Fungal and Parasitic Infections Flashcards
1
Q
T of F
Fungal infections are hard to treat?
A
- True
2
Q
What are the three types of fungal infections?
A
1) Superficial
2) Systemic
3) Opportunistic
3
Q
T of F
Candidiasis can causes both Superficial and Systemic infections?
A
- True
- Both Superficial and Systemic
4
Q
What are some examples of Superficial Candidiasis infections?
A
- Candidal Dermatitis
- Candidal Folliculitis
- Mucosal Cadidiasis
- Vaginal Candidiasis
5
Q
What are some examples of systemic Candidiasis infections?
A
- Candidemia
- Endocarditis
- UTI
- Osteoarticular infections
- Meningitis
6
Q
Most common pathogenic Candida species?
A
- Candida Albicans
7
Q
Mucosal Candidiasis is also know as?
A
- Thrush
- White plaques (Can be scraped off)
- Esophageal Candidiasis S&S resemble GERD
8
Q
Treatment for Thrush?
A
PO Antifungals
- Nystatin
- Fluconazole
- Itraconazole
- Amphotericin B for recurrent infections
9
Q
Vulvovaginal Candidiasis prevalence and risk factors?
A
- High prevalence
- RF Infants Elderly Prego Corticosteroids Antibiotics
Uncontrolled DM & HIV
10
Q
Vulvovaginal Candidiasis S&S?
A
- Pruritus
- Vaginal burning
- Pain with intercourse
- White cottage cheese appearing discharge
11
Q
Vulvovaginal Candidiasis treatment?
A
- Topical Azoles
- Fluconazole
Diflucan
12
Q
Invasive Candidiasis systemic risk factors include?
A
- Neutropenia
- Cancer chemotherapy
- Steroids
- Broad spectrum antibiotics
- Uncontrolled DM & HIV
13
Q
Dx of Invasive Candidiasis?
A
- Blood cultures
- Tissue site culture
- Cell count + Sterile fluid (CSF, joint fluid)
14
Q
Treatment of Invasive Candidiasis?
A
- Systemic antifungals (Azoles, AMP B)
- May require surgery for
- Osteomyelitis
- Septic arthritis
- Endocarditis
15
Q
T or F
You need a high index of suspicion to Dx systemic Candidiasis?
A
- True
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..)
17
Q
Where is Histoplasmosis usually found in?
A
- Fungus in Soil, Bird or Bat droppings
18
Q
How is histoplasmosis transmitted?
A
- Respiratory inhalation
- T Cell mediated defense
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)
20
Q
Histoplasmosis S&S ?
A
- Fever
- Chills
- Fatigue
- Nonproductive cough
- Myalgia
- Patchy lobar or multilobar nodular infiltrate on CXR
21
Q
What is the hallmark sign for Histoplasmosis ?
A
- Enlarged Hilar or Mediastinal lymph nodes
- Strongly consider histoplasmosis
22
Q
When dose Progressive Histoplasmosis occur?
A
- Immunosuppressed Pt’s
- AIDS CD4 < 150
- Infants
- Organ transplant
- Long-term steroids
- Hematologic malignancy
23
Q
Symptoms of Progressive Disseminated Histoplasmosis ?
A
- Fever
- Dyspnea
- Cough
- Weight loss
- Oral Ulcers
- Pharynx
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
25
Most definitive Dx method of Histoplasmosis which is used as a back up?
- Culture of sputum / Fluid
| - But Takes to LONG
26
Most common fastest method to Dx Acute Histoplasmosis?
- Tissue biopsy
| - Methenamine Silver
Special stain
27
Most common fastest method to Dx Dessiminated Histoplasmosis?
- Bone marrow, Liver, Skin lesion Bx or Smear
-- Methenamine Silver
(Special stain)
- Look for Yeast/Buds
28
Histoplasmosis treatment for pulmonary disease > 4 weeks duration:
Mild/moderate
- Itraconazole
(Check serum levels after 2 weeks!)
Severe
- Amphotericin B + Itraconazole
29
Histoplasmosis treatment for Chronic disease?
- Itraconazole
| 12-24 months
30
Histoplasmosis treatment for Disseminated disease ?
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
31
Histoplasmosis treatment for Disseminated disease for Aids pt's?
```
Severe
- Amphotericin B
Until response
3 weeks
+
- Itraconazole
12 months
+
Antiretroviral
```
CD4 > 150
32
T or F
You can add Methylprednisolone if a Histoplasmosis pt is in respiratory distress?
- True
33
How to Immuno comp pt's avoid histoplasmosis?
