Fungi Flashcards
HISTOPLASMOSIS CAPSULATUM
“The Historian’s Cave”
HISTOPLASMOSIS CAPSULATUM
“The Historian’s Cave”
RULE:
Question about fungi will most likely affect what kind of patient?
RULE:
Question about fungi will most likely affect what kind of patient?
Systemic Fungi: what does it mean?
It can spread to other parts of the body besides the lung.
Which disease does Histoplasma capsulatum create?
Histoplasmosis
Where is Histoplasma capsulatum prevalent in?
Indiana
Endemic to Midwest and central US states
Along Mississippi and Ohio river valleys
What are the 3 Buzzwords for Histoplasma capsulatum?
Bird or bat Dropping
Recently in a cave
Exposure to chicken Coup
Mode of transmission for Histoplasma capsulatum?
Respiratory system (spores)
How do you diagnose Histoplasmosis?
Tissue sample or respiratory sample with KOH prep: Macrophage with intracellular oval bodies
Urine rapid antigen test
Serum rapid antigen test
Culture
Diagnosis through KOH or rapid serum (red) or urine (yellow) antigen test
histological size of Histoplasma capsulatum?
Histoplasma much smaller than RBC
2-5ym (smallest) with “a thin cell wall but no true capsule” (think inside the puddles)
How many Histoplasma capsulatum can fit in a macrophage?
10 - 100’s of histospheros
Shape of Histoplasma capsulatum?
Dimorphic: depends of temperature of its Surroundings (just like all systemic fungi).
“mold in the cold and yeast in the heat”
Cold = mold Hot = Yeast
Clinical presentation of Histoplasma capsulatum?
Can be Asymptomatic or Subclinical
Can cause granuloma formation and cause pneumonia. Arethema nodosum (painful red nodules usually found on the sheen)
What do the granulomas in Shape of Histoplasma capsulatum infection look like?
Granulomas, can look like TB w/ calcified nodes with fibrotic scarring and nodules in the hilar region.
Histoplasma may mimic what disease in presentation?
Tuberculosis
Who are affected with disseminated disease?
Occurs in the immunocompromised state patients
What happens when an immunocompromised patient gets histoplasmosis?
Dissemination of fungi to liver and spleen will show up clinically as Hepatosplenomegaly and the gross pathology will show calcifications of liver and spleen.
Fungus targets reticularendothelial system, which has alot of macrophages, and these are prevalent of liver and spleen along
Skin and neurofindings can also be found
What is the treatment of histoplasmosis?
Local, mild infections: “-conazole” class drugs (fluconazole and ketoconazole)
Systemic infections: Amphotericin B (AMP B) (very potent drug with lots of side effects, only used with disseminated/systemic infections especially in immunocompromised patients
COCCIDIOIDES IMMITIS
“Presidio San Joaquin”
COCCIDIOIDES IMMITIS
“Presidio San Joaquin”
Geographic location of Coccidioides immitis?
California and Southwestern United States
What is the route of transmission of coccidiomycosis immitis?
What is the route of transmission of coccidiomycosis immitis?
Why is coccidiomycosis and San Joaquin Valley in CA associated?
San Joaquin Valley Fever
Frequent dust storms in San Joaquin Valley, CA cause a large incidence of coccidiomycosis.
Shape of Coccidioides immitis?
Dimorphic: depends of temperature of its Surroundings (just like all systemic fungi).
“mold in the cold and yeast in the heat”
Cold = mold Hot = Cocci forms spherules filled with endospores inside lungs
Spherules packed with endospores in the lungs instead of yeast when in the body
Coccidioides immitis size compared to RBC?
Larger than RBC
Size comparisons of Histo, Blasto, Cocci?
Histo < RBC
Blasto = RBC
Cocci > RBV
Cocci > Blasto > Histo
Clinical presentation in coccidiomycosis?
Asymptomatic in most, but clinical manifestation may look like an acute pneumonia: cough, fever and altralgia
Erythema nodosum (An inflammatory condition that can lead to red, extremely tender nodules usually on the sheens)
How does coccidiomycosis look in imaging?
Radiographically images may be unremarkable in majority of patients with nothing showing but some might show some cavities and/or nodules.
Erythema nodosum symbolizes what in coccidiomycosis?
Robust immune response only generally seen in healthy people.
What are common sites of infections of coccidiomycosis?
