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Pulm > Fungal Pneumonia > Flashcards

Fungal Pneumonia Flashcards

1
Q

Dimorphic fungi

A
  1. Blastomyces dermatitidis
  2. Histoplasma capsulatum
  3. Coccidioides immitis
  4. Paracoccidioides brasiliensis
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2
Q

Characteristics of Histoplasma capsulatum

A
  1. Endemic in mississippi and ohio river valleys

2. grows in soil and bird droppings

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3
Q

Dx of Histoplasma capsulatum

A
  1. Tissue biopsy: Oval yeast cells within macrophages
  2. serology
  3. Urinary antigen
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4
Q

Tx of Histoplasma capsulatum

A
  1. Itraconazole (mild/moderate)

2. Amphotericin (IV) followed by Itraconazole (PO) (for severe)

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5
Q

Characteristics of Blastomyces dermatitidis

A
  1. Endemic in Ohio/Mississippi river valleys; Missouri and Arkansas river basins
  2. grows in moist soil
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6
Q

Dx of Blastomyces dermatitidis

A
  1. Tissue biopsy: Thick-walled yeast cells with SINGLE BROAD-BASED BUD
  2. serology
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7
Q

Tx of Blastomyces dermatitidis

A
  1. First Line: Itraconazole (IV) or [Amphotericin (IV) - if severe]
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8
Q

Characteristics of Coccidioides immitis

A
  1. Endemic in Southwestern U.S. and latin America
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9
Q

What organisms cause erythema nodosum?

A
  1. Blastomyces dermatitidis
  2. Coccidioides immitis
  3. MTB
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10
Q

Pathogenesis of Coccidioides immitis

A

In the lungs, large spherules form and are filled with endospores

-spherule walls rupture, endospores are released and differentiate into new spherules

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11
Q

Who are at increased risk for Coccidioides immitis dissemination?

A
  1. African-Americans
  2. Filipinos
  3. Women in 3rd Trimester
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12
Q

Dx of Coccidioides immitis

A
  1. serology
  2. spherules seen microscopically
  3. Eosinophilia is common
  4. Skin test (not common)
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13
Q

Tx for Coccidioides immitis infection

A
  1. Amphotericin (for persistant lung lesion or disseminated disease) (also immunocompromised)
    - followed by itraconazole or flucanazole PO
  2. Fluconazole for meningitis
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14
Q

Characteristics of Paracoccidioides brasiliensis

A
  1. Found in rural Latin America, especially Brazil
  2. More severe desseminated clinical manifestation: oral, nasal and facial nodular ulcerated lesions and submandibular LAD
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15
Q

Dx of Paracoccidioides brasiliensis

A
  1. Tissue biopsy: Yeast cells with multiple buds

2. Serology

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16
Q

Tx of Paracoccidioides brasiliensis

A
  1. Itraconazole - for several months

2. Amphotericin for severe disease

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17
Q

Characteristics of Aspergillus fumigatus

A
  1. found worldwide
  2. Mold with septate hyphae
  3. Grow on decaying vegetation producing chains of conidia
18
Q

Features of Aspergillus fumigatus infections

A
  1. Fungus ball within cavities of lung
    - produce hemoptysis
  2. Allergic rxn of the bronchi
    - produces asthmatic symptoms and high IgE titer
  3. Invasive pneumonia
    - producing hemorhage, infarction, and necrosis
    * esp in those w/ heme malignancies and neutropenia
19
Q

Largest risk factor for Aspergillus fumigatus pneumonia?

A

Having a hematologic malignancy and neutropenia

20
Q

Dx of Aspergillus fumigatus

A

Biopsy:

  1. Septate, acute-angle branching hyphae
  2. radiating chains of conidia
21
Q

Characteristic finding in Aspergillus CT scan?