- No demolition areas
- No Spelunking (Cave Diving)
- No Cleaning of farm buildings
- No cleaning of Attics
34
The only indication for Prophylaxis Tx of Histoplasmosis is in what immuno comp pt?
- AIDS Pts
- CD4 < 150
- Midwest high endemic areas
- Itraconazole daily
35
T of F
Acute pulmonary histoplasmosis is self limited, no Tx needed in healthy pts?
- True
36
T or F
Disseminated histoplasmosis usually responds quickly to anti-fungals, even in pts with AIDS unless diagnosis is delayed?
- True
37
T of F
When antifungals must be used, usually patients respond quickly?
- True
38
Where is the opportunistic fungus Crytococcus usually found?
- Encapsulated budding yeast
| - Soil w/ pigeon dung
39
What is the most common opportunistic Crytococcus fungus that affects humans?
- Cryptococcus Neoformans
40
How is Cryptococcus Neoformans transmitted?
- Inhalation
| - Causes diseases in Immuno Comp Pt's
41
Cryptococcus Neoformans can develop in pt's with NON HIV ?
#1 COPD
#2 Chronic Steroid use
#3 Post solid organ transplant
42
Who can contract Cryptococcal Neoformans in the CNS?
- Aids Pts CD4 < 50
- HA
- Meningealoencephalitis
- Nuchal Rigidity
- Lethargy
- Confusion
- Fever 50% of Pt's
43
What are the different stains that can be used for Cryptococcus Neoformans?
- Mucicarmine Stain (Most Common)
- GMS Stain
- PAS Stain
- Gram Stain
44
What is the most important defense against a Cryptococcus infection?
- T Cell Immunity
45
Where does Cryptococcus infection start ?
- Lungs
- Fever
- Cough
- Dyspnea
- CXR = Pleural based nodular lesion
46
In disseminated disease, Cryptococcus tends to infect most organs what are they?
- Skin lesions: Acneiform rash / nodules / ulcers / plaques
- Prostate
- Genitourinary tract
- Breasts
- Eyes
- Larynx
47
T of F
Cryptococcus is an Opportunistic infection?
- True
48
What is the gold standard to Dx Cryptococcus?
- Culture
- CSF
- Blood
- Skin Lesion
49
What does the CSF of a pt with Cryptococcus usually show?
- High WBC
- High lymphocytes
- High protein
- Low glucose
50
T of F
PT with AIDS, CSF may be normal in a Cryptococcus infection because CD4 T cells are low already
- True
| - Low lymphocytes as is
51
Treatment of Mild, isolated pulmonary Cryptococcus infection?
- Oral fluconazole
- 400mg daily
- 6-12 months
52
Treatment of severe Cryptococcus infection in Aids Pt?
```
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
T of F
Prognosis of death in disseminated Cryptococcus is high in the US ?
- True
| - 10%
54
Africa mortality rate is 100% with Cryptococcal + Aids?
T of F
- True
- Even with the cure
- Permanent Neurological damage
55
What is the primary prophylaxsis in pts with HIV and CD4 < 200
- Fluconazole
200mg
3x week
56
What is important before you lower the dose in the treatment of severe Cryptococcus infection in Aids Pt's?
- Make sure CD4 count is high before lowering to the suppressive dose of Fluconazole
57
What is the first and MOST dangerous opportunistic infection described in AIDS?
- Pneumocystis
| - Fungus, Infects through inhalation (Person to Person, Environment)
58
Most cases of Pneumocystis occur in patients who are either:
- Not on ART
- Don't take their PCP prophylaxis
- Unaware of HIV status
59
What cells are critical in defending from Pneumocystis ?
- CD4 T Lymphocytes
60
What are the symptoms of Pnemocystis?
- Fever
- Nonproductive cough
- Dyspnea on exertion
(LESS pleuritic chest pain & purulent sputum than in bacterial pneumonia)
61
T or F
In Pnemocystis pt has LESS pleuritic chest pain & purulent sputum than in bacterial pneumonia
- True
62
Labs for Pneumocystis often show?
- CD4 < 200
| - High LDH Lactate dehydrogenase
63
What are classic CXR signs in Pneumocysitis?
- Bilateral reticular or granular infiltrates
- Start in perihilar region
- Extend toward periphery as disease progresses.
Usually bilateral
- Pneumatoceles
(thin-walled cysts)
- Pneumothoraces
64
If CXR is normal but still suspect Pneumocystis what is the next test to order?
- CT (Can catch what CXR misses)
- If Normal CT
- No PCP
65
How do you test for Pneumocysitis?
