Fungal Disease Flashcards
Describe the etiology of a fungal infection of the lungs
Spore produce a frothy yeast like substance
PMN and macrophages engulf spores
Pulmonary capillaries dilate
Alveolar epithelium swells
Regional lymph nodes become involved
Which lung surfaces are most commonly affected by fungal infections?
Apical and posterior segments of the upper lobes are most commonly affected
What can be a long term result of fungal infection of the lungs?
Fibrosis and calcification of lung parenchyma replaces granulomas
Lung tissue retracts and grows firm
What can severe cases of fungal infection result in?
Tissue necrosis
Granulomas
Cavity formation
What kind of disorder are fungal infection survivors left with?
Restrictive pulmonary disorder
What are the three most threatening fungal infections of the lungs?
Histoplasmosis
Coccodioidomycosis
Blastomycosis
What is the most common fungal infection of the lungs in the united states?
Histoplasmosis
What is another name for histoplasmosis?
Ohio valley fever
Where is histoplasmosis particularly prevalent?
Ohio, michigan, illinois, mississippi, missouri, kentucky, tennessee, georgia, arkansas
What fungus causes histoplasmosis?
Histoplasma capsulatum
Where can the spores of histoplasmosis be found?
Soil with bird turds
What disease presents similarly to histoplasmosis?
Tuberculosis
Why do most people with histoplasmosis not seek medical help?
Only 40% demonstrate symptoms
Only 10% feel sufficiently sick enough to seek medical help
What is the most common form of histoplasmosis?
Asymptomatic primary histoplasmosis
Who is the most susceptible to a histoplasmosis infection?
HIV/AIDS patients
What are the 4 forms that histoplasmosis can take?
Asymptomatic primary histoplasmosis
Acute symptomatic histoplasmosis
Chronic histoplasmosis
Disseminated histoplasmosis
What evidence will be present in a patient who had contracted asymptomatic primary histoplasmosis?
Smalled healed lesion in lung parenchyma
Calcified hilar lymph nodes
Patients will test positive with distoplasmin skin test
What determines the form that a histoplasmosis infection takes?
An individuals immune response dictates the form the histoplasmosis patient takes
What severe symptoms would a patient with acute symptomatic histoplasmosis present with?
Acute pulmonary syndrome
Severe SOB
What mild symptoms would a patient with acute symptomatic histoplasmosis present with?
Fever
Muscle pain
Headache
Dry hacking cough
Chills
Chest pain
Weight loss
Sweats
What is acute symptomatic histoplasmosis also called?
Spelunkers lung
Frequently develops in cave explorers who recessive excessive exposure to bat shit as they raise dust in caves
What does the chest xray of a patient with acute symptomatic histoplasmosis?
Kind of looks star speckled
What occurs in chronic histoplasmosis?
Infiltration and cavity formation in the upper lobes of one or both lobes
Who is chronic histoplasmosis most commonly seen in?
Middle aged men who smoke
What patients are more likely to have disseminated histoplasmosis?
Vulnerable populations
Very young/old
Compromised immune system
What tissues/samples can be used to culture histoplasmosis?
Blood
Sputum
Tissue from lymph node
Lung tissue
Bone marrow
What is the gold standard for testing and diagnosis histoplasmosis?
Fungal culture
What tissues are at risk if histoplasmosis disseminated?
Pretty much everything
What do people infected with Coccidioidomycosis present with?
Fever, chest pain, cough, headaches, malaise
How long does it take for a histoplasmosis to culture?
4 weeks
What are the three tests for histoplasmosis?
Fungal culture - gold standard, but takes a long time
fungal stain - very accurate but invasive
Serological testing -fast, but not as accurate
Where is Coccidioidomycosis endemic to?
Hot dry regions
Coccidioidomycosis is also known as
California fever
Desert rheumatism
San joaquin valley disease
Valley fever
How does chronic Coccidioidomycosis present?
Nodular growths in lungs
Cavity formation in the lungs
How does disseminated Coccidioidomycosis present?
Swollen lymph nodes, meninges, spleen, liver, kidney and adrenal glands
Skin lesions accompanied by joint pain in ankles and knees
Where is blastomycosis endemic to?
South central and midwestern united states and canada
How can Coccidioidomycosis be diagnosed?
Direct visualization of distinctive spherules in microscopy of patients sputum, tissue exudates, biopsies or spinal fluid
Blood tests that can detect antibodies to the function
Culture the organisms
What is blastomycosis also known as?
Chicago disease
Gilchists disease
North american blastomycosis
How does blastomycosis infection present?
Fever, cough, hoarseness, joint and muscle aches, possible pleuritic pain
Productive cough, purulent sputum
Skin lesions
How is blastomycosis diagnosed?
Relies on direct visualization of yeast in sputum smears
Culturing the fungus
What are opportunistic fungal pathogens that infect the lungs?
Candida albicans
Cryptococcus neoformans
Asperigillus
Where is aspergillus typically found?
Soil, vegetation, leaf detritus, food, and compost heap
Air of granaries, barns and silos
What can cause a candida albicans infection?
Inhaled steroid medications without washing mouth
What can an aspergillus infection present as?
Allergic bronchopulmonary aspergillus, associated with asthma
What distinctive formation can be found in the lungs as a result of aspergillus?
Aspergilloma = fungus ball that colonizes in a healed lung scar or abscess from a previous disease
What findings would be present on a patient with a fungal infection in their lungs present with?
Decreased volumes, flows, capacities
What would radiologic findings show in a patient with a pulmonary fungal infection?
Increased opacity
Cavity formation
Pleural effusion
Calcification and fibrosis
Right ventricular enlargement
What is an RTs role in treating a patient with a pulmonary fungal infection?
Supportive treatment
Oxygen therapy
Bronchopulmonary hygiene
Mechanical ventilation
What is the treatment of choice for treating pulmonary fungal infections?
Amphotercicin B
What is an alternative medication that can be used to treat fungal infections?
Azole antifungal agents
Fluconazole and itraconazole
