Fungi Flashcards
What is the causative agent of aspergillosis?
Aspergillus fumigatus
Aspergillosis is the MC cause of what?
Non-candidal invasive fungal infection in stem cell and post organ transplant recipients as well as pts with leukemias and lymphomas
Allergic bronchopulmonary aspergillosis (ABPA) is seen in pts with what medical hx?
Occurs in pts w/ asthma or cystic fibrosis
Associated with sinusitis w/ chronic inflammation w/ eosinophilic mucus and noninvasive hyphal elements
Chronic aspergillosis is seen in pts with what medical hx?
Chronic lung disease w/o immunocompromised state
Cough, SOB, weight loss, malaise
- Not responsive to antibiotics
Invasive aspergillosis is seen in pts with what medical hx?
MC in severely immunodeficient pts and pulmonary disease
Prolonged/severe neutropenia
Chronic granulomatous disease
What are some risk factors in pts s/p stem cell transplant involved with invasive aspergillosis?
Cytopenias Corticosteroids use Iron overload Cytomegalovirus Graft-versus-host disease
What are some clinical manifestations of invasive aspergillosis?
- Patchy infiltration progressing to severe necrotizing pneumonia
- Invasive sinus disease
- Dissemination via bloodstream to brain, skin, heart (endocarditis)
What is a key diagnostic test for Aspergillosis?
CT finding of “halo” sign = suggestive of invasive aspergillosis
What is the treatment of Allergic bronchopulmonary aspergillosis (ABPA)
Prednisone
Itrazconazole
What is the treatment of chronic aspergillosis?
Surgical resection in symptomatic pts
Itrazconazole, voriconazole, posaconazole
What is the treatment of Invasive aspergillosis?
Voriconazole
Blastomycosis most often occurs in who?
Men infected during occupational or recreational activities outdoors
- “digging holes”
What geographic areas is Blastomycosis found?
Ohio, Mississippi, St. Lawrence river valley, great lakes region
What is the MC form of Blastomycosis?
Pulmonary infection
Blastomycosis disseminated infection form is due to what?
Insidious and slow progression of the disease, spreading common
- Skin ulceration, osteomyelitis, meningitis causing lesions
What is the gold standard diagnostic test for Blastomycosis?
Fungal culture
What is the treatment of mild to moderate Blastomycosis ?
Itraconazole
What is the treatment of severe Blastomycosis?
Start with Amphotericin B then start itraconazole (oral)
What is the geographic area of Coccidioidomycosis?
Desert region: Mexico, AZ, CA
How is Coccidioidomycosis spread?
Dispersed disturbed soil (ie. dust storm)
More severe/chronic infection of Coccidioidomycosis is often seen in pts who have what?
Immunosuppressed systems or w/ large arthroconidia inoculum
-Meningitis
What is the desert rheumatism triad associated with Coccidioidomycosis?
Arthralgia
Fever
Erythema nodosum
Tx for mild Coccidioidomycosis?
Itraconazole and fluconazole
Tx for severe Coccidioidomycosis?
Amphotericin B
What is the causative agents of cryptococcosis and which one is it more problematic in?
Cryptococcus neoformans and Cryptococcus Gattii
-Gattii is more problematic in immunocompromised pts
Where is Cryptococcosis found?
Soil and dried pigeon poop
What are some clinical manifestations of Cryptococcosis?
Nuchal rigidity and meningeal sings
Communicating hydrocephalus
Immune reconstitution inflammatory syndrome
What are some diagnostic testing for Cryptococcosis?
CSF
MRI > CT scan
Cryptococcal antigen
What is the tx for Cryptococcosis?
Liposomal amphotericin B - preferred initial management
Followed with fluconazole
Flucytosine may be added - monitor for toxicities
Failure to recognize and correct high ICP results in what?
Increased M and M
What is the most important factor to determine if you can switch the medication regimen from Amphotericin B to Fluconazole?
Conversation of CSF to negative
What is the cause of Histoplasmosis?
Spelunking or excavation/ crawling through caves that is soil enriched with bird or bat guano
What are sxs of severe exposure of Histoplasmosis?
severe dyspnea, marked hypoxemia, impending respiratory failure
- chronic: hemoptysis
What can cause superior vena cava syndrome?
Histoplasmosis
Tx for Histoplasmosis?
Mild to moderate: Itraconazole
Severe: Amphotericin B
AIDS pts: lifelong itraconazole
What are some clinical manifestations of Mucormycosis?
Rhinocerbral disease (MC form) - necrosis tissue d/t hyphal tissue invasion of hard palate, nasal plate, or hemoptysis.
What is diagnostic testing for Mucormycosis?
Reverse hale sign on CT of lungs
What is tx for Mucormycosis?
IV amphotericin B then Posaconazole
What is the causative agent of Sporotrichosis (AKA rose garden disease)?
Sporothrix schenckii
Sporotrichosis fungi is commonly transmitted by what?
Prick from rose thorn and cat scratches
What is the MC clinical manifestation of Sporotrichosis?
Cutaneous
- lesions adherent to overlying skin that then ulcerate
- occurs on fingers, hands, or arms
What is the gold standard for Sporotrichosis?
Fungal infection
