Fungal Infections

Question 1

Blastomycosis Etiology

Answer 1

South central and midwestern US and Can; Blastomyces sp

Question 2

Blastomycosis S/S

Answer 2

Chronic pulm infection common but can be asymptomatic; cough, fever, dyspnea, chest pn, often w/purulent sputum, pleurisy

Question 3

Blastomycosis Lab

Answer 3

Leukocytosis and anemia; CXR/CT: airspace consolidation or masses

Question 4

Blastomycosis Management

Answer 4

No CNS involvement: itraconazole (PO); CNS involvement: IV amphotericin B

Question 5

Blastomycosis Prevention

Answer 5

Monitor pt for relapse

Question 6

Mucormycosis Etiology

Answer 6

Opportunistic infections of Rhizopus, Mucor, Absidia, Cunninghamella; lots of predisposing conditions

Question 7

Mucormycosis S/S

Answer 7

Invasive dz of sinuses, orbits, lungs; widely disseminated more common post-chemo and broad spectrum antifungal prophylaxis

Question 8

Mucormycosis Lab

Answer 8

Biopsy required for dx; cultures us. negative

Question 9

Mucormycosis Management

Answer 9

Prolonged amphotericin B; posaconazole following control of acute infection

Question 10

Mucormycosis Prevention

Answer 10

Control of dm and other underlying conditions; extensive repeated surgical debridement of necrotic tissue

Question 11

Candidiasis Etiology

Answer 11

Common normal flora an opportunistic pathogen; oral (thrush), vaginal (vaginitis), GI mucosal (esophagitis) cardiac (endocarditis) dzs

Question 12

Candidiasis S/S

Answer 12

Esophageal: osynophagia, GERD, nausea
Vulvovaginal: vulvar pruritis, burning discharge, dyspareunia
UTI: same sx as bacterial

Question 13

Candidiasis Lab

Answer 13

Disseminated: blood cx (50%), positive mucosal cx (urine sputum)
Hepatosplenic: alkaline phosphatase elevated, tissue biopsy/cx, blood cx not definitive
Endocarditis: dx requires either pos cx from blood, emboli, or from vegetations on valves
Esophageal: endoscopy w/biopsy and cx

Question 14

Candidiasis Management

Answer 14

Esophegeal: Fluconazole (PO) or Itraconazole (PO)
Vulvovaginal: Clotrimazole (topical) or Fluconazole (PO)
Candidemia: Fluconazole (IV)
Hepatosplenic: Fluconazole (PO) and amphotericin B (IV)
Endocarditis: Amphotericin (IV), Fluconazole (PO) can be added

Question 15

Candidiasis Prevention

Answer 15

Prevent unnecessary usage of broad spectrum abx and IV catheters; relapse common in HIV pts; fluconazole prophylaxis recommended for high-risk pts (induction chemo)

Question 16

Cryptococcoses Etiology

Answer 16

Most common cause of fungal meningitis; many species; usually found in immunocompromised pts (esp. chemo, Hodgkin, corticosteroid use, HIV, transplant)

Question 17

Cryptococcoses S/S

Answer 17

HA, confusion, CN abnormalities, N/V, nuchal rigidity; respiratory sx (C gatti); cellulitis-like sx (C neoformans)

Question 18

Cryptococcoses Lab

Answer 18

HIV pts: serum cryptococcal antigen
Cryptococcal meningitis: CSF shows (a lot of stuff)
MRI more sensitive than CT in finding CNS abnormalities

Question 19

Cryptococcoses Management

Answer 19

Acute: Amphotericin B (IV) eventually switching to Fluconazole (PO)
Maintenance: Fluconazole (AIDS pt should receive continuous prophylaxis)

Question 20

Cryptococcoses Prevention

Answer 20

Repeated lumbar punctures or ventricular shunting to relieve high CSF pressure or hydrocephalus

Question 21

Histoplasmosis Etiology

Answer 21

H capsulatum; found in soil contaminated w/bird or bat droppings in endemic areas (OH/MS River valleys, etc); common in immunocompromised; inhaled

Question 22

Histoplasmosis S/S

Answer 22

Most cases asymptomatic; flu-like illness sx; more severe atypical pneumonia sx
Progressive/disseminated: Fever, weight loss, dyspnea, cough, ulcers of MM, HSM, IBD-like sx, septic shock (immunocompromised pts)

Question 23

Histoplasmosis Lab

Answer 23

Elevated: alkaline phosphatase, lactase dehydrogenase, ferritin; anemia; sputum culture only pos in chronic resp histo; antigen testing of bronchoalveolar lavage fluid may be beneficial; bone marrow cx and urine antigen very sensitive; lung/splenic calcifications may be seen with radiographs

Question 24

Histoplasmosis Management

Answer 24

Acute: Itraconazole (POP)
Severe: Amphotericin B (IV)
HIV prophylaxis: Itraconazole (PO)

Question 25

Histoplasmosis Prevention

Answer 25

Acute histoplasmosis usually resolves within 6 months w/tx; Progressive/disseminated histoplasmosis will result in death if untreated