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ClinMed1 Exam 4 > Fungal infections > Flashcards

Fungal infections Flashcards

1
Q

6 reasons why fungal infections are on the rise

A 
solid organ transplant
high doses of chemotherapy
indwelling catheters
broad spec ABX
surgical and ICU patients
Immunocompromised
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2
Q

what three types of patients have fungal infections as a major cause of death?

A

cancer, transplant and AIDS patients

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3
Q

what species accounts for 78% of all nosocomial fungal infections?

A

Candida

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4
Q

how are most fungal infections acquired?

A

accidental inhalation

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5
Q

what are some lab tests for fungal infections? (4)

A 
fungal culture (SLOW growth)
PCR, western blot (more rapid ID), KOH
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6
Q

Endemic infection:

A

disease causing fungi to normal healthy & immunosuppressed individuals in a specific geographic region

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7
Q

opportunistic infection:

A

cause invasive infections in only severely immunosupressed pts

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8
Q

types of endemic fungi:

A

histoplasmosis, blastomycosis, coccidiomycosis

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9
Q

types of opportunistic fungi:

A

cryptococcis, aspergillus, candida

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10
Q

where is Histoplasma capsulatum found?

A

in soil that is contaminated with bird or bat droppings (central/eastern US)
-moist environments

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11
Q

how is Histoplasma capsulatum transmitted?

A

inhalation of spores; small budding cells are engulfed by phagocytes in the lungs and carried to other tissues

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12
Q

signs and sx of a mild histoplasmosis infection

A
  • depends on immune sys of host
  • asymptomatic or mild
  • mild flu (1-4 days)
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13
Q

S/SX for a moderate/severe histoplasmosis infection (4)

A

atypical pneumonia
fever
cough
central chest pain (5-15 days)

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14
Q

acute histoplasmosis (sx, duration, prognosis)

A
  • prostration, fever, few pulm complaints
  • 1 week-6 mo
  • almost never fatal
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15
Q

chronic progressive pulmonary histoplasmosis is MC seen in which pts?

A

usually seen with older pts w/ COPD (impaired cillia, can’t clear infection)

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16
Q

disseminated histoplasmosis happens in which patients?

A

severely immunocomramised (primary infection or re-occurrence)

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17
Q

6 need to knows about disseminated histoplasmosis

A
  • Often reactivation of prior infection
  • Commonly seen in patients with HIV
  • CD4 count
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18
Q

8 lab findings for histoplasmosis

A
  1. CBC= anemia
  2. sputum= + in chronic dz 12wk growth
  3. blood culture
  4. antibody testing (cross reacts with other fungi)
  5. MRI/CT (CNS histo)
  6. urine assay (90% sen for dissem dz in HIV pts)
  7. CXR
  8. skin test (high rate in endemic areas, not recomm.)
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19
Q

CXR findings of histoplasmosis

A

calcification, diffuse pneumonia, miliary pattern

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20
Q

general tx for histoplasmosis

A

-none for actue
-mild/moderate:
itraconazole 200-400mgQD/2-3 months

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21
Q

tx for histoplasmosis in AIDS pt

A

life long itraconazole 200-400mg/day

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22
Q

tx for histoplasmosis in severely ill/immunocomp or pts who have failed itra or oral tx

A

amphotericin B, liposomal (lipid form of ampho B, may be safer for really ill pts)

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23
Q

what organism causes blastomycosis?

A

blastomyces dermatitidis

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24
Q

where is blastomyces dermatitidis found?

A

nitrogen rich soil of central and southeast US and Canida

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25
Q

how does blastomycosis present? (normal, not chronic or disseminated)

A

asympomatic in mild dz
80% chronic pulm dz
cough, moderate fever, dyspnea, CP
breif flu like illness with rapid resolution

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26
Q

how do pts present with chronic blastomycosis infections?

A

bloody, purulent sputum, pleurisy, chills

pneumonia like

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27
Q

presentation of disseminated blastomycosis

A

-lesions on skin, bones and urogenital system
-raises, verucous lesions
-epididymitis, prostatitis
-

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28
Q

what patients is disseminated dz most commonly seen in?

A

immunocompromised; if they are not move to HIV/cancer testing

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29
Q

lab tests for blastomycosis

A

CBC: leukocytosis, anemia
Sputum: grows readliy, keep for 4 weeks
serological: not well standarized

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30
Q

1st choice tx of blastomycosis

A

-itraconazole 200-400mg/day/2-3 mo (non meningeal dz)

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31
Q

backup tx for blastomycosis

A
  • amphotericin B 0.3-0.6mg/kg/day IV (CNS, tx failure, bad infections)
  • ketoconazole (not well tolerated)
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32
Q

what do you see on a CXR of blastomcosis

A

cavitary lesion with fluid/air line, cotton ball infiltrates

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33
Q

what organism causes coccidioidomycosis

A

cocidiodes immitis

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34
Q

where is cocidiodes immitis found?

