Fungi II

Question 1

opportunistic mycoses

Answer 1

-candida
-cryptococcus
-aspergillis
-mucormycosis
-pneumocystis

Question 2

candidiasis - overview

Answer 2

*YEAST
*spectrum of infectious
*endogenous in origin (normal flora and then invades)

Question 3

candidiasis - causative agent

Answer 3

C. albicans is most common

Question 4

candidiasis - risk factors

Answer 4

*immunocompromised hosts
*critically ill patients (ICU)
*catheters/parenteral nutrition/GI surgery
*broad spectrum antibiotics

Question 5

candidiasis - clinical syndromes

Answer 5

*cutaneous infections
*mucosal infections
*invasive infections (bloodstream or organs)

Question 6

chronic disseminated candidiasis

Answer 6

*s/s: fever, RUQ pain, elevated liver enzymes
*small candida abscesses in liver
*cutaneous involvement
*primarily occurs in pts with LEUKEMIA (or other immunocompromising conditions/neutropenia)

Question 7

candidiasis - diagnosis

Answer 7

*yeast and/or PSEUDOHYPHAE (with constrictions)
*cultures of blood

Question 8

cryptococcosis - causative agent

Answer 8

cryptococcus neoformans

Question 9

cryptococcosis - acquisition

Answer 9

*INHALATION of spores
*bird droppings or eucalyptus/fir trees

Question 10

cryptococcosis - risk factors

Answer 10

*defects in T cell function:
-HIV
-high dose steroids
-transplant pts

Question 11

cryptococcosis - clinical features

Answer 11

*primary presentation = meningitis
*sometimes pulmonary disease or cutaneous manifestations

Question 12

cryptococcosis - diagnosis

Answer 12

-encapsulated yeast with narrow-based budding on INDIA INK
-ANTIGEN (CSF and serum) detection

Question 13

aspergillosis - causative agent

Answer 13

A. fumigatus

Question 14

aspergillosis - overview

Answer 14

MOLD INFECTION
*exhibit ANGIOINVASION (invade and occlude arteries)
*most common form of invasive filamentous fungal disease

Question 15

aspergillosis - epidemiology

Answer 15

*INHALATION of spores
*risk factor = severe and prolonged neutropenia

Question 16

aspergillosis - clinical features

Answer 16

*pneumonia
*rhinosinusitis
*CNS infection

Question 17

invasive pulmonary aspergillosis (IPA)

Answer 17

*most severe aspergillosis infection
*rapidly progressive
*HALO-SIGN or AIR-CRESCENT SIGN on radiography
*fever, cough, pleuritic chest pain, hemoptysis

Question 18

invasive aspergillosis - diagnosis

Answer 18

*septated hyphae with ACUTE angle branching
*aspergillus GALACTOMANNAN antigen test (serum or respiratory specimens)

Question 19

mucormycosis - agents

Answer 19

*several species can cause
*rhizopus most common
*MOLD

Question 20

mucormycosis - epidemiology/acquisition

Answer 20

*environmental
*INHALATION most common

Question 21

mucormycosis - risk factors

Answer 21

*diabetes (poorly controlled, esp DKA)
*hematologic malignancy
*prolonged neutropenia

Question 22

mucormycosis - clinical features

Answer 22

*pneumonia
*rhinosinusitis
**RHINO-ORBITAL INFECTION (really bad)
*CNS disease
*disseminated disease

Question 23

mucormycosis - diagnosis

Answer 23

*broad, NON-SEPTATE, RIGHT-ANGLE BRANCHING hyphae

Question 24

mucormycosis - management

Answer 24

*aggressive surgical debridement
*antifungal Rx

Question 25

pneumocystosis - agent

Answer 25

pneumocystis jirovecii

Question 26

pneumocystosis - overview

Answer 26

*opportunistic fungal pathogen
*primarily targets the lungs in immunocompromised hosts

Question 27

pneumocystosis - acquisition

Answer 27

*INHALATION

Question 28

pneumocystosis - clinical features

Answer 28

*subactue pneumonia
*fever, dyspnea, non-productive cough
*classic CXR findings = bilateral diffuse infiltrates
*elevated B-D-glucan levels in serum

Question 29

pneumocystosis - diagnosis

Answer 29

*thick and thin walled cysts on GMS staining of respiratory secretions
*PCR or direct fluorescent antibody staining on respiratory specimens