Skin and lungs
coccidiomycosis May disseminate to the what in immunocompromised patients?
Bone and meninges and may cause meningitis (may cause stiff neck and headaches associated with meningitis)
How do you diagnose coccidiomycosis?
KOH stain to prove,
IgM against coccimycosis indicates recent infection
Treatment of coccidiomycosis?
Local, mild infections: “-conazole” class drugs (ketoconazole)
Systemic infections: Amphotericin B (AMP B) (very potent drug with lots of side effects, only used with disseminated/systemic infections especially in immunocompromised patients since systemic infections can be fatal.
BLASTOMYCOSIS DERMATITIDIS
“The Blast of the Cannons”
BLASTOMYCOSIS DERMATITIDIS
“The Blast of the Cannons”
What is a risk factor for the spread of infection for blastomycosis dermatitidis?
Earthquakes are a risk factor for spread of infection.
very common after earthquakes (dust dispersed in air) (Northridge earthquake of 1994) or dust storms
BUZZWORDS for geographic location for blastomycosis dermatitidis?
Great lakes and Ohio River Valley
Shape of blastomycosis dermatitidis?
Dimorphic: depends of temperature of its Surroundings (just like all systemic fungi).
“mold in the cold and yeast in the heat”
In Blastomycosis dermatitidis:
Cold = mold = soil
Hot = Yeast = bodies
Transmission of blastomycosis dermatitidis?
Transmission: Inhalation of aerosolized spores
How does blastomycosis dermatitidis replicate INSIDE our bodies?
Single Broad Based Budding, commonly seen on slides
size of blastomycosis dermatitidis?
Blastomycosis is typically the same size as RBC’s
So blastomycosis are very large.
On chest x-ray, how does blastomycosis dermatitidis look?
Chest X-ray has patchy alveolar infiltrate (“Haziness”)
Lesions or cavities in lungs
Symptoms of blastomycosis dermatitidis?
Subclinical or asymtomatic
Pnenumonia
how is the pneumonia from blastomycosis dermatitidis classified as?
Local lung infection
Dissemination of blastomycosis dermatitidis (systemic disease) from lungs go where?
Skin and bone
Chronic blastomycosis infection to the bones leads to what?
Osteomyelitis
How do you diagnose a blastomycosis dermatitidis infection?
KOH prep or culture: will observe Round yeast with single based bud
Urine antigen test
What is the treatment for blastomycosis dermatitidis infection?
Local, mild infections: “-conazole” class drugs (itraconazole)
Systemic infections: Amphotericin B (AMP B) (very potent drug with lots of side effects, only used with disseminated/systemic infections especially in immunocompromised patients
PARACOCCIDIOIDES BRASILIENSIS
“Piratas del Sur (south)”
PARACOCCIDIOIDES BRASILIENSIS
“Piratas del Sur (south)”
What is the disease caused by Paracoccidioides brasiliensis?
Paracoccidioides mycosis
Aka “Brazilian mycosis”
Where is the fungus Paracoccidioides brasiliensis distributed?
Brazil and other parts of South America
Describe the shape of paracoccidioides brasiliensis
Dimorphic Paracocci
Mold in the COLD, yeast in the HEAT
Yeast form in the Lung (Body): multiple buds radiation out in a central
pattern. Rounded and bulbish shape, how it looks in the lungs.
Looks like a “captain’s wheel”
Mold Form in the environment:
What is the size of paracoccidioides brasiliensis compared to a RBC and other fungi?
Yeast is large compared to RBC
Sizes: Histo < Blasto < Cocci < Paracocci
How is paracoccidioides brasiliensis transmitted?
Respiratory droplets
Describe the pathophysiology of paracoccidioides brasiliensis .
After the respiratory droplets are inhaled, the cause lymphadenopathy that can be cervical, axillary, one even inguinal.
It is lymphadenopathy in chains of lymph nodes in cervical region, as disease progresses, it moves downward. Then it affects upper respiratory system and lungs.
What can paracoccidioides brasiliensis cause in the upper mouth?
Mucosal ulcers and cutaneous lesions in the upper mouth leading to small hemorrhages
What happens once paracoccidioides brasiliensis progresses to lungs?
Causes granulomas in the lungs.
What is the TXT of paracoccidioides brasiliensis ?
