Fungal Pneumonia

Question 1

3 yeast pathogens

Answer 1

candida, PJP, crypto

Question 2

2 mold pathogens

Answer 2

aspergillus, mucor/rhizopus

Question 3

3 dimorphic pathogens

Answer 3

blastomyces, histoplasma, coccidiodes

Question 4

2 branching bacteria

Answer 4

nocardia, actinomyces

Question 5

structure of candida

Answer 5

budding yeasts and/or pseudohyphae

*germ tube formation at 37 degrees in culture for Dx, looks kinda like sperm

Question 6

candida infection

Answer 6

usually extrapulmonary - mucocutaneous or blood

rare pulm infections in neutropenic pts

Question 7

candida Rx

Answer 7

requires isolation from biopsy, use echinocandins or ampho B

Question 8

structure of crypto

Answer 8

heavily encapsulated, ring around it on culture

Question 9

crypto infection

Answer 9

most commonly meningitis

pulm sx are non specfiic

if either meningitis or pneumonia is found, need to look for the other

Question 10

dx and rx for crypto

Answer 10

direct visualization in india ink, culture, antigen detection

rx w/ ampho B and flucytosine

Question 11

shape of PJP

Answer 11

disc shaped years in lungs, hamburger like

Question 12

PJP and HIV

Answer 12

can have extrapulm infection in late AIDS

strongly associated w/ HIV

Question 13

PJP outcomes

Answer 13

worse in those immunocompromised by something other than HIV

Question 14

PJP dx and rx

Answer 14

diffuse interstitial pneumonia (ground glass) on CXR, direct visualization from lung tissue/sputum/BAL

silver stain!

rx w/ SMX/TMP (bactrim), not antifungals

Question 15

shape of aspergillus

Answer 15

septate hyphae w/ acute angle branching

Question 16

aspergillus associations

Answer 16

heme malignancies

sinusitis, brain abscess, catheter infections, ABPA (in asthmatics)

Question 17

aspergillus infections

Answer 17

aspergilloma/fungus ball in lungs, forms cavity and causes hemoptysis

Question 18

dx and rx of aspergillus

Answer 18

direct tissue observation

rx w/ voriconazole

Question 19

shape of mucor/rhizopus (zygomycetes)

Answer 19

aseptate hyphae w/ wide angle branching

Question 20

zygomycetes infection

Answer 20

necrosis following angioinvasion: rhinocerebral, GI, cutaneous

pulm infection- prolonged fever, airway obstruction, hemoptysis

Question 21

dx and rx for zygomycetes

Answer 21

direct tissue observation

rx w/ ampho b

Question 22

shape of histoplasma

Answer 22

oval yeast inside tissue macrophages

mold form in cold/ lab- budding around circular organism

Question 23

histoplasma infection

Answer 23

fungal homologue to Mtb- high exposure causes cavitary lesions

Question 24

dx and rx of histoplasma

Answer 24

direct observation in tissue/culture, urine antigen

rx w/ itraconazole or ampho B when serious

Question 25

shape of blastomyces

Answer 25

thick walled yeast, broad based budding in extracellular spaces

Question 26

blasto infection

Answer 26

can go anywhere- commonly skin, bones, joints

acute pulm looks bacterial but doesnt respond to antibiotics, can progress to ARDS

chronic pulm looks like Tb and histo

Question 27

dx and rx of blasto

Answer 27

direct obs in tissue or culture

rx even for asymptomatic, itraconazole or ampho B

Question 28

coccidioides shap

Answer 28

spherules w/ endospores in tissue, barrels in environment

Question 29

coccidioides infection

Answer 29

often disseminated to skin, lymph nodes, bones

erythema nodosum (desert bumps)

lung nodules or cavities

Question 30

dx and rx of coccidioides

Answer 30

direct observation in biopsy or culture, skin test

rx w/ fluconazole or ampho B for persistent/ disseminated disease

Question 31

describe actinomyces

Answer 31

filamentous G+ anaerobe, normal oral flora

Question 32

actinomyces infection

Answer 32

oral/facial abscesses (sulfer granules), PID w/ IUD

rarely bronchopulm, looks like cancer or TB

Question 33

dx and rx of actinomyces

Answer 33

direct obs in tissue or biopsy

rx w/ penicillin

Question 34

describe nocardia

Answer 34

beaded filaments, G+ and weakly acid fast (less than Tb), aerobe, found in soil

Question 35

nocardia infection

Answer 35

brain abscess in immunocompromised, pulm disease w/ pneumonia or lung abscess w/ cavities

Question 36

dx/rx for nocardia

Answer 36

direct obs, culture

rx w/ bactrim