Fungi

Question 1

What is the causative agent of aspergillosis?

Answer 1

Aspergillus fumigatus

Question 2

Aspergillosis is the MC cause of what?

Answer 2

Non-candidal invasive fungal infection in stem cell and post organ transplant recipients as well as pts with leukemias and lymphomas

Question 3

Allergic bronchopulmonary aspergillosis (ABPA) is seen in pts with what medical hx?

Answer 3

Occurs in pts w/ asthma or cystic fibrosis

Associated with sinusitis w/ chronic inflammation w/ eosinophilic mucus and noninvasive hyphal elements

Question 4

Chronic aspergillosis is seen in pts with what medical hx?

Answer 4

Chronic lung disease w/o immunocompromised state
Cough, SOB, weight loss, malaise
- Not responsive to antibiotics

Question 5

Invasive aspergillosis is seen in pts with what medical hx?

Answer 5

MC in severely immunodeficient pts and pulmonary disease
Prolonged/severe neutropenia
Chronic granulomatous disease

Question 6

What are some risk factors in pts s/p stem cell transplant involved with invasive aspergillosis?

Answer 6

Cytopenias
Corticosteroids use
Iron overload
Cytomegalovirus
Graft-versus-host disease

Question 7

What are some clinical manifestations of invasive aspergillosis?

Answer 7

• Patchy infiltration progressing to severe necrotizing pneumonia
• Invasive sinus disease
• Dissemination via bloodstream to brain, skin, heart (endocarditis)

Question 8

What is a key diagnostic test for Aspergillosis?

Answer 8

CT finding of “halo” sign = suggestive of invasive aspergillosis

Question 9

What is the treatment of Allergic bronchopulmonary aspergillosis (ABPA)

Answer 9

Prednisone

Itrazconazole

Question 10

What is the treatment of chronic aspergillosis?

Answer 10

Surgical resection in symptomatic pts

Itrazconazole, voriconazole, posaconazole

Question 11

What is the treatment of Invasive aspergillosis?

Answer 11

Voriconazole

Question 12

Blastomycosis most often occurs in who?

Answer 12

Men infected during occupational or recreational activities outdoors
- “digging holes”

Question 13

What geographic areas is Blastomycosis found?

Answer 13

Ohio, Mississippi, St. Lawrence river valley, great lakes region

Question 14

What is the MC form of Blastomycosis?

Answer 14

Pulmonary infection

Question 15

Blastomycosis disseminated infection form is due to what?

Answer 15

Insidious and slow progression of the disease, spreading common
- Skin ulceration, osteomyelitis, meningitis causing lesions

Question 16

What is the gold standard diagnostic test for Blastomycosis?

Answer 16

Fungal culture

Question 17

What is the treatment of mild to moderate Blastomycosis ?

Answer 17

Itraconazole

Question 18

What is the treatment of severe Blastomycosis?

Answer 18

Start with Amphotericin B then start itraconazole (oral)

Question 19

What is the geographic area of Coccidioidomycosis?

Answer 19

Desert region: Mexico, AZ, CA

Question 20

How is Coccidioidomycosis spread?

Answer 20

Dispersed disturbed soil (ie. dust storm)

Question 21

More severe/chronic infection of Coccidioidomycosis is often seen in pts who have what?

Answer 21

Immunosuppressed systems or w/ large arthroconidia inoculum

-Meningitis

Question 22

What is the desert rheumatism triad associated with Coccidioidomycosis?

Answer 22

Arthralgia
Fever
Erythema nodosum

Question 23

Tx for mild Coccidioidomycosis?

Answer 23

Itraconazole and fluconazole

Question 24

Tx for severe Coccidioidomycosis?

Answer 24

Amphotericin B

Question 25

What is the causative agents of cryptococcosis and which one is it more problematic in?

Answer 25

Cryptococcus neoformans and Cryptococcus Gattii

-Gattii is more problematic in immunocompromised pts

Question 26

Where is Cryptococcosis found?

Answer 26

Soil and dried pigeon poop

Question 27

What are some clinical manifestations of Cryptococcosis?

Answer 27

Nuchal rigidity and meningeal sings
Communicating hydrocephalus
Immune reconstitution inflammatory syndrome

Question 28

What are some diagnostic testing for Cryptococcosis?

Answer 28

CSF
MRI > CT scan
Cryptococcal antigen

Question 29

What is the tx for Cryptococcosis?

Answer 29

Liposomal amphotericin B - preferred initial management
Followed with fluconazole
Flucytosine may be added - monitor for toxicities

Question 30

Failure to recognize and correct high ICP results in what?

Answer 30

Increased M and M

Question 31

What is the most important factor to determine if you can switch the medication regimen from Amphotericin B to Fluconazole?

Answer 31

Conversation of CSF to negative

Question 32

What is the cause of Histoplasmosis?

Answer 32

Spelunking or excavation/ crawling through caves that is soil enriched with bird or bat guano

Question 33

What are sxs of severe exposure of Histoplasmosis?

Answer 33

severe dyspnea, marked hypoxemia, impending respiratory failure
- chronic: hemoptysis

Question 34

What can cause superior vena cava syndrome?

Answer 34

Histoplasmosis

Question 35

Tx for Histoplasmosis?

Answer 35

Mild to moderate: Itraconazole
Severe: Amphotericin B
AIDS pts: lifelong itraconazole

Question 36

What are some clinical manifestations of Mucormycosis?

Answer 36

Rhinocerbral disease (MC form)
- necrosis tissue d/t hyphal tissue invasion of hard palate, nasal plate, or hemoptysis.

Question 37

What is diagnostic testing for Mucormycosis?

Answer 37

Reverse hale sign on CT of lungs

Question 38

What is tx for Mucormycosis?

Answer 38

IV amphotericin B then Posaconazole

Question 39

What is the causative agent of Sporotrichosis (AKA rose garden disease)?

Answer 39

Sporothrix schenckii

Question 40

Sporotrichosis fungi is commonly transmitted by what?

Answer 40

Prick from rose thorn and cat scratches

Question 41

What is the MC clinical manifestation of Sporotrichosis?

Answer 41

Cutaneous

• lesions adherent to overlying skin that then ulcerate
• occurs on fingers, hands, or arms

Question 42

What is the gold standard for Sporotrichosis?

Answer 42

Fungal infection