Fungal Meningitis (10) Flashcards

0
Q

What is the most common agent in fungal meningitis in immunocompromised patients?

A

Cyrptococcus neoformans

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1
Q

What population would a fungal meningitis most likely be seen in?

A

Immunocompromised–> 85% of cases are in HIV-infected patients

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2
Q

What form are cryptococcus always seen in?

A

always encapsulated yeasts (not dimorphic)

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3
Q

How is cryptococcus n. acquired?

A

Via inhalation (comes from pidgeon droppings or soil)–> establishes an asymptomatic initial pulmonary infection that subsequently spreads via blood to CNS

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4
Q

What three ways can cryptococcus be identified in the CSF?

A
  1. Microscopic identification of yeast forms in CSF
  2. Antigen detection for fungi in CSF
  3. Culture of CSF for fungo
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5
Q

What test is used to detect Cryptococcus antigen in the CSF?

A

Latex agglutination test

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6
Q

What test is used to confirm microscopic presence of Cryptococcus?

A

India ink–> will see yeast with “halos”

*halos due to the capsule

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7
Q

What medium must Crytococcus n. be cultured on?

A

Saborad’s agar

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8
Q

What fungus account for most cryptococcal infections of healthy individuals?

A

Crytptococcus gattii–> found in sub-tropical regions and in US o the west coast

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9
Q

What is treatment for cryptococcosis?

A

Maximum tolerated doses of amphotericin B + flucytosine

*flucytosine enters the CNS better

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10
Q

What organism is the causative agent of the fungal meningitis outbreaks due to contaminated steroids in Fall 2012?

A

Exserohilum rostratum–> is a common environmental black mold that rarely causes infection

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11
Q

If steroid-associated fungal meningitis is suspected, what two things should be done to confirm?

A
  1. culture of CSF

2. send CSF to CDC for PCR analysis

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12
Q

How do Exderohilim rostratum differ from cryptococcus neoformans morphologically?

A

Exserohilum r. are branched-looking fungi, not the rounded encapsulated yeast seen with cryptococcus n.

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13
Q

What is treatment for sterioid-associated meningitis due to Exserohilum rostratum?

A
  1. IV voriconazole for 3 months

* non-responders or sever cases should receive amphotericin B for 3 mo or more

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