fungal infections

Question 1

IV treatment for fungal infections

Answer 1

amphoteracin B

Question 2

Cryptococcosis

• describe organism
• Usually affects ___patients
• 3 Classifications
• Spread of infection? Not how?

Answer 2

Cryptococcus neoformans – encapsulated yeast
Usually affects immunocompromised patients
Wound or cutaneous cryptococcosis
Pulmonary cryptococcosis
Cryptococcal meningitis
Spread of infection: Inhalation of airborne fungi, not known to be spread from person to person
*soil contaminated with dried pigeon poop

Question 3

Pulmonary infection
Cough
Cough with the production of scant mucoid sputum
Pleuritic chest pain
Low-grade fever, dyspnea, weight loss, and malaise (less common)

Answer 3

Cryptococcosis

Question 4

Headache, Confusion, Lethargy
Obtundation
Nausea and vomiting – with increased intracranial pressure
Fever and stiff neck – with an aggressive inflammatory response
Blurred vision, photophobia, and diplopia
Seizures, Ataxia, Aphasia, Coma

Answer 4

Meningitis and meningoencephalitis in Cryptococcosis

Question 5

Diagnosis of Cryptococcosis

• cutaneous lesions
• blood
• CSF

Answer 5

*Cutaneous lesions
Biopsy with fungal stains and cultures
*Blood:
Fungal culture
Cryptococcal antigen testing 
*Cerebrospinal fluid
India ink smear – ink doesn’t enter the capsule
Fungal culture
Cryptococcal antigen testing

Question 6

Treatment of Cryptococcosis (3)

Answer 6

Amphotericin B in severe cases or non HIV cases
Flucytosine
po Fluconazole 10 weeks if HIV

Question 7

Histoplasmosis

• found where
• organism
• Typically patients have little or no symptoms if what.

Answer 7

Inhaled spores often found in bird and bat droppings
Histoplasma capsulatum
Typically patients have little or no symptoms if not immunocompromised.

Question 8

Chest pain
Chills
Cough
Fever
Joint pain and stiffness
Muscle aches and stiffness
Extreme weakness

Answer 8

Histoplasmosis

Question 9

Diagnosis testing for Histoplasmosis

Answer 9

Medical and travel history
Laboratory tests
Blood and urine antigen detection – to diagnose systemic disease
CBC – may present mild anemia, pancytopenia
Alkaline phosphatase and lactate dehydrogenase – elevated
Sputum culture
Complement-fixing antibodies
Immunoprecipitating antibodies
Chest x ray – miliary infiltrates
CT Scan of the lungs

Question 10

Histoplasmosis
CBC
CMP
CXR

Answer 10

CBC – may present mild anemia, pancytopenia
CMP: Alkaline phosphatase and lactate dehydrogenase elevated
Chest x ray – miliary infiltrates

Question 11

Histoplasmosis treatment (3)

Answer 11

Symptoms may go away without treatment
Medication – to treat severe histoplasmosis in the lungs, chronic histoplasmosis, and disseminated histoplasmosis
Antifungal Medications
Itraconazole for several months is first line
Amphotericin B
Corticosteroids – to treat acute respiratory distress symptoms

Question 12

Curd like discharge should make you think of what type of infection?

How would you treat a vaginal candida infection?

What component of bactrim are patients often allergic to?

What medication would you use to treat a severe cryptococcus infection?

Which pathogenic fungus should you think of if the question talks about birds or bats as pets?

Answer 12

Curd like discharge should make you think of what type of infection?
Vaginal candida
How would you treat a vaginal candida infection?
Fluconazole one time dose of 150 mg
What component of bactrim are patients often allergic to?
Sulfa
What medication would you use to treat a severe cryptococcus infection?
IV amphotericin B
Which pathogenic fungus should you think of if the question talks about birds or bats as pets?
Histoplasmosis

Question 13

Biopsy –

Thickened alveolar septa with fluffy eosinophilic exudate in the alveoli

Answer 13

to confirm diagnosis for PCP