FUNGAL INFECTIONS OF THE LUNGS Flashcards
AGENTS OF SYSTEMIC MYCOSIS
•_____________
•________________
•________________
•___________________
•_______________
Histoplasma capsulatum
Coccidides immitis
Blastomyces dermatidis
Paracoccidiodes Brasilensis
Cryptococcus neoformans
AGENTS OF SYSTEMIC MYCOSIS
Yeast or mold
•Histoplasma capsulatum
• Coccidides immitis
• Aspergillus fumigatus
• Cryptococcus neoformans
•Blastomyces dermatidis
•Paracoccidiodes brasillensis
Dimorphic
Dimorphic
Mold
Yeast
Dimorphic
Dimorphic
The primary focus of infection for all five agents is the ________.
lungs
Infections of systemic mycosis
• Most cases are (asymptomatic or symptomatic?) or (mild or severe?) of very (short or long?) duration,
asymptomatic
Mild
Short
Infections of systemic mycosis
resolve without therapy
accompanied by a high degree of specific resistance to reinfection.
T/F
T
T
General characteristics of systemic mycosis infections
(Primary or Secondary ?) spread usually brings the patient to hospital.
All grow on _____________ Agar though ____ phases may be inhibited by _______
Secondary
Sabaurauds Dextrose
yeast; cycloheximide
Histoplasma capsulatum
______ disease, _______ disease, ________ disease or reticuloendothelial cytomycosis.
Cave; Darlings
spelunkers
Histoplasma capsulatum
• Occurs by a ______ of the ______
Inhalation
conidia
Histoplasma capsulatum
• Worldwide distribution but is most common in the ———.
• African variant is H. ________ (H. capsulatum var. ________)
USA
duboisii; duboisii
Histoplasma capsulatum
• Over _____ cases reported in Africa and ______ of them are from Nigeria
• a natural reservoir is the _____ cave in Ogbunike in _________ State
250; Half
bat; Anambra
Morphology of Histoplasma capsulatum
The parasitic phase is a (small or large?) budding ______ found almost exclusively in ____________.
•_______has both _____ and _____ conidia
Small
yeast; macrophages
Mould
micro and macro
Histoplasma capsulatum
Mold phase: Note characteristic (small or large?), (rounded or flattened?) , _____-celled, tuberculate _____conidia formed on (short or long?) , _______, (differentiated or undifferentiated?) conidiophores
Large
Rounded
Single
Macro
Short
Hyaline
Undifferentiated
EPIDEMIOLOGY of histoplasma capsulatum
•Habitat is ______ especially in area contaminated with ________________. E.g. ________,___________
Soil
bat and bird droppings
caves, chicken coops barn attics
EPIDEMIOLOGY of histoplasma capsulatum
•Birds are not affected
bats are not affected.
T/F
T
F
Birds not affected though bats may be affected.
histoplasma capsulatum
•Has been known to occur in epidemics
T/F
T
CLINICAL SYNDROME of Histoplasma capsulatum
•________ is portal of entry
•Depends on degree of __________
Lung
immunocompetence
CLINICAL SYNDROME of Histoplasma capsulatum
In Immunocompetent host
•________ or ________-like illness (normal exposure)
•_________ histoplasmosis – heavy exposure
•Complications are (common or rare?) e.g. pericarditis, mediastinal fibrosis
Asymptomatic or mild flu
Acute pulmonary
Rare
CLINICAL SYNDROME of Histoplasma capsulatum
In Immunocompromised host
_________ histoplasmosis – immune defect e.g. in AIDS, leukemia, chronic steroid therapy
___________ histoplasmosis- structure defect (chronic obstructer pulmonary diseases) e.g. cavity
Disseminated
Chronic pulmonary
In Africa – H. duboisii , has a predilection for _______ and ________ tissues.
bone and subcutaneous
TREATMENT of histoplasmosis
•______________
•RELAPSE OCCURS OFTEN IN _______ .
AMPHOTERICIN B
AIDS
ASPERGILLOSIS
• Caused by _____________
•__________ in environment
Aspergillus fumigatus
Ubiquitous
ASPERGILLOSIS
• Molds or yeasts?
• Requires _________ for growth but _______ because of sporolation
Molds
4-5 days
1-3 weeks
ASPERGILLOSIS
• Hyphae are (branching or non -branching?) and (septate or aspetate?)
Branching
Septate
Clinical Syndrome of ASPERGILLOSIS
• Most often route of transmission is by __________
inhalation
ASPERGILLOSIS Causes infections in only both immunosuppressed patients
T/F
F
ASPERGILLOSIS Causes infections in both immunocompetent and immunosuppressed.
