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Respiratory > Fungal Infections of the Respiratory Tract > Flashcards

Fungal Infections of the Respiratory Tract Flashcards

1
Q

What is the most common endemic fungal infection in the US?

A

Histoplasmosis

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2
Q

Where is histoplasma usually found?

A

Midwest and central states along the ohio and Mississippi river valleys

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3
Q

What type of soil is histoplasmosis usually found in?

A

Those with bird or bat droppings

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4
Q

Spelunkers disease = ?

A

Histoplasmosis

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5
Q

What is the morphological change that histoplasma undergoes from the soil to in the body?

A

Yeast in the heat, mold in the cold

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6
Q

What are the typical locations that contain histoplasmosis? (3)

A

Caves
Farm buildings
Wood lots

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7
Q

What are the two major routes through which histoplasmosis gains access to the body?

A

Inhalation

Transplantation

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8
Q

Who is at risk for the development of histoplasmosis?

A

Impaired cell mediated immunity

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9
Q

What are the findings with resolved histoplasmosis infections?

A

Calcified lung nodules

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10
Q

What is the mortality rate with histoplasmosis?

A

7.5%

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11
Q

What is the most common manifestation of histoplasmosis?

A

Asymptomatic infection

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12
Q

How long do subacute cases of histoplasmosis last for?

A

Weeks to months post exposure

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13
Q

What are the ssx of histoplasmosis?

A 
Fevers
Chills
Cough
Chest pain
Myalgias

(non-specific)

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14
Q

What are the usual exam findings with histoplasmosis?

A

Rales and possibly consolidation

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15
Q

What are the CXR finding with histoplasmosis?

A

Hilar and mediastinal lymphadenopathy with focal infiltrates which are patchy or nodular in appearance

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16
Q

Cavitations with histoplasmosis, but are sometimes seen with what disease?

A

COPD

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17
Q

How long does the LAD with histoplasmosis last for?

A

Years

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18
Q

What is the main other noninfectious disease that looks very similar to histoplasmosis?

A

Sarcoidosis

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19
Q

What is sarcoidosis?

A

Decreased cell mediated immunity, but increase humoral immunity. This causes

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20
Q

Who is sarcoidosis usually seen in (Ethnicity)?

A

Blacks

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21
Q

What are the two forms of acute histoplasmosis?

A

Reticulonodular

Milliary

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22
Q

What are the pulmonary clinical manifestations of histoplasmosis? (3)

A

Broncholithiasis
Mediastinal granuloma
Fibrosing mediastinitis

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23
Q

What are the cardiac/vascular clinical manifestations of histoplasmosis? (2)

A

Pericarditis

Superior vena cava syndrome

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24
Q

What are the systemic clinical manifestations of histoplasmosis? (1)

A

Rheumatological

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25
Q

What are the dermatological clinical manifestations of histoplasmosis? (2)

A

Erythema nodosum

Erythema multiforme

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26
Q

What is erythema nodosum?

A

an inflammatory condition characterised by inflammation of the fat cells under the skin, resulting in tender red nodules or lumps that are usually seen on both shins. It can be caused by a variety of conditions

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27
Q

What pulmonary findings what suggest histoplasmosis? (4)

A
  • Pneumonia with mediastinal adenopathy
  • Mediastinal or hilar masses
  • Pulmonary nodule
  • Cavitary lung disease
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28
Q

What other finding with pericarditis should histoplasmosis be suspected?

A

-Pericarditis with LAD

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29
Q

What is the most useful test to diagnose Histoplasmosis? How long does this take?

A

Cultures

Weeks

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30
Q

What is the fastest way to diagnose histoplasmosis?

A

Antigen detection in the blood or urine

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31
Q

What does the urine/blood test for histoplasmosis look for?

A

H. Capsulatum galactomannan

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32
Q

Complement tities of what value are highly suggestive of histoplasmosis?

A

1:32

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33
Q

Which has a higher sensitivity, and which has a higher specificity: complement fixation, immunodiffusion

A 
CF = sensitive
ID = specific
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34
Q

How do you treat mild-moderate Histoplasmosis?

A

Itraconazole for 6-12 weeks

35
Q

How do you treat moderate-severe Histoplasmosis?

A

Amp B 1-2 weeks, then itraconazole for 12 weeks

36
Q

How do you treat the cavitary form of histoplasmosis?

A

Itraconazole for at least 12 months

37
Q

What is the most common region of the US for coccidioidomycosis?

A

Desert southwest

38
Q

What are the 2 specific of coccidioidomycosis? Where are each of these found?

A

Immitis = california

Posadasii =elsewhere

39
Q

What form is coccidioidomycosis found in?

A

Yeast in the heat, mold in the cold

40
Q

What is the seasonal variation with coccidioidomycosis?