#1 Staining induced sputum
#2 If negative DOES NOT RULE OUT
```
#3 Proceed to do a Bronchoscopy with bronchoalveolar lavage
>90% sensitivity
```
66
T or F
You can repeat the staining of the induced sputum in a pt with possible Pnumocysitis?
- False
| - Instead do a Bronchoscopy with bronchoalveolar lavage (>90% sensitivity)
67
What is the treatment of Pneumocysitis?
- Trimethoprim sulfamethoxazole (Bactrim)
If severe disease
- 21 days of IV therapy followed by orals
68
What are some side effects of Trimethoprim sulfamethoxazole (Bactrim) in HIV pt while treating Pneumocysitis ?
- Rash
- Nausea
- Vomiting
- Abnormal liver values
- Hyperkalemia
- Fever
- Myelosuppression
69
What are the alternative tx drugs if pt can not take Trimethoprim-sulfamethoxazole (TMP - SMX) ?
- IV Pentamidine
- Clindamycin PLUS primaquine
- Trimethoprim PLUS dapsone
- Atovaquone
70
Prevention of Pneumocysitis in HIV pt's consist of?
- TMP-SMX (Bactrim) preferred
- Primary prophylaxis
- HIV pt
- CD4 < 200
OR
- With oral candidiasis
71
If HIV pt does not tolerate TMP-SMX (Bactrim) for Pneumocysitis what can you use?
- Dapsone
- Atovaguone
or
- Aerosolized pentamidine
72
When can a pt taking prophylaxis for Pneumocysitis stop taking TMP-SMX (Bactrim) ?
- CD4 count > 200
| - @ least for 3 months
73
What is the most important parasitic disease in humans?
- Malaria Plasmodium falciparum, vivax
- Female Anopheles mosquito
- Dusk and Dawn Bite
74
What population is at poorest outcomes of Malaria?
- Young Children
| - Pregnant woman
75
Where does Malaria currently exist?
- Africa
- Central and South America
- Asia
76
How many days after the initial bite from a mosquito do you start feeling symptoms?
- Asymptomatic for 12 to 35 days
77
Most common feature of Malaria ?
- Cyclic Fevers
| - @ Regular intervals during the day
78
What is a sign of Cerebral Malaria?
- Seizures
79
What are some Non specific symptoms of Malaria?
-Tachycardia
- Headache
-Tachypnea
- Cough
- Chills
- Anorexia
- Malaise
-
Nausea/Vomiting/Diarrhea
- Fatigue
- Abdominal pain
- Sweating
- Myalgias / arthralgias
80
How many deaths of Malaria in 2018 ?
- 600K
81
How can you Dx Malaria in a Pt outside the US ?
- Parasite on a peripheral blood smear
| - Giemsa or Wright stain
82
Whats the easiest way to Dx Malaria in the US?
- Antigen based tests
83
T or F
PCR in Dx Malaria is routinely done ?
- False
| - Highly sensitive but not routinely used
84
T or F
Treatment for Malaria is dependent on where you travel?
- True
| - Refer to CDC
85
Most common Chemoprophylaxis for Malaria?
- Chloroquine
86
If there is resistance to Chloroquine in treating Malaria then use?
- Mefloquine
87
T or F
Patients should be diagnosed and started on therapy ASAP and then referred to Infectious Disease specialist when treating Malaria ?
- True
88
What are the three main groups of Helminths that are parasitic in human?
1) Flatworms
- Trematodes (Flukes)
- Cestodes (Tapeworms)
2) Ascanthocephalins
3) Roundworms (nematodes)
89
Where are the most serious helminthiasis infections located ?
- Poor Tropical areas
| - Subtripical areas
90
Most common Nematode infection?
- Enterobius vermicularis (pinworm)
- Often Asymptomatic
or
- Perianal pruritis at night
91
Nematode infections caused by Enterobius vermicularis (pinworm) usually found in ?
- Children
92
How do you Dx Enterobius vermicularis (pinworm)
| ?
- Cellophane tape
| - Find Adult worm and Eggs
93
Treatment of Enterobius vermicularis (pinworm) ?
- Pyrantal pamoate
+
Albendazole or Mebendazole
- Repeat in 2 weeks
94
Most freq used medication in the US?
Pyrantal pamoate
- Cheap
- Available otc
- Efficacy rate is at 100%
- Helps prevent recurrences
95
Prevention of Enterobius vermicularis (pinworm) ?
- Entire household should be treated
- Wash all bedding and clothes
- Stress the importance of frequent hand washing and bathing
96
How do pt gets Cutaneous Larva Migrans?
- Dog or cat hookworm larvae
- Beach
- Sandboxes
97
Where is Cutaneous Larva Migrans found?
