe disease
- 21 days of IV therapy followed by orals

68
Q

What are some side effects of Trimethoprim sulfamethoxazole (Bactrim) in HIV pt while treating Pneumocysitis ?

A
  • Rash
  • Nausea
  • Vomiting
  • Abnormal liver values
  • Hyperkalemia
  • Fever
  • Myelosuppression
69
Q

What are the alternative tx drugs if pt can not take Trimethoprim-sulfamethoxazole (TMP - SMX) ?

A
  • IV Pentamidine
  • Clindamycin PLUS primaquine
  • Trimethoprim PLUS dapsone
  • Atovaquone
70
Q

Prevention of Pneumocysitis in HIV pt’s consist of?

A
  • TMP-SMX (Bactrim) preferred
  • Primary prophylaxis
  • HIV pt
  • CD4 < 200

OR

  • With oral candidiasis
71
Q

If HIV pt does not tolerate TMP-SMX (Bactrim) for Pneumocysitis what can you use?

A
  • Dapsone
  • Atovaguone
    or
  • Aerosolized pentamidine
72
Q

When can a pt taking prophylaxis for Pneumocysitis stop taking TMP-SMX (Bactrim) ?

A
  • CD4 count > 200

- @ least for 3 months

73
Q

What is the most important parasitic disease in humans?

A
  • Malaria Plasmodium falciparum, vivax
  • Female Anopheles mosquito
  • Dusk and Dawn Bite
74
Q

What population is at poorest outcomes of Malaria?

A
  • Young Children

- Pregnant woman

75
Q

Where does Malaria currently exist?

A
  • Africa
  • Central and South America
  • Asia
76
Q

How many days after the initial bite from a mosquito do you start feeling symptoms?

A
  • Asymptomatic for 12 to 35 days
77
Q

Most common feature of Malaria ?

A
  • Cyclic Fevers

- @ Regular intervals during the day

78
Q

What is a sign of Cerebral Malaria?

A
  • Seizures
79
Q

What are some Non specific symptoms of Malaria?

A

-Tachycardia
- Headache
-Tachypnea
- Cough
- Chills
- Anorexia
- Malaise
-
Nausea/Vomiting/Diarrhea
- Fatigue
- Abdominal pain
- Sweating
- Myalgias / arthralgias

80
Q

How many deaths of Malaria in 2018 ?

A
  • 600K
81
Q

How can you Dx Malaria in a Pt outside the US ?

A
  • Parasite on a peripheral blood smear

- Giemsa or Wright stain

82
Q

Whats the easiest way to Dx Malaria in the US?

A
  • Antigen based tests
83
Q

T or F

PCR in Dx Malaria is routinely done ?

A
  • False

- Highly sensitive but not routinely used

84
Q

T or F

Treatment for Malaria is dependent on where you travel?

A
  • True

- Refer to CDC

85
Q

Most common Chemoprophylaxis for Malaria?

A
  • Chloroquine
86
Q

If there is resistance to Chloroquine in treating Malaria then use?

A
  • Mefloquine
87
Q

T or F

Patients should be diagnosed and started on therapy ASAP and then referred to Infectious Disease specialist when treating Malaria ?

A
  • True
88
Q

What are the three main groups of Helminths that are parasitic in human?

A

1) Flatworms
- Trematodes (Flukes)
- Cestodes (Tapeworms)

2) Ascanthocephalins
3) Roundworms (nematodes)

89
Q

Where are the most serious helminthiasis infections located ?

A
  • Poor Tropical areas

- Subtripical areas

90
Q

Most common Nematode infection?

A
  • Enterobius vermicularis (pinworm)
  • Often Asymptomatic

or

  • Perianal pruritis at night
91
Q

Nematode infections caused by Enterobius vermicularis (pinworm) usually found in ?

A
  • Children
92
Q

How do you Dx Enterobius vermicularis (pinworm)

?

A
  • Cellophane tape

- Find Adult worm and Eggs

93
Q

Treatment of Enterobius vermicularis (pinworm) ?

A
  • Pyrantal pamoate

+

Albendazole or Mebendazole

  • Repeat in 2 weeks
94
Q

Most freq used medication in the US?

A

Pyrantal pamoate

  • Cheap
  • Available otc
  • Efficacy rate is at 100%
  • Helps prevent recurrences
95
Q

Prevention of Enterobius vermicularis (pinworm) ?

A
  • Entire household should be treated
  • Wash all bedding and clothes
  • Stress the importance of frequent hand washing and bathing
96
Q

How do pt gets Cutaneous Larva Migrans?

A
  • Dog or cat hookworm larvae
  • Beach
  • Sandboxes
97
Q

Where is Cutaneous Larva Migrans found?

A
  • Southeastern US

- Children

98
Q

Cutaneous Larva Migrans S&S?

A
  • Pruritic

- Serpiginous track

99
Q

Treatment of Cutaneous Larva Migrans?

