fungal infection 3

Question 1

what is a primary pathogen that acts more like an opportunistic pathogen

Answer 1

cryptococcus

Question 2

what are the 2 pathogenic species of cryptococcosis

Answer 2

Cryptococcus neoformans (most common)
Cryptococcus gaittii

Question 3

how does cryptococcosis infect people, who is at high risk for this type of infection

Answer 3

inhalation of organism

AIDS patients

Question 4

where is cryptoccoccosis typically found outside of the human body

Answer 4

soil and pigeon droppings

Question 5

what is the pathogenesis involved in cryptococcis infection

Answer 5

1. inhalation
2. yeast particles rehydrate in alveoli
3. capsules form resisting phagocytosis
4. macrophages carry pathogen via bloodstream to lymph nodes and meninges

Question 6

where is a culture typically taken to diagnose cryptoccocal infections

Answer 6

CSF; always starts in lungs but meningitis is very common

Question 7

what are the symptoms of non-AIDs dissimenant cryptococcosis

Answer 7

headache
fever
n/v
mental status changes
neck stiffness

Question 8

what are the symptoms of AIDs pt. dissimenant cryptococcosis

Answer 8

fever and headache

Question 9

what are the symptoms of non-AIDs dissimenant cryptococcosis that are uncommon in AIDs patients

Answer 9

meningismus and photophobia

Question 10

primary cryptococcosis in humans almost always occurs where? how is this typically treated if asymptomatic?

Answer 10

in the lungs

usually resolves itself spontaneously

Question 11

how is cryptococcosis diagnosed

Answer 11

india ink staining (stain the background, not the organism)

Question 12

what levels of cryptococcal antigens indicates a diagnosis

Answer 12

>1:4 = infection 
>1:8 = active disease

Question 13

a pt. with isolated pulmonary disease and mild to moderate symptoms of cryptococcal infection should be treated how?
for what duration?

Answer 13

fluconazole 200-400 mg daily

3-6 months

Question 14

a pt. with isolated pulmonary disease and severe symptoms of cryptococcal infection should be treated how?
for what duration?

Answer 14

amphotericin B
until a cumulative dose of 1-2 grams is given
(may also be used if pt. is mild but can’t take azoles)

Question 15

what are the 3 different strategies for treating a cryptococcal infection in the CNS?

Answer 15

1. induction phase - rapid fungicidal activity
2. consolidation phase - to achieve remission
3. maintenance phase - to prevent relapse

Question 16

what is the induction phase treatment for HIV infected patients who have aCNS cryptococcal infection?
duration?

Answer 16

amphotericin B plus flucytosine

2 weeks

Question 17

what is a risk for flucytosine

Answer 17

cardiac problems

Question 18

if renal dysfunction is a concern, what is the induction phase treatment for HIV infected patients who have a CNS cryptococcal infection?

Answer 18

lipid formulation of ampho B

Question 19

If flucytosine intolerant, what is the induction phase treatment for HIV infected patients who have a CNS cryptococcal infection?

Answer 19

treat with amphotericin monotherapy

Question 20

what is the consolidation phase treatment for HIV infected patients who have a CNS cryptococcal infection?

Answer 20

high dose fluconazole

Question 21

what is the maintenance phase treatment for HIV infected patients who have a CNS cryptococcal infection?

Answer 21

low dose fluconazole

Question 22

what is the induction phase treatment for transplant patients who have a CNS cryptococcal infection?

Answer 22

amphotericin B plus flucytosine

Question 23

what is the consolidation phase treatment for transplant patients who have a CNS cryptococcal infection?

Answer 23

high dose fluconazole

Question 24

what is the maintenance phase treatment for transplant patients who have a CNS cryptococcal infection?

Answer 24

low dose fluconazole