A

Halo sign (cloudiness) around lesions

  • caused by focal hemorrhage around the lesion
22
Q

Tx of Aspergillus fumigatus

A
  1. First line: Voriconazole (IV/PO)
    2nd: Amphotericin or posaconazole (PO)
  2. Remove fungus balls
  3. for allergic bronchopulmonary aspergillus fumigatus (ABPA): steriods and antifungal agents
23
Q

Characteristics of Mucormycosis

A
  1. Oppertunistic infection caused by bread mold fungi
  2. nonseptate broad hyphae with frequent right angle branching*
  3. Tranmission: airborne spores
  4. invade tissues and vessels (angioinvasive)
24
Q

Risk factors for mucormycosis

A
  1. DM
  2. Neutropenia
  3. Iron overload
  4. Burns/surgical wounds
  5. Corticosteroid use
25
Q

Clinical manifestations of mucormycosis

A
  1. invasive rhinocerebral sinusitis, brain abscesses
    - originates in paranasal sinuses and spreads to orbit, hard palat
    - high mortality rate
  2. Pneumonia
  3. Cutaneous infection
26
Q

Dx of mucormycosis

A

Biopsy

  • nonseptate broad hyphae with frequent right angle branching.
  • spores in a sporangium
27
Q

Tx of mucormycosis

A
  • tx underlying disorder
  • amphotericin
  • surgical removal of necrotic infected tissue
  • posaconazole can also be used
28
Q

Characteristics of Pneumocysitis jiroveci (carinii)

A
  1. Yeast
  2. leading cause of death in AIDs patients
  3. causes pneumonia in immunocompromised (PCP)
29
Q

Pathogenesis of Pneumocysitis jiroveci (carinii)

A

Cysts in alveoli produce inflammatory response resulting in frothy exudate that blocks 02 exchange

  • CD4+ T cells clear out the organism
30
Q

Main risk factor for Pneumocysitis jiroveci (carinii)

A

CD4 count

31
Q

Dx of PCP

A
  1. Lung biopsy: cysts
    - Methenamine silver or Giemsa stains
  2. Flourescent antibody staining
  3. PCR on respiratory tract specimens
32
Q

Tx of PCP

A

1st line: Trimethoprim-Sulfamethoxazole

  • Clindamycin/Primaquine
  • Atovaqone
  • Pentamidine

*prophylaxis for AIDs patients with CD4 ct

33
Q

Characteristics for Cryptococcus neoformans

A
  1. Oval budding yeast with polysaccharide capsule

2. Found in soil and bird (pigeon) droppings

34
Q

Clinical manifestations of Cryptococcus neoformans

A
  1. Causes meningitis in immunocomp. (AIDS)
    - most common life-threatening disease in AIDS pts
  2. Pneumonia in immunosuppressed/compromised
35
Q

Characteristics of cytomegalovirus (CMV)

A
  1. DNA enveloped Virus
    - similar in morphology and structure to other herpes virus
  2. Enters latent state primarily in monocytes and reactivates when immunity decreased
36
Q

Clinical manifestations of CMV

A

Asymptomatic except in immunosuppresed (esp renal and stem cell transplant recipients)
=> Pneumonitis

  • Colitis and retinitis in AIDS pts. (no pneumonitis)
37
Q

Characteristics of Nocardia asteroides

A
  1. Aerobic GP bacterium
  2. may be weakly acid-fast
  3. thin branching filaments
  4. Found in soil
  • causes Nocardiosis
38
Q

Clinical manifestation of Nocardiosis in immunocompromised

A
  1. causes pneumonia, lung abscess with cavity formation, lung nodules or emphysema
  2. Predilection for brain tissue causing abscesses
39
Q

Dx for Nocardiosis

A
  1. Gram stain/acid-fast stain

2. culture

40
Q

Tx for Nocardiosis

A

Trimethoprim-sulfamethoxazole

  • may need combination therapy. Resistance can occur
41
Q

Tx for Cryptococcus neoformans infection

A
  1. CNS: Amphotericin B (IV) + flucytosine (PO)

2. Non-CNS: Fluconazole (PO)

Pulm (14 decks)

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