Fungal lung infection Flashcards

1
Q

What are the 4 most common microbes that cause fungal infections of the lung?

A

Histoplasmosis
Coccidiomycosis
Blastomycosis
Pneumocystis

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2
Q

What is charicteristic of Histoplasmosis infection?

A

Thermal Dimorphism

  • Mycelial at 25 C
  • yeast at 37 C
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3
Q

In what geographic area and exposure history is Histoplasmosis most common

A

Found worldwide mostly in north and central America
Most common in Midwest and central states along Ohio ad Mississippi rivers
Speulunking
Demolition
Bird Droppings

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4
Q

What is the disease course in Histoplasmosis?

A

Cell mediated immunity dev in 2 weeks. if not controlled, calcified nodules will develop in lungs, spleen, etc
Immunocompromised will have disseminated infection

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5
Q

WHat is seen on imaging in Histoplasmosis?

A

Hilar and mediastinal lymphadenopathy with focal infiltrates (patchy and nodular)
Rare cavitation
DIFFERENTIATE FROM SARCOIDOSIS!!! dont want to immunosupress if it’s Histo

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6
Q

When is Acute vs Chronic Histoplasmosis seen?

A
Acute with extensive exposure
-Infiltrates 
-resp failure
Chronic with underlying COPD
-fever, chils, chest pain, prod cough
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7
Q

What syndromes are associated with Histoplasmosis?

A
Broncholithiasis
Mediastinal granuloma
Fibrosing mediastinitis 
Pericarditis
Rheumatologic manifestations 
Derm findings with erythema nodosum/multiform
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8
Q

What is the treatment of Histoplasmosis?

A
Amphoteracin B -Most potent but terrible Side effects
Itraconazole
Fluconazole
Posaconazole/vorcoanzole
Related to severity of infection
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9
Q

What are the geographic locations associated with Coccidiomycosis?

A

Grows in the Soil in lower desert areas
C. immitis only in Cali
C. Posadosaii in other states
Can be infected with very brief exposure

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10
Q

How is Coccidiomycosis diagnosed?

A

Serological Testing Immunodiffusion(most specific), precipitin antibodies , complement fixation,
ELISA (most sensitive)

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11
Q

WHat is the treatment of coccidiomycosis?

A

Can either resolve on its own or be asymptomatic for long periods
12 month program with an Azole

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12
Q

What is the geographic and exposure association with Blastomycosis?

A

North America and Africa
Southeastern and south central states, and Midwestern states by great lakes
Moist wooded areas(decaying vegitation and wood)

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13
Q

How is blastomycosis diagnosed?

A

Budding yeast on wet prep of samples of Sputum, pleural fluid, urine, or CSF.

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14
Q

What people are predisposed to developing Pneumocystis?

A

HIV or immunosupressed CD4 count

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15
Q

What are the symptoms of Pneumocystitis in non-HIV patients?

A

Fulminant respiratory failure
Fever and non-productive cough
Bilateral infiltrates on X-ray
Grpund glass on CT

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16
Q

How is Pneumocystis diagnosed?

A

Staining of organisms

Sputum induced with hypertonic saline or BAL

17
Q

What is the Treatment of Pneumocystis?

A

TMP-SMX in non-HIV patients
if intolerant use atovaquone, clindamycin/primaquine
IV Pentamidine in severe cases (bad side effects)

18
Q

Which patients should be given prophylaxis for Pneumocystis?

What drug is used?

A

Pts recieving >20 mg/day Prednisone + other immunosupressives
alemtuzamab
ALL
TMP/SMX is drug for prophylaxis