Mild infections: Itraconazole
Severe infections: Amphotericin B
MALASSEZIA’S FURFUR
Malassezia’s Italian Restaurant
MALASSEZIA’S FURFUR
Malassezia’s Italian Restaurant
What is the disease that malassezia furfur creates?
Pityriasis versicolor
Under a microscope, what kind of appearance does malassezia furfur have?
Spaghetti and meatball appearance on KOH prep of skin scprapings
Where can malassezia furfur be found?
Normal Skin flora
Condition where malassezia furfur thrive?
Malassezia furfur thirves under hot and humid conditions, and the fungus will convert to disease from this humidity
Describe the symptoms that one manifests with pityriasis versicolor.
Forms hyperpigmented and/or hypopigmented patches on the back and chest of individuals.
Not itchy.
TEST QUESTION:
Pathogenicity of malassezia furfur.
Lipid degradation which produces acid that will cause damage to melanocytes causing loss of pigmentation problems
What kind of mycosis is malassezia furfur considered as?
Cutaneous mycosis; generally remains confined to the skin
Which layer of skin is affected by malassezia furfur?
Stratum corner is the layer that is damaged (top layer of the skin)
TEST QUESTION:
How can one be infected with malassezia furfur and what will it cause?
Malessezia fungimia may come with TPN, total parental infusion, fungus will grow in the catheter of lipid transfusions causes sepsis and thrombocytopenia.
TEST QUESTION:
Which type of patient is at most risk of an malassezia furfur infection?
NICU neonates receiving Total Parenteral Nutrition (TPN) (with liquid infusions) are at risk for M. furfur fungemia due to lipophilicity of M. furfur
Treatment for Pityriasis versicolor?
Selenium Sulfate (Selsum Blue) - txt for malassezia furfur
Works by promoting the shedding of Stratum cornea
DERMATOPHYTES
“Tinea Tin Man”
DERMATOPHYTES
“Tinea Tin Man”
What does the name Dermatophyte literally mean?
Skin Plant in Greek
Which test can be done to find dermatophytes?
Represented by the T, E, and M on the little Munchkins test
What are the three types of dermatophytes?
Trichophyton
Epidermophyton
Microsporum
Which rash is caused by dermatophytes?
Tinea
What is another name of dermatophytes?
Ring worm
All types of tinea have same pathology but vary in name how?
Depending on location it affects
Where are dermatophytes normally found in?
Dermatophytes are found of skin, rarely invades
Which tinea is found on head and scalp?
Tinea capitus
Which tinea is found on body?
Tinea corpus
Which tinea is found on the groin?
Tinea cruris (crura is the structure that connects the base of the penis to ischial pubic rami)
Which tinea is found on foot?
Tinea pedis
What is the most common disease caused by dermatophytes?
Athlete’s foot by tinea pedis
Who are at most risk for tinea infections?
Athlete are most risk, swimmers and wrestlers
What is another source of infection for dermatophytes?
animals are common source of dermatophytes
Tinea lesions are pruritic or nonpruritic?
Tinea lesions are pruritic
How can you diagnose a tinea infection?
Hyphae can be seen with KOH prep of skin scrapings.
Woods lamp to diagnose the microsporum because they illuminate them.
What is the TXT for a tinea infection?
Used to TXT generally -azoles
Clitrimazole
Which disease is created when dermatophytes affects the nails?
Onchomycosis: dermatophyte infection of the nails.
What is the TXT for onchomycosis?
Terbanifine is used to treat onchomycosis
What is the TXT for more severe dermatophyte infections?
Griseofulvin is used for more serious dermatophyte infections.
Likes to deposit on ketratin containing tissues such as skin and nails.
Can be used on onchomycosis that wont go away.
Has alot of GI side effects.
SPOROTHRIX SCHENCKII
“Shanked by a Rose”
SPOROTHRIX SCHENCKII
“Shanked by a Rose”
What is the disease caused by Sporothrix Schenckii?
Sporotrichosis
How is sporothrix schenckii classically contracted?
Classically contracted by the Cuts from the thornes of a rose bush
What is another name for sporotrichosis infection?
“Rose Gardener’s Disease”
What is Sporotrichosis?
a chronic fungal infection producing nodules and ulcers in the lymph nodes and skin.
Where can sporothrix be found in?
Rose thorns, tree bark and other plants
TEST QUESTION:
Shape of Sporothrix Schenckii?
Dimorphic fungus
Cigar shaped yeast under a microscope
what will you see under a microscope of Sporothrix Schenckii?
