Fungal Pneumonias Flashcards
What are the 3 endemic dimorphic fungi in the US, and where are they found?
- Histoplasma capsulatum - Ohio/Mississippi river valley
- Blastomyces dermatitidis - states east of Mississippi (and South America)
- Coccidoides immitis - SW United States and California
What are the 4 opportunistic fungi, and where are they found?
- Candida sp. - normal flora of nasopharynx, skin, and vagina
- Aspergillis sp. - found in soil, manue, decomposing vegetation
- Pneumocystis jiroveci - may be part of normal flora; inhalation aquired
- Mucor and Rhizopis sp.
What type of environment does Histoplasma capsulatum live?
- In the soil.
- Caves (bat poop)
- Chicken coops (bird poop)
- Old buildings
Breifly describe the pathogenesis of Histoplasmosis.
You inhale it. It turns to yeast. Macrophages eat, but cannot kill it. Th1 cells come and produce interferon gamma. Granulomas are formed that can be reactivated any time you’re immue suppressed.
What are the clinical manifestations of Histoplasmosis?
- Flu-like symptoms
- Patchy pnumonitis
- Severe pnumonia
- Chronic cavitary histoplasmosis (in COPD patients)
- Disseminated histoplasmosis (in elderly or immune suppressed patients)
How do you diagnosis and treat Histoplasmosis?
- Culture on Sabouraud’s agar
- Yeast within macrophages [Histo Hides]
- Granuloma formation
- Calcified nodules on x-ray
- Amphotericin B (severe infection) or Itraconazole (for mild to moderate infection)
What type of environment does Blastomyces dermatitidis live?
- soil
- decaying vegetation
- dogs
- prairie dogs
- the great open plains
What are the clinical manifestations of Blatomycosis?
Blastomyces enters the blood, goes to skin and forms pustular lesions
How do you diagnosis and treat Blastomycosis?
- [Blasto Buds Broadly]
- Amphotericin B or Itraconazole
What the hell is this?
Skin pustular lesion due to Blastomyces dermatitidis infection. (It’s very common to see this.)
What the hell is this?
[Blasto Buds Broad]
What type of environment does Coccidoides immitis live?
In the desert (“San Joaquin” valley fever)
What is the pathogenesis of Coccidioidomycosis?
You inhale it. It transforms into endospore containing spherules that resist phagocytosis. The endospores are released and cause disease.
What are the clinical manifestations of Coccidioidomycosis?
- Flu-like symptoms (“San Joaquin” Vallet fever)
- “Desert bumps” = erythema nodosum
- “Desert rheumatism” = arthralgia
- Meninges can be affected
What the hell is this?
Spherule full of endospores due to Coccidioidomycosis. [Coccidio Crowds]
What the hell is this?
Skin lesions (“Desert bumps” erythema nodosum) due to Coccidioidomycosis
(Skin lesions due to fungus are more common with Blastomyces, not Coccidio… but you can see this with an immunocompromised patient.)
How do you diagnose and treat Coccidioidomycosis?
- We see spherules.
- AmphoB or Itraconazole
What are the 2 most common opportunist fungal infections?
- Candida albicans
- Aspergillus fumigatus/flavus
Why would someone get Candida?
- T cell immue supression
- Antibiotic therapy
- Insertion of catheter
- Neutropenia
Remember, this is opportunistic fungal infection.
What clinical manifestations would you see in a Candida infection, how would you diagnosis it, and how would you treat it?
- Oral thrush
- Vaginal yeast infection
- UTI
- Esophagitis
- Fever
- Pnemonia
- Blood agar or Sabouraud’s agar
- AmphoB
What the hell is this?
This is oral thrush causes by Candida
Why might someone get an Aspergillus infection?
- Neutropenic
- Transplant patient
- Patient on long-term corticosteroids
What are the clinical manifestations for Aspergilis fumigatus, how would you diagnose it, and how would you treat it?
- Sinusitis
- Pneumonia
- Pulmonary nodules with cavitation
- Sabouraund’s agar
- Acutely branching hyphae [Acute Angles in Aspergillus]
- Voriconazole (is superior to AmphoB)
What the hell is this?
[Acute Angles in Aspergillus]