Clinical Syndromes of aspergillosis
3 types
• _______
•___________/________
•__________ pulmonary aspergillosis
Allergic
Aggressive/acute Invasive
Chronic
Clinical Syndromes
•Allergic : Aspergillus ________ aspergillosis. Leads to _________ with Fungal Sensitivity
•Aggressive/acute Invasive: _______ pulmonary aspergillosis
•Chronic pulmonary aspergillosis – a ____ of disease ranging from ____________ to ________
Brochopulmonary; Severe Asthma
Invasive
spectrum
aspergilloma (fungal ball) to chronic necrotising aspergillosis
TREATMENT of ABPA (Allergic Bronchopulmonary Aspergillosis)
•______________
•Recurrent or Acute; __________
Oral Glucocorticoids
Itraconazole
TREATMENT of Chronic Pulmonary Aspergillosis
Aspergilloma
•_________ or ___________
•Surgical _______ e.g _______
Itraconazole or voriconazole
resection; lobectomy
TREATMENT of Invasive Aspergillosis
•________
•__________ may be used in combination therapy
Voriconazole
Caspofungin
COCCIDIODOMYCOSIS
Aka
_________ disease, ________ fever, _________
Posada’s
San Joaquin Valley
Desert rheumatism
COCCIDIODOMYCOSIS
•Agent: ________________
•A ________mycete.
Coccidiodes immitis
Deutero
MORPHOLOGY of Coccidiodes immitis
• Mold phase: (Branching or non-branching?) (septate or aseptate?) hyphae with alternate cell developing into __________.
• Yeast Phase: (Small or Large?) _______ structures. they are ______ that are filled with ————-.
Branching; septate
arthroconidia
Large; spherical
spherules; endospores
Culture of Coccidioides immitis on Sabouraud’s dextrose agar showing a _____-like to downy, _______ colony with a __________ reverse.
suede
greyish white
tan to brown
Epidemiology of Coccidiodes immitis
•Geographically restricted to _____,______, and _______
•Has been known to spread extensively following __________
North, Central and South America
dust storms
Disease of New world is ???
COCCIDIODOMYCOSIS
Clinical Syndrome of Coccidiodes immitis
•_____ is the Portal of Entry
• (Mildly or Highly?) pathogenic
Lung
Highly
Clinical Syndrome of Coccidiodes immitis
• Unlike ________, Inhalation of conidia (Spores) leads a (lesser or greater?) number of people to develop a mild febrile to moderately severe pulmonary disease
histoplasma
Greater
Clinical Syndrome of Coccidiodes immitis
• About _____% of individuals develop symptomatic infection following exposure.
• Disseminated infection most commonly affects the _______ and/or ______
40
meninges
skin
Clinical Syndrome of Coccidiodes immitis
Most primary infections are not self-limited
F
Most primary infections are self-limited, may progress in some patients
Coccidiodes immitis Can be grown easily on conventional media but it must be carefully handled because ????
C. immitis is the leading cause of laboratory-acquired fungal infection
__________ is the leading cause of laboratory-acquired fungal infection
C. immitis
Treatment of Coccidiodes immitis
•Long term therapy with __________
•_____________ is a useful alternative
Amphotericin B
Ketoconazole
Cryptococcosis
Agent:____________________
•Class ________
Cryptococcus neoformans
Basidiomycete
Cryptococcosis
•_______________’s Disease, Torulosis
or _______________________
Busse-Buschke
European Blastomycosis.
MORPHOLOGY of cryptococcus neoformans
•Budding (yeast or mold?)
•Most distinctive feature is ______________________
Yeast
an acidic mucopolysaccharide capsule
acidic mucopolysaccharide capsule is Required for pathogenicity by cryptococcus neoformans
T/F
T
Visualisation of capsule of cryptococcus neoformans is in _____________
India ink preparation
Epidemiology of cryptococcus neoformans
• World wide distribution
• Recovered in large numbers from excreta and debris of __________
• True prevalence unknown due to _________________________
pigeon roosts
a lack of reliable skin or serological tests
Clinical Syndrome of cryptococcus neoformans
• _______ is the Portal of Entry
•Primary pulmonary infection frequently (asymptomatic or symptomatic?) but can become progressive
•Most common picture is that of a ____________
Lung; asymptomatic
solitary pulmonary nodule
Clinical Syndrome of cryptococcus neoformans
Symptomatic infection is mainly _______ and is usually but not always __________.
•Other disseminated disease include ______ lesions and __________ lesions
meningitis
opportunistic
skin ; osteolytic bone
Pathogenesis of cryptococcus neoformans
• Inhalation of _______ cells & small _______ into lungs
• Migrate to ____ where they cause __________
• Major clinical manifestation may resemble brain tumour brain abscess, degenerative CNS disease or T.B /fungal meningitis
• May have lesions in _____,_______ and other organs
dessicated yeast; basidiospore
CNS; meningoencephalitis
skin (orofacial) , lungs
Cryptococcus neoformans produces urease
T/F
T
Treatment of cryptococcus neoformans
• Pulmonary lesions usually ____—-
• Disseminated disease is usually ____ if untreated
• ________________
• Add _____________ in meningitis for better CSF penetration
self-limited
fatal
Amphotericin B
5-fluocytosine
