Fungal Dz Jill Flashcards
Toxoplasmosis infectious agent
protozoa
toxoplasma gondii
Toxoplasmosis transmission
- ingestion of meat containing cysts or contaminated fruit/veggies/water
- ingestion of cat feces or contaminated soil
- vertical
- organ transplant
Toxoplasmosis cycle
completes reproductive cycle in a cat
cat excretes oocytes in feces
animal or human ingests oocytes
organisms invades epithelium
live nucleated cell until patient is immunocompressed
immunocompetent Toxoplasmosis
resemble EBV and CMV
mild fevers, chills, sweats
cervical lymphadenopathy
mylagias/arthralgias, HA, sore throat, chorioretinitis*
Toxoplasmosis recovery (immunocompetent)
spontaneous
about 2-3 months
Toxoplasmosis immunocompromised pts
flu like symptoms + CNS involvement (seizure, balance change)
abrupt or subacute
congenital Toxoplasmosis risk assessment
15% risk of infection in first trimester
30% in second
60% in third
severity of symptoms decrease as pregnancy continues
s/s of congential Toxoplasmosis
retinochorionitits
intracranial calcification
hydrocephalus
treatment Toxoplasmosis
immunocompetent - usually treated unless disease
ocular treated by ophthalmologist
may be reactivated in patients who are immunocompromised
histoplasmosis infectious agent
histoplasmosis capsulatum
fungus
found in solid with bird or bat droppings
histoplasmosis geographical prevalence
Mississippi and Ohio river valleys
histoplasmosis can be found worldwide in temperature climates with most, rich organic soil
histoplasmosis transmission
infection by inhalation of fungal spores
contaminated soil may remain infectious for years
histoplasmosis pathophysiology
inhaled pulmonary macrophages will ingest fungus but don’t kill
delayed hypersensitivity reaction occurs once t lymphocytes develop
immunocompetent - caseating granuloma
immunosuppressed - spread hematogenously
histoplasmosis asymptomatic symptoms
immunocompetent
most never have symptoms
10% develop flu like illness (1-4 wks that clear)
+/- calcifications on CXR
acute histoplasmosis
fever and severe weakness
few pulmonary symptoms
diffuse pneumonia on CXR
ill for weeks to months, but not fatal
chronic progressive histoplasmosis
older patients with COPD
apical cavitary lesions, productive cough, dyspnea
progressive disseminated histoplasmosis
occurs in immunocompromised (AIDS, infants, steroids)
dyspnea and weight loss
altered mental status, ulcerative lesions (mucous membranes and viscera)
fatal in weeks
when to suspect histoplasmosis?
pneumonia with lymphadenopathy
cavitary lung disease (tb -)
pulmonary manifestations with arthritis or arthralgia
erythema nodosum
histoplasmosis diagnostic testing
disseminated disease: pancytopenia, LFT, abnormalities
dx made with complement fixation Ab titer or serum/urine antigen detection assay
Coccidiomycosis geographical location
dessert southwest, mexico and central/south america
Coccidiomycosis transmission
infection occurs via inhalation of spores (can be by minimal exposure)
most often in summer or lateral
Coccidiomycosis primary
60-70% subclinical
10-30 day s following exposure
presents as CAP (respiratory, joint, erythema multiform and erythema nodosum)
Coccidiomycosis disseminated
hematogenous spread (rapid and fatal) so any organ is involved
fungemia, rapid death, respiratory (cough, sputum, empyema), abscess and cavitary lesions, fungal meningitis
Coccidiomycosis diagnostic test
IgM or IgG serology (not ideal)
PCR on biopsy of lesion (DX of choice)
body fluid culture
Coccidiomycosis treatment
supportive for mild disease
disseminated: amphotericin B (severe), itraconazole or fluconazole for 6 months - year
surgery for empyema, caviations, abscesses
opportunities for candida to become pathogenic
antibiotics
immunosuppression
uncontrolled DM
Skin candida presentation
eruption over trunk, thorax, extremities (uncommon)
intertrigo (skin folds) where heat and moisture reddened lesion that form vesiclopustules
maceration (prune looking fingers)
oropharyngeal candidiasis
AKA thrush
pain, thick white plaque on oral mucousa
when scraped causes reddened erosion
esophageal candidiasis
odynophagia (painful swallowing)
can result in weight loss
concomitant thrush
candida in bloodstream
endocarditis (posible with fungemia)
difficult to diagnose due to difficulty isolation of fungus
change or remove invasive catheters
urinary tract candida
vaginal involvement
itching and burning
pain with urination
treatment of skin candida
topical nystatin
clotrimazole or miconazole
oropharyngeal candida treatment
nystatin swish +/- spit
clotrimazole
esophagus candida treatment
systemic fluconazole
can use itraconazole, voriconazole, caspofungin or micafungin
blood candida treatment
w/p neutropenia: flucaonzole
neutropenia: micafungin, anidulafungin, caspofungin
urinary tract candida treatment
diflucan (only when urinary candida is persistent and symptomatic)
why can’t oral ketoconazole be used?
