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Fungi: Opportunistic Fungal Infections Flashcards

1
Q

List the opportunistic fungal infections

A
  1. candida albicans
  2. aspergillus fumigatus
  3. Cryptococcus neoformans
  4. mucor
  5. rhizopus
  6. pneumocystis jirovecii
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2
Q

Candida albicans is a

A

dimorphic fungus, but differs from other dimorphic fungi in that it forms pseudohyphae and budding yeast at 20°C (yeast form), and germ tubes at 37°C (mold form)

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3
Q

Candida albicans forms

A
  1. germ tubes at 37°C (mold form)

2. pseudohyphae and budding yeast at 20°C (yeast form)

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4
Q

Candida albicans fungi are

A

catalase positive

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5
Q

Candida albicans can cause

A
  1. cutaneous candidiasis in areas exposed to heat and humidity (diaper rash in infants)
  2. disseminated disease in immunocompromised patients (especially those with neutropenia)
  3. HIV-associated esophagitis (an AIDS-defining illness), which presents with adherent grey/white pseudomembranes
  4. infection of the vulva and vagina (vulvovaginal candidiasis), which typically presents with vulvar pruritus and a thick white vaginal discharge
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6
Q

oral thrush due to Candida albicans

A

oral thrush due to Candida albicans (which commonly presents as white patches on the lining of the mouth) is associated with oral or inhaled steroid use and immunosuppression

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7
Q

the white patches of Candida albicans fungi that form on lining of the mouth can be

A

scraped off

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8
Q

Candida albicans infection can be diagnosed with

A

KOH mount of oral/vaginal/skin scrapings (microscopic examination will show budding yeast and pseudohyphae)

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9
Q

esophageal candidiasis is an

A

AIDS-defining illness that generally occurs in patients with a CD4+ count <200

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10
Q

risk factors for vulvovaginal candidiasis

A

uncontrolled diabetes mellitus, antibiotic use, and high estrogen levels (i.e. oral contraceptives, pregnancy)

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11
Q

the vaginal pH in vulvovaginal candidiasis

A

the vaginal pH typically remains normal (3.8-4.5) in vulvovaginal candidiasis

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12
Q

Candida infective endocarditis commonly affects

A

Candida infective endocarditis commonly affects the tricuspid valve and is associated with IV drug use, prosthetic heart valves, and indwelling lines

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13
Q

_________ is effective against Candida albicans

A

fluconazole

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14
Q

__________ can be used to treat Candida albicans infections (typically when resistance or intolerance to antifungals is suspected or proven)

A

amphotericin B

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15
Q

_________ is used topically to treat Candida skin infection (but is not indicated for vaginal candidiasis) and orally for thrush

A

nystatin

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16
Q

________ can be used to treat oral, esophageal, and systemic candidiasis

A

caspofungin/micafungin (echinocandins antifungals)

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17
Q

Aspergillus spp. fungi are

A

catalase positive

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18
Q

________ produced by Aspergillus flavus can be found in nuts, legumes, wheat, and other crops

A

aflatoxins

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19
Q

aflatoxins

A

aflatoxins of Aspergillus flavus have been linked to hepatocellular carcinoma

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20
Q

Aspergillus spp. have

A

septate hyphae that form 45-degree angle branches

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21
Q

Aspergillus is transmitted via

A

inhalation of spores (contained in fruiting bodies)

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22
Q

allergic bronchopulmonary aspergillosis (a type I hypersensitivity reaction) presents with

A

migratory pulmonary infiltrates, wheezing, and increased serum IgE (most commonly in cystic fibrosis and asthma patients)

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23
Q

elevated serum IgE is a common clinical manifestation of

A

allergic bronchopulmonary aspergillosis (a type I hypersensitivity reaction)

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24
Q

colonization of Aspergillus in the lung

A

colonization of Aspergillus in the lung (“fungus balls” that usually form in old pulmonary cavities) may cause fever, hemoptysis, and cough

