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.Pathology 2 > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

list the endemic vs. opportunist fungi

A
  • endemic:
    • histoplasmosis
    • coccidioides
  • opportunistic:
    • candida
    • aspergillus
    • mucor
    • cryptococcus
    • pneumocystis jiroveci
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2
Q

describe the damage by fungal infections and an exception

A
  • causes tissue inflammation (mixture of acute and chronic)
  • the presence of PMN + lymphocytes + monocytes + giant cells
  • tendency to invade blood vessels → hemorrhage, thrombosis, infarction
  • exceptions:
    • cryptococcus: elicits minimal or absent inflammatory cell infiltrate in immunodeficient hosts
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3
Q

describe th etiology and risk factor pneumocystis jeroveci pneumonia (PCP)

A
  • etiology:
    • P. jiroveci
  • risk factor:
    • advanced HIV infection (<200 CD4 T-cell); may also affect severe malnourished children, organ transplant patients and individuals on chemotherapy
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4
Q

describe the clinical features and diagnosis of PCP

A
  • clinical features:
    • SOB, dry cough, hypoxia
  • diagnosis:
    • CXR (best initial test)
    • bronchio-alveolar lavage
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5
Q

describe the 4 types of candidiasis

A

caused by Candida albicans

  1. oral thrush: gray-white, dirty gray pseudomembrane
  2. esophagitis: seen in AIDS and hematolymphoid malignancies
    • presentation: odynophagia
  3. vaginitis: seen in diabetes, pregnancy, oral contraceptive pills
    • itching, soreness, redness, thick (creamy cheese) discharge
  4. skin infection: onychomycosis, paronychia, folliculitis, balanitis, diaper rash
  5. invasive candidiasis
    • immunocompromised patient
    • causes candidemia with wide spread abscesses in the brain, eyes, kidney, bones, lung, liver, heart
    • candida endocarditis: most common fungal endocarditis
      • occurs in pt with prosthetic heart valves or IV drug abusers
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6
Q

describe the investigations of Candidiasis

A
  • investigation: PAS stain → pink slender hyphae
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7
Q

describe what is seen in the image

A
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8
Q

describe the etiology and risk factors for Cryptococcus infections

A
  • etiology:
    • Cryptococcus neoformans: budding yeast with narrow-based buds; surrounded by a thick capsule
      • found in pigeon excretions
  • risk factors:
    • HIV/AIDS, organ transplant, leukemia and lymphomas
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9
Q

describe the pathogenesis of Cryptococcus infections

A
  • pathogenesis:
    • the polysaccharide capsule is a major virulence factor, inhibiting phagocytosis, leukocyte migration and recruitment of inflammatory cells
    • primary lung disease (40%): granulomatous inflammation with caseation
      • do NOT have to be immunocompromised
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10
Q

describe a complication of Cryptococcus infection

A
  • if disseminated: meningitis and meningoencephalitis
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11
Q

describe the cycle of Cryptococcus infection

A
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12
Q

describe the clinical features of Cryptococcus infections

A
  • clinical features:
    • lung: fever, dry cough, SOB and chest pain
    • brain: fever, headache, confusion, nausea and vomiting
      • brain gross examination: cystic spaces containing “soap bubble” like organisms
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13
Q

describe investigations of Cryptococcus infections

A
  • investigations:
    • sputum and BAL
    • PAS, silver stain, mucicarmine
    • CSF: add a drop of India ink → organisms appear as clear halo → negative staining (best initial test)
    • latex agglutination test: using antibodies that detects cryptococcal antigens in blood and CSF (most specific test)
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14
Q

describe what is seen in the image

A
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15
Q

describe what is seen in the image

A
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16
Q

describe what is seen in the image

A
17
Q

describe the etiology of aspergillosis

A
  • opportunistic fungal infection: occurs with weakened immunity or with the presence of an underlying lung disease
  • caused by Aspergillus fumigatus
  • ubiquitous in nature, spores can be isolated from air anywhere on earth
18
Q

describe allergic bronchopulmonary aspergillosis

A
  • common in patients with asthma
  • can lead to COPD in untreated
  • IgE mediated (type I hypersensitivity reaction
  • presents as worsening asthma (cough, wheezing, SOB)
19
Q

describe aspergilloma

A
  • also called fungal balls
  • occurs after the fungus colonizes pre-existing lung cavities (TB, old abscesses)
  • can cause massive hemoptysis in 60-80% of patients
20
Q

describe invasive aspergillosis

A
  • occurs in severely immune suppressed patients
  • necrotizing pneumonia with vascular invasion
  • presents with cough, dyspnea, pleuritic chest pain and sometimes, hemoptysis
  • vascular involvement can lead to hemorrhagic infarctions
  • can disseminate to heart, brain kidney
21
Q

describe investigations of aspergillosis

A
  • investigation:
    • demonstrate hyphae by PAS, silver stains
      • hyphae have frequent septae, narrow angled (<45 degrees)
22
Q

describe what is seen in the image

A
23
Q

describe the etiology of mucromycosis

A
  • caused by zygomycetes (Rhizopus and mucor)
  • opportunistic infection:
    • common in immunosuppressed patients
    • associated with diabetes-1 (DKA)
24
Q

describe the pathogenesis of mucormycosis

A
  • pathogenesis:
    • route of entry: spores inhalation, ingestion or via skin
    • colonize nasal cavity/sinuses → extend to brain, orbit and other head/neck structures
    • can affect the lungs (cavitation) or gut (among malnourished)
    • marked vascular invasion → necrosis, infarction
25
Q

describe the clinical features of mucormycosis

A
  • clinical features:
    • rhinocerebral mucormycosis: headache, nasal congestion, black pus discharge and fever
    • late symptoms: diplopia, visual loss, proptosis and confusion
    • pulmonary mucormycosis: cough, hemoptysis, SOB
    • GI mucromycosis: abdominal pain, bloody stool and diarrhea
26
Q

describe the investigations for mucormycosis

A
  • investigations:
    • MRI/CT scan, biopsy with silver stain, PAS
    • non-septate hyphae, which branch at 90 degree angles
27
Q
A
28
Q

describe the etiology of histoplasmosis

A
  • caused by histoplasma capsulatum
  • most common systemic fungal infxn
  • endemic in Ohio and central Mississippi river valleys
  • exposure occurs in construction sites, caves
  • inhalation of spores in dust contaminated with excreta from bats, starlings or chickens
29
Q

describe the pathogenesis of histoplasmosis

A
  • weakened immunity → inhalation of spores → multiplication within macrophages → spread to different organs via lymphatics
30
Q

describe the clinical features of histoplasmosis

A
  • usually asymptomatic
  • if symptoms occur, they are nonspecific; flu-like syndrome usually self-limited
  • fever, fatigue, night sweats, dry cough +/- hemoptysis
  • similar to TB
31
Q

describe the pathology/morphology of histoplasmosis

A
  • acute (primary) pulmonary infxn
  • chronic (granulomatous) pulmonary disease
  • disseminated military disease
32
Q

describe the investigations of histoplasmosis

A
  • investigations:
    • CXR, CT scan
    • serology
    • BAL with Gomori Methenamine Silver (GMS) stain
    • fine needle aspiration cytology from LN or lungs
33
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34
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.Pathology 2 (28 decks)

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