A
  • Self limited in 1 to 6 months

- Can not complete life cycle in human

100
Q

Dx of Cutaneous Larva Migrans?

A
  • Clinical
101
Q

What medications can you use to treat Cutaneous Larva Migrans?

A
  • Topical thiabendazole

or

Albendazole

or

Ivermectin

102
Q

Most common helminthic infection world wide ?

A
  • Ascaris lumbricoides
  • Largest intestinal round worm (Nematode)
  • Most Common in Asia (Kids)
  • Not common in US
103
Q

Ascaris lumbricoides transmission?

A
  • Ingestion of water or food contaminated with Ascariasis eggs
  • Uncooked pig or chicken livers with larva
104
Q

Ascaris lumbricoides is usually asymptomatic but in heavy infections may see?

A

2 GI tract with adult worms

#1 Larval migration through lungs 
(occurs prior to GI evidence of disease)
105
Q

Dx of Ascaris lumbricoides in lung disease ?

A
  • Sputum analysis for larva, eosinophils or
  • Charcot-Leyden crystals
  • Infiltrates on XCR
106
Q

Dx of Ascaris lumbricoides GI disease?

A
  • Stool O&P after day 40
107
Q

Dx of Ascaris lumbricoides GI obstruction?

A
  • Ultrasound or ERCP
108
Q

Tx of Ascaris lumbricoides in lung disease ?

A
  • Inhaled bronchodilators
  • Oral steroids
  • Follow up in two months
109
Q

Tx of Ascaris lumbricoides GI disease?

A
  • Albendazole
    400mg PO
    single dose

Alternative: Mebendazole
500mg PO
single dose

or

100mg daily for 3 days

100% cure rate

110
Q

Most commonly diagnosed intestinal parasitic disease in U.S ?

A
  • Giardia protozoan flagellate
111
Q

T or F

50% pt’s asymptomatic
1-2 weeks of illness

A
  • True
112
Q

S&S of Giardia protozoan flagellate?

A
  • Profuse watery diarrhea
  • Stomach cramping
  • N/V
113
Q

Tx of Giardia protozoan flagellate?

A
  • Metronidazole or Tinidazole
114
Q

Dx of Giardia protozoan flagellate?

A
  • Stool ova/parasite testing
115
Q

2nd most common parasite causing diarrheal illness in U.S ?

A
  • Cryptosporidiosis

- Kids

116
Q

Tx of Cryptosporidiosis?

A
  • Most people recover without treatment

- Nitazoxanide

117
Q

Dx of Cryptosporidiosis?

A
  • Stool stain
    or
  • Ab or antigen testing
118
Q

U.S. 3rd most common parasitic infection / 2nd most common cause of diarrhea in travelers returning from endemic areas?

A
  • Amebiasis protozoan Entamoeba histolytica

- Poor sanitation

119
Q

Transmission of Amebiasis protozoan Entamoeba histolytica ?

A
  • Cyst stage
    (Infective stage)
    (Chlorine Resistance)
  • Trophozoite stage (Invasive disease)
120
Q

How does Amebiasis protozoan Entamoeba histolytica enter pt?

A
  • Ingestion of amebic cysts in the form of contaminated food and water
  • Associated with venereal transmission from fecal oral contact
121
Q

T or F

Most Amebiasis protozoan Entamoeba histolytica diseases are asymptomatic and self limiting?

A
  • True
  • 90%
  • 10% invasive disease
122
Q

Factors that influence Amebiasis protozoan Entamoeba histolytica invasive disease include?

A
  • Strain of E. histolytica
  • Genetic susceptibility
  • Age
  • Immune status
123
Q

Complications of Amebiasis protozoan Entamoeba histolytica?

A
  • Appendicitis
  • Bowel perforation
  • Fulminant colitis
  • Massie mucosal sloughing
  • Hemorrhage
  • Toxic megacolon
124
Q

Extra-abdominal complications of Amebiasis protozoan Entamoeba histolytica?

A
  • Liver abscess
  • Thoracic amebiasis
  • Cerebral amebic abscess
125
Q

Amebiasis protozoan Entamoeba histolytica risk factors for severe disease?

A
  • Young age
  • Pregnancy
  • Steroid treatments
  • Malignancy
  • Malnutrition
  • Alcoholism
126
Q

Dx of Amebiasis protozoan Entamoeba histolytica ?

A
  • Stool microscopy
  • Demonstration of cysts and trophozoites in the stool
  • Must check 3 times
127
Q

Tx of Amebiasis protozoan Entamoeba histolytica ?

A
  • Metronidazole
    500-750mg PO
    TID for 7-10 days
  • Tinidazole (Alternative)
    2g PO for three days
128
Q

Prevention of Amebiasis protozoan Entamoeba histolytica ?

A
  • Vaccine development underway
  • Sanitation
  • Clean water
129
Q

Prognosis of Amebiasis protozoan Entamoeba histolytica ?

A
  • Good / no drug resistance, very treatable disease

Clinical Medicine II (9 decks)

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