A

soil of warm, dry region of southwest US, more common in heavily populated areas

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35
Q

what is coccidioidomycosis AKA

A

San Joaquin valley fever or desert rheumatism

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36
Q

incubation period of coccidoidomycosis

A

10-30 days

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37
Q

what are the Sx of coccidoidomycosis

A

60% asymptomatic
-flu like, pnumonia like infection
-myalgia, fatigue, arthralgia
rash/lesions

38
Q

describe the rash/lesions of coccidoidomycosis

A

nodules with rat eaten boarder (seen in acute dz 2-20 days)

39
Q

what does the CXR show for coccidoidomycodid?

A

cavitary lesions, abscesses

40
Q

1% of coccidioidomycosis cases become disseminated, how does that present and in which patients?

A

meningitis (stiff neck, fever, HA)

HIV, DM

41
Q

how do you Dx coccidioidomycosis?o B

A
  • serologic testing (good for dx and prognosis)
  • CSF (inc WBC, red glucose, 30% of the time you see organism)
  • blood cultures (rarely positive)
42
Q

tx for coccidioidomycosis

A
  • mild pulm cases: oral azoles
  • severe pulm: Ampho B
  • Meningitis: fluconazole, ampho B, Voiconazole
  • bones/SST: itraconazole
43
Q

cryptococcus: how many species and what’s the one found in humans?

A

20 species

C. neoformans, also gattii

44
Q

where is cryptococcus found?

A

in bird feces, fresh fruits, veggies and dairy products

45
Q

where geographically is neoformans found vs gattii?

A

neoormins: universally
gatti: mostly tropical and subtropical climates

46
Q

what population does neoformans/gattii infect?

A

neo=immunocompromised (90%)

gatti= more immunocompetent

47
Q

pulmonary s/sx/prognosis for cryptococcus

A
  • mild and rapid resolution (pneumonia like)
  • severe sx usu disseminated dz
  • 40% mortatlity in AIDS
48
Q

What is the MOST COMMON manifestation of disseminated cryptococcus?

A

CNS/meningitis

49
Q

what are 6 Sx of CNS cryptococcus

A

headache, fever, AMS, memory loss, meningismus, photophobia

50
Q

3 other manifestations of cryptococcus (not pulm or CNS)

A

skin, skeletal and prostate lesions have been observed

51
Q

how do you Dx cryptococcus infections?

A 
-CSF/culture (DO A HEAD CT 1ST)
 (inc opening pressure, inc protein, dec sugar)
-CT or MRI
-Cryptococcal capsule antigen 
-india ink stain= budding
52
Q

what two lab test together have a 90% sensitivity for cryptococcus infections?

A

CSF findings and CSF culture together

53
Q

prognostic signs associated with poor outcomes with cryptococcus infections?

A
  • altered mental status
  • elevated opening pressure on LP
  • low CFS leukocyte count
  • high CSF and serum cryptococcal antigents
54
Q

tx of cryptococcus infection (include meningitis, severe dz and maintenance

A
  • AIDS/meningitis: oral flucanazole for 10 weeks
  • severe dz in AIDS pt: Ampho B X14 days; oral flucanazole life long; flucytosine (prevents reoccurnace)
  • maintenance in AIDS pts: fluconazole until CD4>200
55
Q

what is the most commin invasive mold infection in the world?

A

Aspergillosis

56
Q

what organism causes aspergillosis?

A

Aspergillus fumigatus (90%)

57
Q

where is Aspergillus fumigatus found?

A

soil, plants, rotten veg, hot water supply, ground spices

58
Q

what makes Aspergillus fumigatus dangerous in reguards to respiratory system?

A

they have small spores that when inhaled can penetrate deep into the lungs

59
Q

In what type of patients do you see Aspergillosis? (5)

A 
immunocompromised
organ transplant
neutropenic pts
burn victims
DM
60
Q

5 pulmonary S/Sx of Aspergillosis

A

dyspnea, cough, hypoxia, bilateral infiltrates, hemotypsis (w/ normal CBC)

61
Q

S/Sx of tracheobronchitis d/t aspergillosis (3-4)

A

fever, cough, ranges from mucus production to ulceration

62
Q

S/Sx of sinusitis d/t aspergillosis (4)

A

fever, sinus pain, sore throat, spreading to orbits/palate

63
Q

S/Sx of disseminated aspergillosis (2-3)

A

(rare, usually discovered post mortem)

  • cutaneous, errythema/red or purple lesions
  • mental status changes
64
Q

lab finding of aspergillosis

A
  • cultures, serologic testing
  • ELISA (most specf. and sen)
  • tissue biopsy
  • CT scan
65
Q

what’s the most specific and sensitive test for aspergillosis?