Branching hyphae of sporothrix at 25 degree C
TEST QUESTION:
Describe the pathophysiology of sporotrichosis.
Sporothrix is usually introduced into the skin by local trauma that will lead to a pustule or nodules and then will develop an ascending pattern along the lymphatics causing red bumps along the skin.
How can you diagnose a sporotrichosis infection?
Culture is the gold standard
Biopsy can also be used
What will a biopsy of sporotrichosis infection show?
Biopsy yields cigar shaped budding yeasts, multinucleate giant cells, histiocytic
What is the TXT for lymphocutaneous sporotrichosis?
Litraconazol
Saturated solution of potassium iodine
ASPERGILLUS FUMIGATUS
Asparagus Farm
ASPERGILLUS FUMIGATUS
Asparagus Farm
Which test can be done for aspegillus fumigatus?
Catalase positive
What is the name of the toxin produced by aspegillus flavus?
aflatoxins
Which everyday food is associated with aspergillus fumigatus?
Peanuts are associated with aflatoxins produced by aspergillum flavus
Aflatoxins also associated with grain crops
why is aflatoxin so important?
They are extremely carcinogenic, especially for Hepatocellular carcinoma
What will be inhaled by humans to get infected with aspegillus fumigatus?
Condiophores with fruiting bodies, those will be inhaled by humans
What is the shape of the branching of the aspegillus fumigatus?
Acute angle branching (less than 45 degrees)
Name the three types of infection that can be caused by aspegillus fumigatus.
3 types if infection.
Allergic Bronchopulmonary Asperigillosis (ABPA)
Aspergillomas
Angioinvasive aspergillosis
Describe Allergic Bronchopulmonary Asperigillosis (ABPA).
Type 1 hypersensitivity reaction (Type I HSR) Migratory pulmonary infiltrate fever wheezing Associated with CF patients Increased IgE
Describe Aspergillomas.
Aspergillomas are gravity dependent so fungus balls will be at the bottom of the cavity.
Susceptivity increases with TB cavities.
Apergillosis causing aspergillomas.
Describe Angioinvasive aspergillosis.
Worst type in case of severity
Affects patients immunocompromised patients especially those with neutropenia from leukemia or lymphoma
Invades blood vessels and the surrounding tissues.
Kidney failure
Endocarditis
Ring enhancing lesions in the brain
Spread to paranasal sinuses, may cause necrosis around the nose.
What is the treatment for aspegillus fumigatus?
Voriconazole for less serious infections
Aspergillomas must be surgically debrited
Amphotericin B for angioinvasive disease
TEST QUESTION:
What are the 5 key points to remember with aspergillum gimigatus?
Acute angle branching
Aspergillus flavus produces aflatoxin that causes heptaocellular carcinoma.
Allergic Bronchopulmonary aspergillosis (ABPA)
Aspergillosis causing aspergilomas
Angiovasive aspergillosis
CANDIDA ALBICANS
“Candid Canadians”
CANDIDA ALBICANS
“Candid Canadians”
What is the most opportunistic mycosis?
Candida albicans
What is the shape of candida albicans?
It is dimorphic: Pseudo hyphae at 25 degree C and true hyphae germ tubes at 37 degree C
What is the shape of candida in yeast form?
At 20 degree C candida is in the yeast for with pseudo hyphae formation
At what temperature does candida form germ tubes?
37 degree C
Which test is positive for candida?
Catalase positive
Which type of patients are especially susceptible to candida that are also catalase positive?
Patients with Chronic Granulomatous Disease (CGD) are especially susceptible to catalase producing organisms
Where is candida normally found in?
Candida is normal flora of the GI tract and Oral cavity, commonly contaminates sputum cultures.
Present in 40% of population and as long as the patient is immunocompetent, it wont cause any problems.
Commonly contaminates sputum cultures but just because its there, it wont cause pathology.
Candida normally lives inside the body (in places such as the mouth, throat, gut, and vagina) and on skin without causing any problems.
What does candida cause in a baby?
Candida causes diaper rash in a characteristic distribution to the heat and humidity within a baby’s diaper.
What can happen to patients who use oral steroids?
Oral candidiasis is usually in immunocompromised or used with inhaled steroids.
Asthmatic kids that don’t rinse mouth after the use of oral steroids.
Patient who uses oral steroids must be advised to do what?
