Fungal lung infection Flashcards
What are the 4 most common microbes that cause fungal infections of the lung?
Histoplasmosis
Coccidiomycosis
Blastomycosis
Pneumocystis
What is charicteristic of Histoplasmosis infection?
Thermal Dimorphism
- Mycelial at 25 C
- yeast at 37 C
In what geographic area and exposure history is Histoplasmosis most common
Found worldwide mostly in north and central America
Most common in Midwest and central states along Ohio ad Mississippi rivers
Speulunking
Demolition
Bird Droppings
What is the disease course in Histoplasmosis?
Cell mediated immunity dev in 2 weeks. if not controlled, calcified nodules will develop in lungs, spleen, etc
Immunocompromised will have disseminated infection
WHat is seen on imaging in Histoplasmosis?
Hilar and mediastinal lymphadenopathy with focal infiltrates (patchy and nodular)
Rare cavitation
DIFFERENTIATE FROM SARCOIDOSIS!!! dont want to immunosupress if it’s Histo
When is Acute vs Chronic Histoplasmosis seen?
Acute with extensive exposure -Infiltrates -resp failure Chronic with underlying COPD -fever, chils, chest pain, prod cough
What syndromes are associated with Histoplasmosis?
Broncholithiasis Mediastinal granuloma Fibrosing mediastinitis Pericarditis Rheumatologic manifestations Derm findings with erythema nodosum/multiform
What is the treatment of Histoplasmosis?
Amphoteracin B -Most potent but terrible Side effects Itraconazole Fluconazole Posaconazole/vorcoanzole Related to severity of infection
What are the geographic locations associated with Coccidiomycosis?
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
How is Coccidiomycosis diagnosed?
Serological Testing Immunodiffusion(most specific), precipitin antibodies , complement fixation,
ELISA (most sensitive)
WHat is the treatment of coccidiomycosis?
Can either resolve on its own or be asymptomatic for long periods
12 month program with an Azole
What is the geographic and exposure association with Blastomycosis?
North America and Africa
Southeastern and south central states, and Midwestern states by great lakes
Moist wooded areas(decaying vegitation and wood)
How is blastomycosis diagnosed?
Budding yeast on wet prep of samples of Sputum, pleural fluid, urine, or CSF.
What people are predisposed to developing Pneumocystis?
HIV or immunosupressed CD4 count
What are the symptoms of Pneumocystitis in non-HIV patients?
Fulminant respiratory failure
Fever and non-productive cough
Bilateral infiltrates on X-ray
Grpund glass on CT
How is Pneumocystis diagnosed?
Staining of organisms
Sputum induced with hypertonic saline or BAL
What is the Treatment of Pneumocystis?
TMP-SMX in non-HIV patients
if intolerant use atovaquone, clindamycin/primaquine
IV Pentamidine in severe cases (bad side effects)
Which patients should be given prophylaxis for Pneumocystis?
What drug is used?
Pts recieving >20 mg/day Prednisone + other immunosupressives
alemtuzamab
ALL
TMP/SMX is drug for prophylaxis
