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ID REVIEW > Fungal Infections > Flashcards

Fungal Infections Flashcards

1
Q

Candidemia TOC

A

Echinocandin

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2
Q

.

Invasive aspergillosis TOC

A

Voriconazole

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3
Q

Allergic bronchopulmonary aspergillosis TOC

A

Itraconazole or voriconazole

+ glucocorticoids

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4
Q

Aspergilloma (fungus ball) TOC

A

Itraconazole, voriconazole, posaconazole

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5
Q

Mucormycosis TOC

A

Liposomal amphotericin B, high-dose amphotericin B deoxycholate; posaconazole

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6
Q

Cryptococcal meningitis TOC

CSF findings . . .

A

Induction period: amphotericin B and flucytosine

Consolidation period: oral fluconazole

Maintenance period: oral fluconazole

Organ transplant may require life-long antifungal therapy.

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7
Q

Nonmeningeal cryptococcosis TOC

A

Fluconazole

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8
Q

Cutaneous/pulmonary/extrapulmonary Blastomycosis TOC

A

Lipid formulation of amphotericin B followed by itraconazole (check blood levels)

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9
Q

CNS Blastomycosis TOC

A

Lipid formulation of amphotericin B followed by fluconazole

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10
Q

Mild to moderate acute pulmonary Histoplasmosis TOC

A

Itraconazole

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11
Q

Moderately severe to severe pulmonary Histoplasmosis TOC

A

Lipid formulation of amphotericin B followed by itraconazole

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12
Q

Acute progressive disseminated Histoplasmosis TOC

A

Lipid formulation of amphotericin B followed by itraconazole

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13
Q

Pulmonary (patient at low risk) Coccidioidomycosis TOC

A

No treatment indicated

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14
Q

Primary pulmonary (patient at high risk) Coccidioidomycosis TOC

A

Itraconazole, fluconazole

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15
Q

Severe coccidioidal pneumonia or disseminated disease TOC

A

Conventional or lipid formulation of amphotericin B until improved, then itraconazole or fluconazole

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16
Q

Coccidioidal meningitis TOC

A

Fluconazole

should be lifelong

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17
Q

Cutaneous sporotrichosis TOC

A

Itraconazole

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18
Q

Can a negative culture exclude the diagnosis systemic candidiasis ?

A

N O !

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19
Q

How can candida present on skin?

A

As painless skin papules or pustules on an erythematous base

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20
Q

When NOT to use echinocandins

A

Not for those with Candida meningitis, UTI, or endophthalmitis because of poor organ penetration.

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21
Q

TOC for Candida parapsilosis

A

Fluconazole;

because C. parapsilosis may have reduced susceptibility to echinocandins.

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22
Q

Treatment duration for uncomplicated candidemia

A

14 days after clearance of the organism from the bloodstream and resolution of symptoms.

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23
Q

When to treat ASYMPTOMATIC candiduria

A

Only in neutropenic patients and those undergoing urologic procedures.

Neutropenic patients with asymptomatic candiduria should be treated similarly to those with candidemia.

24
Q

Common sites for Aspergillus infection . . .

A

Lung being the principal site of clinical infection, followed by the paranasal sinuses.

25
Q

Manifestations of pulmonary Aspergillosis . . .

A

Colonization,

allergic bronchopulmonary aspergillosis,

aspergilloma (fungus ball), or

invasive aspergillosis.

26
Q

Cardinal features of Allergic bronchopulmonary aspergillosis

A

asthma-like symptoms,

fleeting pulmonary infiltrates on imaging,

peripheral eosinophilia,

elevated serum IgE levels,

serum Aspergillus-precipitating antibodies, and

cutaneous reactivity to Aspergillus antigens

27
Q

When can you see an “halo sign” ?

A

Invasive pulmonary Aspergillosis and mucormycosis

28
Q

What can impair sensitivity of β-D-glucan assay ?

A

Antifungal drugs and Zosyn

29
Q

“Particular” risk factor for Mucormycosis ?

A

hematologic malignancies,

organ transplantation,

diabetes /ketoacidosis

deferoxamine for iron-overload

Outbreaks have also been reported during natural disasters.

30
Q

Pathognomonic finding of rhinocerebral mucormycosis ?

A

presence of a black eschar on nose or palate

31
Q

Mucormycosis histology . . .

A

broad, irregular, and ribbon-like aseptate hyphae with right-angle branching.

32
Q

Predominant Crypto species in the United States?? In California?