A

dry seasons following rainy ones

41
Q

Valley fever = ?

A

coccidioidomycosis

42
Q

What is the histological finding with coccidioidomycosis?

A

Spherules

43
Q

Spherules on histology = ?

A

coccidioidomycosis

44
Q

What is the most common clinical presentation of coccidioidomycosis?

A

Asymptomatic to benign fever

45
Q

What is the most common symptom of coccidioidomycosis?

A

Pneumonia with hemoptysis

Fatigue and arthralgias

46
Q

What are the skin lesions that can be found with coccidioidomycosis? HOw common is this compared to Histoplasmosis?

A

Erythema multiforme
Erythema nodosum

Much less common than histo

47
Q

What is the treatment for the pulmonary nodules that can occur with coccidioidomycosis?

A

None needed

48
Q

Which 2 forms of pneumonia d/t coccidioidomycosis infection requires treatment?

A

Reticulonodular

Chronic fibrocavitary pneumonia

49
Q

What is the best way to diagnose coccidioidomycosis? Why?

A

Serological testing

Culture takes too long to grow, and exposes lab workers

50
Q

True or false: any positive test for coccidioidomycosis is significant

A

True

51
Q

Does a negative test for coccidioidomycosis r/o it definitively?

A

No

52
Q

What are the specific serological tests for coccidioidomycosis?

A

ELISA

Complement fixation

53
Q

How do you determine if the cavitary lesions seen with coccidioidomycosis need treatment?

A

If cavities are thin walled and asymptomatic

54
Q

What is the use of the skin test for coccidioidomycosis?

A

helps to r/o, but any exposure will result in a positive test

55
Q

What is the treatment for chronic fibrocavitary disease caused by coccidioidomycosis?

A

12 months of an azole

56
Q

What is the treatment for reticulonodular pneumonia caused by coccidioidomycosis?

A

Amp B

57
Q

Where, geographically, is Blastomycosis usually found?

A

Southeastern and south-central states

58
Q

Where in the environment is Blastomycosis usually found

A

WOoded areas with decaying vegetation

59
Q

What is the form of blastomycosis in the environment and in the body

A

Yeast in the heat, mold in the cold

60
Q

What are the histological findings of Blastomycosis?

A

Broad based budding yeast with a thick wall

61
Q

What are the two most common infections with Blastomycosis?

A

Lung (91%)

Skin (18%)

62
Q

What are the characteristics of the skin lesion produced by Blastomycosis?

A

Verrucous with irregular borders and gray to violet color

63
Q

What is the usual presentation of Blastomycosis (when symptomatic)?

A

Pneumonia (just like TB/others)

64
Q

What are the characteristics of the cough with Blastomycosis ?

A

non-productive, progressing to productive

65
Q

How do you diagnose Blastomycosis?

A

Culture is definitive, but presumptive diagnosis can be made with sputum sample with yeast

66
Q

True or false: symptomatic Blastomycosis usually requires treatment

A

True

67
Q

What is the treatment for Blastomycosis?

A

Amp B until 1-2 weeks

If mild, then itraconazole

68
Q

Who gets infected with pneumocystis?

A

Only Immunocompromised

69
Q

True or false: most of us never encounter pneumocystis

A

False–very common. Is a opportunistic infection

70
Q

What type of tumors predisposed to pneumocystis infection?

A

Solid tumors or hematological malignancies

71
Q

What is the usual presentation of pneumocystis infection in the HIV patient? Non HIv?

A
  • HIV = gradual

- Non-HIV = fulminant respiratory failure

72
Q

What are the typical ssx of pneumocystis infection?

A

Cough and fever

73
Q

What are the CXR findings with pneumocystis?

A

Bilateral interstitial infiltrates, maybe pneumothorax

74
Q

What are the CT findings with pneumocystis?

A

Ground glass changes

75
Q

HIV patient who develops pneumonia leading to a pneumothorax should be suspected of having what infection?

A

pneumocystis

76
Q

Can you culture pneumocystis? How do you diagnose it?

A
  • No

- Need to stain with special stains

77
Q

What is the typical way to diagnose pneumocystis?

A

Hypertonic saline and BAL sample

78
Q

What is the treatment for pneumocystis?

A

TMP-SMX

79
Q

What level of prednisone use should prophylaxis begin for pneumocystis?

A

Greater than than 20 mg daily

80
Q

Use of what drug indicates that need to use prophylactic therapy for pneumocystis?

A

Alemtuzumab

81
Q

What leukemia should have prophylaxis for pneumocystis?

A

ALL

82
Q

What is the prophylactic treatment for pneumocystis?

A

TMP-SMX once daily

83
Q

Below what CD count are HIV patients susceptible to pneumocystis?

A

200

Respiratory (34 decks)

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