A

ELISA

66
Q

treatment for aspergillosis

A

voriconazole
Ampho B
Cancidas

67
Q

Candida is a normal flora found in…..

A

skin, GI, GU, pulmonary

68
Q

what candida species are pathogenic to humans?

A
  • C. albicans (50-70%)
  • C. tropicalis
  • C. glabrata
  • C. parapsilosis
  • C. krusei
69
Q

candida infections require what:

A

breakdown in host’s defense

70
Q

where are Candida fungi found?

A

food, soil, inanimate objects, prevalent in hospital environments, body secretions

71
Q

what are the two major portals of entry for candida?

A

skin and GI tract

72
Q

who is at risk for a candida infection? (6)

A 
neutropenic Pt
cancer pt
renal failure
use of ABX or corticosteroids
prolonged hospitalization
invasive treatments
73
Q

what 3 organs are typically involved in invasive/candidemia infections

A

liver, brain heart

74
Q

S/SX of candidemia of

A

acute onset of fever, tachycardia, tachypnea

-deterioration of condition w/ or w/out fever

75
Q

three fun facts about oropharyngeal and esophogeal candidiasis

A
  • oral mucosa=thrush
  • c. albicans is primary pathogen
  • found in oral flora in 30-60% of adults
76
Q

risk factors for oropharyngeal and esophageal candidiasis (~7)

A 
use of steroids and ABX
dentures
disruption of oral mucosa
HIV, neonates, Elderly
Diabetes
malignancy
nutritional deficiencies
77
Q

presentation of oropharyngeal candidiasis

A

-stomatitis (inflamed sore mouth)
-dysphagia
-diffuse erythemia, whit patcheson surface of tongue, bucal mucosa, throat or gums
“cheesy”

78
Q

pt’s with oropharyngeal candidiasis will ahve what in their Hx (~3)

A
  • Hx of local defense damage
  • mucous MB damage
  • Hx of ABX, chemo, trauma, corticosteroid
79
Q

lab studies for oropharyngeal candidiasis (2)

A
  • scrape the lesion- microscopic eval=budding yeast

- cultures (does not distinguish b/t colonization and true infection)

80
Q

what do you see on endoscopy with esophageal candidiasis?

A

white, ulcerative patch (with odynophagia)

81
Q

lab studies for esophageal candidiasis? (2)

A
  • GI endoscopy (biopsy confirms dx)

- cultures- helpful w/ sensitivity/ susecptable drugs

82
Q

tx of esophageal candidiasis?

A
  • nystatin suspension, clotrimazole troches (contact for 20-30 mins, swish)
  • systemic: for more severe infections
83
Q

what organism causes 80% of the vulvo-vaginal candidiasis infections?

A

candida albicans (common vaginal flora)

84
Q

5 risk factors for vulvo-vaginal candidiasis infections?

A 
sexual activity
oral contraceptives
ABX use
pregnancy
diabetes
85
Q

presentation of vulvo-vaginal candidiasis infections (6)

A

itching, soreness, irritation, burning with urination, erythema, vaginal DC

86
Q

Dx of vulvo-vaginal candidiasis

A
  • Clinical Dx usually

- 10% potassium hydroxide microscopy

87
Q

non-pharmacological tx for vulvo-vaginal candidiasis

A

avoid harsh soaps and perfumes, keep genital area clean and dry, eat lactobacillus containing (probiotic) yogurt

88
Q

pharmacological tx for vulvo-vaginal candidiasis

A

uncomplicated: topical or oral
fluconazole (oral)
(a bunch of “-azole” options, and nystatin)

89
Q

pharmacological tx for complicated vulvo-vaginal candidiasis

A

same (topcial) drugs increase duration of tx to 10-14 days

upto date says: 2-3 oral doses of fuconazole every other day

90
Q

how does candidasis become a deep, invasive infection

A
  • cathederization and broad spec ABX can cause candida cystitis
  • an also be in blood stream (candidemia/ candiduria)
91
Q

what do you see in blood or urine cultures fo rdeep, invasive candidasis infections?

A
  • leukocytosis, no bands

- 100,000 organisms/ml in urine is diagnostic w/ fever

92
Q

tx of candiduria

A

-tx only required if symptomatic
-fluconazole 200mg/d X14d
(Ampho B bladder irrigation BID is minimally effective)

ClinMed1 Exam 4 (5 decks)

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