Oral steroid use must be followed by oral rinsing to avoid development of oral candidiasis.
What is a tall tale sign of oral candidiasis?
White patches that form in the mouth that can be scraped off the oral mucosa unlike the leukoplakia (a type of precancer that cant be scraped off).
What can be used to diagnose for candida infection?
KOH is used to prep oral scrapings when attempting to diagnose oral candidiasis.
KOH can be scrapped off, KOH is used to prep plates.
What is the difference between candidiasis and candidosis/moniliasis?
candidiasis: mouth of babies
candidosis/moniliasis: mouth or throat of adults
Where else can candida affect besides the oral mucosa?
It can extend down to the esophagus causing Esophageal candidiasis.
Which is an opportunistic infection of the esophagus by Candida albicans.
What should you think of when you see a patient with esophageal candidiasis?
It is presented commonly in people with AIDS.
It is considered as an AIDS defining illness.
Knowing that esophageal candidiasis is considered as an AIDS defining illness will be hugely important. As with most AIDS defining illness, it also helps to know at which CD4 count will be at risk for developing illness.
At what CD4 can you be at risk for esophageal candidiasis?
For esophageal candidiasis you begin to develop for it CD4 count of <100
What is the medical name for “vaginal yeast infection.” ?
Vaginal candidiasis
Other names for this infection are “vaginal candidiasis,” “vulvovaginal candidiasis,” or “candidal vaginitis.”
What are some predisposing factors for candida infections?
Diabetes
Antibiotic and birth control users
IV drug users
Patients with Chronic Granulomatous Disease (CGD) patients
Candida vulvovaginitis is common is what kind of patient?
Antibiotics and birth control pills can predispose women to yeast infections.
Antibiotics kills vaginal microflora which allows candida to flourish but it doesnt change vaginal pH.
What is the vaginal pH required for candida to flourish?
4 pH
Candida infections dont happen after 4 pH
Candida is an important cause of what kind of inflammation?
Endocarditis –> Candidal endocarditis
Candida is found in certain types of heroine that infects tricuspid valve.
Candidal endocarditis ins commonly seen in drug users commonly affecting the tricuspid valve.
What is the TXT for candida infections?
Azoles for minor infections. Conazoles
Amphotericin B for major injections.
Nystatin for oral or esophageal candidiasis.
Capsofungin for resistant candida to amphotericin or disseminated candida infections,
CRYPTOCOCCUS NEOFORMANS
“Crypt for Cryptococcus”
CRYPTOCOCCUS NEOFORMANS
“Crypt for Cryptococcus”
What makes cryptococcus so tough and special?
Cryptococci are heavily encapsulated.
4-10 ym yeast with a broad, slimy capsule.
Describe the Cryptococci capsule.
Cryptococci capsule is made up of repeating polysaccharide capsular antigens.
Repeating polysaccharide antigen that is the main virulence factor for making it antiphagocytic and basis for the diagnostic test.
BUZZWORDS:
How is Cryptococci neoformans transmitted?
Transmitted by pigeon droppings and found in soil, then inhaled into the lungs
Cryptococci neoformans is positive to what?
Urease positive
Who is most at risk of an cryptococcal neoformans infection?
Opportunistic infection;
Immunocompromised patients (HIV) High dose steroids Malignancies
Describe the pulmonary symptoms of cryptococcus neoformans.
Pulmonary symptoms: cough, dyspnea and other serious lung infections.
What is a complication that can be caused by cryptococcus neoformans?
The most common cause of fungal meningitis.
Spread to CSF and cause meningitis, this isn’t good and can very often lead to pemament neurons deficits.
What are the three main clinical findings for cryptococcus neoformans?
- Fever
- Pneumonia
- Meningitis
What is the agar used for all fungal infections?
Sabouraud dextrose agar
But takes weeks to come back.
TEST QUESTIONS:
What are the different diagnostic methods of cryptococcus neoformans?
Sabouraud dextrose agar (CULTURE) Bronchopulmonary washing (aka lung tissue) Lumbar puncture Latex agglutination test "Soap Bubble lesions" seen on imaging
Tissue samples of cryptococcus are stained with what?
Tissue samples can be stained with mucicarmine (red) or methanamine (silver) stains
Describe the lumbar puncture for cryptococcus neoformans.
Lumbar puncture then the CSF gets stained with India ink and this ink will stain the background dark while organism will remain transparent thus, it is a negative staining technique.