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25
aspergillomas (“fungus balls”) typically develop in
old pulmonary cavities (from tuberculosis, sarcoidosis, emphysema, etc.)
26
aspergillomas ("fungus balls") classically appear as
radiopaque structures that shift with change in position on chest X-ray (gravity-dependent)
27
invasive pulmonary aspergillosis
invasive pulmonary aspergillosis (angioinvasive, airway centered invasive) occurs in immunosuppressed and neutropenic patients
28
in severely immunocompromised and neutropenic patients, Aspergillus can
in severely immunocompromised and neutropenic patients, Aspergillus can invade blood vessels and spread hematogenously to the kidneys, endocardium, brain, skin, and paranasal sinuses, causing infection and infarction
29
invasive pulmonary aspergillosis occurs in
immunocompromised/neutropenic patients
30
invasive pulmonary aspergillosis occurs in immunocompromised/neutropenic patients and can present with
some combination of fever, cough, and hemoptysis, chest pain and dyspnea
31
in immunocompromised and neutropenic patients, Aspergillus can spread hematogenously to the
1. kidneys, which may result in infarction and renal failure 2. endocardium, which may result in endocarditis 3. CNS; CNS aspergillosis can present with ring-enhancing lesions 4. paranasal sinuses, which may lead to tissue necrosis
32
_______ is effective against aspergillosis
viroconazole
33
_________ can be used to treat invasive aspergillosis
amphotericin B
34
Cryptococcus neoformans yeast cells are
1. encapsulated by a thick polysaccharide layer with antiphagocytic properties 2. urease positive
35
the thick capsule surrounding Cryptococcus neoformans yeast cells is composed of
polysaccharides
36
Cryptococcus neoformans is commonly found in
bird (particularly pigeon) droppings and soil and enters the body through inhalation
37
Cryptococcus neoformans yeast cells are encapsulated by
a thick polysaccharide layer with antiphagocytic properties
38
Cryptococcus neoformans is an
opportunistic fungi that more commonly affects immunocompromised patients (i.e. HIV patients)
39
pulmonary cryptococcosis is often
asymptomatic, but may present with coughing and dyspnea
40
the most common manifestation of Cryptococcus neoformans infection is
meningitis (particularly in immunocompromised patients), which often presents with fever and neck stiffness
41
Diagnosis of pulmonary cryptococcosis
1. microscopic examination of bronchoalveolar lavage prepared with mucicarmine or methenamine stain 2. bronchoalveolar lavage can be prepared with mucicarmine (red) or methenamine (silver) stain
42
in cryptococcal meningitis, India ink staining of cerebrospinal fluid will show
a wide clear zone (capsular “haloes”) around Cryptococcus neoformans yeast cells on a dark background
43
the latex agglutination test detects the polysaccharide capsule antigen of Cryptococcus neoformans in the serum and cerebrospinal fluid for diagnosis of
cryptococcosis
44
Diagnosis of Cryptococcosis via latex agglutination test
the latex agglutination test detects the polysaccharide capsule antigen of Cryptococcus neoformans in the serum and cerebrospinal fluid for diagnosis of cryptococcosis
45
cryptococcal meningoencephalitis may present with
“soap bubble” brain lesions on MRI
46
initial treatment of cryptococcal meningitis is
a combination of amphotericin B and flucytosine (followed by long-term therapy or fluconazole)
47
_______ is given for long-term maintenance therapy for cryptococcal meningitis (after initial treatment of amphotericin B and flucytosine)
fluconazole
48
Mucor spp. and Rhizopus spp. are opportunistic fungi that cause
mucormycosis
49
mucormycosis affects
immunocompromised patients
50
mucormycosis is strongly associated with
diabetes mellitus and diabetic ketoacidosis
51
certain species of Rhizopus are
common bread molds
52
Mucor spp. and Rhizopus spp. enter the body through
inhalation
53
mucormycosis caused by Rhizopus spp. is strongly associated with
diabetic ketoacidosis (likely due to ketone reductase activity of Rhizopus spp., which allows for survival in an acidic environment)
54
_____ _____ of Mucor spp. and Rhizopus spp. form nonseptate hyphae that branch at right angles (90°)
mold forms
55
Mucor spp. and Rhizopus spp. proliferate in
blood vessel walls
56
Mucor spp. and Rhizopus spp. can enter the brain via the
cribriform plate
57
rhinocerebral mucormycosis can lead to
necrosis of the nasal cavity, presenting as a black eschar on the palate or turbinates
58
treatment of mucormycosis includes
amphotericin B and surgical debridement
59
Pneumocystis jirovecii pneumonia is the most prevalent opportunistic infection in
HIV patients and is an AIDS-defining illness
60
Pneumocystis jirovecii is an opportunistic fungi and affects
immunocompromised patients almost exclusively
61
disease caused by Pneumocystis jirovecii in immunocompetent patients is
extremely rare (immunocompetent individuals may be asymptomatic carriers of P. jirovecii)
62
HIV patients with a CD4+ count <200 are at risk of developing
Pneumocystis jirovecii pneumonia
63
“ground glass” infiltrates on chest X-ray are a feature of
Pneumocystis jirovecii pneumonia
64
microscopic examination or PCR of bronchoalveolar lavage fluid or induced sputum sample can be used to
diagnose Pneumocystis jirovecii pneumonia
65
methenamine silver stain of lung biopsy or bronchoalveolar lavage fluid shows
disc-shaped yeast-like cells in Pneumocystis jirovecii pneumonia
66
yeast-like cells of Pneumocystis jirovecii have
an ovoid or “crushed ping pong ball” appearance on microscopic examination of methenamine silver stained lung tissue or bronchoalveolar lavage fluid
67
______ is used in HIV patients for prevention (given prophylactically when CD4+ count is <200) and treatment of Pneumocystis jirovecii pneumonia
Bactrim (trimethoprim-sulfamethoxazole)
68
_______ is used in HIV patients for prevention (given prophylactically when CD4+ count is <200) and treatment of Pneumocystis jirovecii pneumonia
trimethoprim-sulfamethoxazole
69
________ can be used in HIV patients for prevention (given prophylactically when CD4+ count is <200) and treatment of Pneumocystis jirovecii pneumonia when trimethoprim-sulfamethoxazole is not tolerated
pentamidine

Sketchy Medical (46 decks)

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