- Southeastern US
| - Children
98
Cutaneous Larva Migrans S&S?
- Pruritic
| - Serpiginous track
99
Treatment of Cutaneous Larva Migrans?
- Self limited in 1 to 6 months
| - Can not complete life cycle in human
100
Dx of Cutaneous Larva Migrans?
- Clinical
101
What medications can you use to treat Cutaneous Larva Migrans?
- Topical thiabendazole
or
Albendazole
or
Ivermectin
102
Most common helminthic infection world wide ?
- Ascaris lumbricoides
- Largest intestinal round worm (Nematode)
- Most Common in Asia (Kids)
- Not common in US
103
Ascaris lumbricoides transmission?
- Ingestion of water or food contaminated with Ascariasis eggs
- Uncooked pig or chicken livers with larva
104
Ascaris lumbricoides is usually asymptomatic but in heavy infections may see?
```
#1 Larval migration through lungs
(occurs prior to GI evidence of disease)
```
#2 GI tract with adult worms
105
Dx of Ascaris lumbricoides in lung disease ?
- Sputum analysis for larva, eosinophils or
- Charcot-Leyden crystals
- Infiltrates on XCR
106
Dx of Ascaris lumbricoides GI disease?
- Stool O&P after day 40
107
Dx of Ascaris lumbricoides GI obstruction?
- Ultrasound or ERCP
108
Tx of Ascaris lumbricoides in lung disease ?
- Inhaled bronchodilators
- Oral steroids
- Follow up in two months
109
Tx of Ascaris lumbricoides GI disease?
- Albendazole
400mg PO
single dose
Alternative: Mebendazole
500mg PO
single dose
or
100mg daily for 3 days
100% cure rate
110
Most commonly diagnosed intestinal parasitic disease in U.S ?
- Giardia protozoan flagellate
111
T or F
50% pt's asymptomatic
1-2 weeks of illness
- True
112
S&S of Giardia protozoan flagellate?
- Profuse watery diarrhea
- Stomach cramping
- N/V
113
Tx of Giardia protozoan flagellate?
- Metronidazole or Tinidazole
114
Dx of Giardia protozoan flagellate?
- Stool ova/parasite testing
115
2nd most common parasite causing diarrheal illness in U.S ?
- Cryptosporidiosis
| - Kids
116
Tx of Cryptosporidiosis?
- Most people recover without treatment
| - Nitazoxanide
117
Dx of Cryptosporidiosis?
- Stool stain
or
- Ab or antigen testing
118
U.S. 3rd most common parasitic infection / 2nd most common cause of diarrhea in travelers returning from endemic areas?
- Amebiasis protozoan Entamoeba histolytica
| - Poor sanitation
119
Transmission of Amebiasis protozoan Entamoeba histolytica ?
- Cyst stage
(Infective stage)
(Chlorine Resistance)
- Trophozoite stage (Invasive disease)
120
How does Amebiasis protozoan Entamoeba histolytica enter pt?
- Ingestion of amebic cysts in the form of contaminated food and water
- Associated with venereal transmission from fecal oral contact
121
T or F
Most Amebiasis protozoan Entamoeba histolytica diseases are asymptomatic and self limiting?
- True
- 90%
- 10% invasive disease
122
Factors that influence Amebiasis protozoan Entamoeba histolytica invasive disease include?
- Strain of E. histolytica
- Genetic susceptibility
- Age
- Immune status
123
Complications of Amebiasis protozoan Entamoeba histolytica?
- Appendicitis
- Bowel perforation
- Fulminant colitis
- Massie mucosal sloughing
- Hemorrhage
- Toxic megacolon
124
Extra-abdominal complications of Amebiasis protozoan Entamoeba histolytica?
- Liver abscess
- Thoracic amebiasis
- Cerebral amebic abscess
125
Amebiasis protozoan Entamoeba histolytica risk factors for severe disease?
- Young age
- Pregnancy
- Steroid treatments
- Malignancy
- Malnutrition
- Alcoholism
126
Dx of Amebiasis protozoan Entamoeba histolytica ?
- Stool microscopy
- Demonstration of cysts and trophozoites in the stool
- Must check 3 times
127
Tx of Amebiasis protozoan Entamoeba histolytica ?
- Metronidazole
500-750mg PO
TID for 7-10 days
- Tinidazole (Alternative)
2g PO for three days
128
Prevention of Amebiasis protozoan Entamoeba histolytica ?
- Vaccine development underway
- Sanitation
- Clean water
129
Prognosis of Amebiasis protozoan Entamoeba histolytica ?
- Good / no drug resistance, very treatable disease