no longer used for first line bc risk of liver damage
topical preps are oka
four types of aspergillosis
- allergic bronchopulmonary
- sinusitis
- chronic necrotizing pulmonary
- invasive
allergic bronchopulmonary aspergillosis
findings
cough, eosinophilia, pulmonary infiltrates
heavy mucous production – atelectasis
leads to bronchiectasis/fibrosis
itraconazole and steroids (stop allergic rxn)
allergic bronchopulmonary aspergillosis
population most likely to get it
asthmatics and patients with CF
sinusitis or aspergillosis
fungus ball in lungs
hemoptysis (bloody mucous)
requires surgical and anti fungal tx
sinusitis aspergillosis population
sinus surgery or pulmonary vavitaitons
chronic necrotizing pulmonary aspergillosis
subacute pneumonia unresponsive to Abx
progresses and cavititates
fever, cough, night sweats, weight loss
chronic necrotizing pulmonary aspergillosis population
its with underlying disease
i.e. steroid dependent COPD or alcoholism
invasive aspergillosis
fever, dyspnea, cough, pleuritic CP, hemoptysis
tracheobronchitis and necrotizing pneumonia w/ hematogenous spread to organs (CNS)
invasiv aspergillosis population
severe immunodeficient
Cryptococcosis geography
encapsulated yeast found world wide in soil
Cryptococcosis transmission
inhalation of spores
Cryptococcosis patients at risk
HIV/AIDS
solid organ transplants
Cryptococcosis pathophysiology
capsule with anti-phagocytic properties
block recognition by WBCs to inhibit leukocyte migration
Cryptococcosis immunosuppressed manifestations
fever, cough, pain, ARDS (cavitation and hilarious LAD uncommon)
progressive menintitis/encephalitits, cyrptoccoma (blurred vision, photophobia)
can go to skin, bone, prostate, and eyes
Cryptococcosis diagnostic testing
Cryptococcal capsular antigen testing
CSF (to show the meningitis)
Cryptococcosis treatment
amphotercin B
forms of mycobacterium avian complex (MAC)
- fibrocavitary form
- fibronodular
- disseminated
BACTERIAL disease
population of fibrocavitary MAC
elderly MALE smokers w/chronic pulmonary symptoms
fibrocavitary MAC presentation
variable
cough, fatigue, malaise, weakness, chest discomfort
chronically ill, development of exacerbations
Fibronodular MAC population
non-smoking WOMEN, no underlying lung disease
Fibronodular MAC symptoms
similar to fibrocavitary
all infected patients have similar body types
disseminated MAC population
AIDS and/or lymphoma w/CD4 counts less than 50 cells
disseminated MAC symptoms
ill
bacteremia and present with fever of unknown origin, sweats, weight loss, dyspnea and RUQ
diagnostic work up disseminated MAC
blood, sputum and urine cultures
biopsy of cutaneous lesions
MAC treatments
calrithromycin (Biaxin) or azithromycin (Zithromax)
Rifampin
Ethambutol
antivirals until CD4 counts >100