What will be left?
5-10 micrometers of yeast with wide capsular halos.
Is lumbar puncture the gold standard?
No, since it is not very sensitive.
Which type of ink is used for cryptococcus neoformans?
India ink outlines crytococci capsules as “halos”
Which test is used thats considered gold standard for cryptococcus neoformans?
Latex Agglutination Test that detects polysaccharide capsular antigen and causes agglutination.
Detects the repeating polysaccharide capsular antigen and causes agglutination.
BUZZWORD
After cryptococcus neoformans invades CSF, What happens next?
Gross pathology seen in cryptococcal meningitis: causes “soap bubble lesions” in gray matter of the brain.
What is the treatment for cryptococcus neoformans infection?
Order of TXT for cryptococcal meningitis:
Joint therapy: Amphotericine + flucytosine
Followed by maintenance therapy: fluconazole
MURCORMYCOSES
“Mu Car Auto Shop”
MURCORMYCOSES
“Mu Car Auto Shop”
What population is at risk of murcomycoses?
Immunocompromised patients are highly susceptible to infection especially leukemia or neutropenia.
Diabetes are at risk.
What is bread mold?
Rhizopus
How is murcomycoses transmitted?
Transmitted via spore inhalation.
What is the most common predisposing facto to infection to murcomycoses?
Diabetic ketone acidosis (DKA) is the most common predisposing factor to infection to mucormycoses since it is high blood sugar and ketones.
What is the counterpart fungi to murcomycoses?
Aspergillus
TEST QUESTION:
What is shape of murcomycoses?
USMLE will show an image of it.
Hyphae are non-septate and have 90 degree angle branching.
“Wide angle non-septate Branching”
Where does murcomycoses like to proliferate in?
Blood Vessels
What does murcomycoses do after it proliferates in blood vessels?
After invading the blood vessels, murcomycoses invade through cribriform plate in the skull and will continue to cause necrosis of tissues and frontal cortex abscesses.
What is the name of the disease that murcomycoses creates after invading the brain?
Rhinocerebral mucormycosis
Describe Rhinocerebral mucormycosis.
Proliferation of fungi eventually leads to necrosis of surrounding tissue.
Black eschar and necrosis of nasal cavity and eyes, causing neurons deficits and death.
How do you diagnose mucormycosis?
Biopsy
What is the treatment for mucormycosis?
Surgical TXT: Debridement first
Pharmacological TXT: Amphotericin B
PNEUMOCYSTIS JIROVECI
“PCP PING PONG”
PNEUMOCYSTIS JIROVECI
“PCP PING PONG”
What is the disease caused by pneumocystis jiroveci?
Pneumocystis pneumonia (PCP)
Describe Pneumocystis pneumonia (PCP)
Diffuse interstitial pneumonia with pneumonia like symptoms: cough (not a productive cough), disnea, fever.
pneumocystis jiroveci is the fungi most associated with what?
AIDS
Associated with AIDS CD4 count below 200
Who are most likely to be infected with pneumocystis jiroveci?
Immunocomprised patients
Why is pneumocystis jiroveci associated with AIDS?
Pneumocystis pneumonia (PCP) is a AIDS defining illnesses (CD4 count: < 200)
How is Pneumocystis pneumonia (PCP) transmitted?
Respiratory transmission
What will you see in a chest x-ray of Pneumocystis pneumonia (PCP)?
Wont see consolidation like you see on chest X-rays.
But if you see something it will have a ground glass appearance in both lungs.
Can look also like crushed ping pong balls.
How can you diagnose Pneumocystis pneumonia (PCP)?
Bronchoalveolar Lavage (BAL) for diagnosis
How can you stain Pneumocystis pneumonia (PCP) and what will it look like?
Bronchoalveolar Lavage (BAL) is stained with Methamine silver stain to identify fungus that looks like disc shaped yeasts
What are the different clinical presentations between a healthy individual infected with pneumocystis jiroveci and an inmunocompromissed individual?
Healthy individual: asymptomatic
Symptoms are evident in immunocompromised people
What is the prophylaxis TXTT for Pneumocystis pneumonia (PCP)?
Prophylaxis begins when CD4 count is below
200, Bactrim (TMP/SMX)
Sulfamethoxazole and Trimethoprim
What can be used for as TXT on a patient with sulfa allergies?
Pentadamine
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