A

All US: C. neoformans

California: C. gattii

33
Q

Most common site of disseminated cryptococcosis

A

CNS

subacute or chronic meningoencephalitis.

34
Q

What to do when cryptococcosis is found outside of the CNS

A

Lumbar puncture !!!

Skin lesions imply disseminated disease.

35
Q

Check crypto Ag (serum or CSF)

A

sensitivity of the serum assay is lower in patients without HIV infection

Confirm w/ culture

36
Q

Blastomyces dermatitidis is endemic to .

MOIST EARTH NEAR RIVER, BEAVER DAMS.

A

Ohio and Mississippi river valleys,

Great Lakes, and

the St. Lawrence River

37
Q

MoCo site of infection for Blastomycosis ?

A

Primarily lungs.

Second most frequent is SKIN (painless chronic ulcer/lesion), followed by the bones, joints, and prostate.

38
Q

What test should all patients with disseminated blastomycosis get

A

Bone scan to detect occult osteoarticular infection

39
Q

What serves as nidus for infection/relapse in Blastomycosis ?

A

Prostate, thus get UCx

40
Q

Histoplasma capsulatum is the MoCo mycosis in the US and is found in . . .

A

the Ohio and Mississippi river valleys.

41
Q

Histoplasmosis presentation . . .

A

Asymptomatic,

Pulmonary Histoplasmosis (miliary lung lesions)

Disseminated disease (subacute fever, pancytopenia, hypoadrenalism, mucosal lesions- gingival ulcers)

42
Q

May be seen in Histoplasmosis on peripheral blood smear

A

Small yeast forms within neutrophils

Check urine Ag

43
Q

Coccidioides immitis and Coccidioides posadasii are endemic to . . .

Both serious lab hazards

A

Desert areas of the southwestern US, including Arizona, New Mexico, Texas, and the central valley of California;

Also parts of Central and South America

44
Q

What is Valley fever ?

A

Valley fever is a subacute Coccidioidomycosis infection with respiratory symptoms, fever, and erythema nodosum.

45
Q

What is “desert rheumatism,” ?

A

Arthralgia of multiple joints seen in Coccidioidomycosis

46
Q

Risk factors for disseminated Coccidioidomycosis . . .

A

Immunosuppression,

AIDS, or

pregnancy

skin, bones (including vertebrae), joints, and the meninges.

47
Q

Where is Sporothrix schenckii found ?

A

Soil, moss, and other vegetation

landscaping, gardening.

48
Q

Sporotrichosis lesions

A

A papule appears days to weeks after
inoculation and ulcerates.

Similar lesions “spread” along lymphatics

Skin, pulmonary, osteoarticular infection

49
Q

Exserohilum rostratum

A

Outbreak of meningitis and other infections due to contaminated lots of methylprednisolone

Treated with voriconazole

50
Q

endemic mycoses = dimorphic fungi

• USA

A

 Histoplasmosis
 Coccidioidomycosis
 Blastomycosis

51
Q

endemic mycoses = dimorphic fungi

• Overseas

A

 Talaromycosis marneffei (Penicilliosis marneffei)
 Paracoccidioidomycosis (South American
blastomycosis)

52
Q

Histoplasmosis exposure risk factor

A

Dust from rich earth (digging, raking) or bat guano (caving).

53
Q

Coccidiodomycosis HY points

A

thin walled cavity may persist

chronic meningitis- Serum and CSF serology useful.

Eosinophilia in CSF.

COCCI SPHERULE BIG, NO BUDDING

Rx: fluconazole. Nonmeningeal: itraconazole

54
Q

Paracoccidioides brasiliensis, HY points

A

Multiply budding yeast, slow growing mold.

skin and mucosal membranes

Asymptomatic infiltrates on chest xray.

-Serodiagnosis in endemic areas. Biopsy.

55
Q

TALAROMYCOSIS

 Talaromyces marneffei (Penicilosis)

A

 divides by binary fission, no budding
 Thailand, South China
 Bamboo rats
 AIDS, normal children
 Skin lesions (looks like crypto [moluscum like]), lymph nodes, liver, spleen, bone
 Methenamine silver stain of skin or other tissue. Blood culture+
 Treatment: ampho B then itraconazole.

56
Q

Other names for MUCORMYCOSIS

Hyphae invade blood vessels (like Aspergillus)

A

Cunninghamella,
Apophysomyces,
Saksenaea

ID REVIEW (25 decks)

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