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NBME Micro > Fungi: Opportunistic Fungal Infections > Flashcards

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
Q

aspergillomas (“fungus balls”) typically develop in

A

old pulmonary cavities (from tuberculosis, sarcoidosis, emphysema, etc.)

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26
Q

aspergillomas (“fungus balls”) classically appear as

A

radiopaque structures that shift with change in position on chest X-ray (gravity-dependent)

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27
Q

invasive pulmonary aspergillosis

A

invasive pulmonary aspergillosis (angioinvasive, airway centered invasive) occurs in immunosuppressed and neutropenic patients

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28
Q

in severely immunocompromised and neutropenic patients, Aspergillus can

A

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
Q

invasive pulmonary aspergillosis occurs in

A

immunocompromised/neutropenic patients

30
Q

invasive pulmonary aspergillosis occurs in immunocompromised/neutropenic patients and can present with

A

some combination of fever, cough, and hemoptysis, chest pain and dyspnea

31
Q

in immunocompromised and neutropenic patients, Aspergillus can spread hematogenously to the

A
  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
Q

_______ is effective against aspergillosis

A

viroconazole

33
Q

_________ can be used to treat invasive aspergillosis

A

amphotericin B

34
Q

Cryptococcus neoformans yeast cells are

A
  1. encapsulated by a thick polysaccharide layer with antiphagocytic properties
  2. urease positive
35
Q

the thick capsule surrounding Cryptococcus neoformans yeast cells is composed of

A

polysaccharides

36
Q

Cryptococcus neoformans is commonly found in

A

bird (particularly pigeon) droppings and soil and enters the body through inhalation

37
Q

Cryptococcus neoformans yeast cells are encapsulated by

A

a thick polysaccharide layer with antiphagocytic properties

38
Q

Cryptococcus neoformans is an

A

opportunistic fungi that more commonly affects immunocompromised patients (i.e. HIV patients)

39
Q

pulmonary cryptococcosis is often

A

asymptomatic, but may present with coughing and dyspnea

40
Q

the most common manifestation of Cryptococcus neoformans infection is

A

meningitis (particularly in immunocompromised patients), which often presents with fever and neck stiffness

41
Q

Diagnosis of pulmonary cryptococcosis

A
  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
Q

in cryptococcal meningitis, India ink staining of cerebrospinal fluid will show

A

a wide clear zone (capsular “haloes”) around Cryptococcus neoformans yeast cells on a dark background

43
Q

the latex agglutination test detects the polysaccharide capsule antigen of Cryptococcus neoformans in the serum and cerebrospinal fluid for diagnosis of

A

cryptococcosis

44
Q

Diagnosis of Cryptococcosis via latex agglutination test

A

the latex agglutination test detects the polysaccharide capsule antigen of Cryptococcus neoformans in the serum and cerebrospinal fluid for diagnosis of cryptococcosis

45
Q

cryptococcal meningoencephalitis may present with

A

“soap bubble” brain lesions on MRI

46
Q

initial treatment of cryptococcal meningitis is

A

a combination of amphotericin B and flucytosine (followed by long-term therapy or fluconazole)

47
Q

_______ is given for long-term maintenance therapy for cryptococcal meningitis (after initial treatment of amphotericin B and flucytosine)

A

fluconazole

48
Q

Mucor spp. and Rhizopus spp. are opportunistic fungi that cause

A

mucormycosis

49
Q

mucormycosis affects

A

immunocompromised patients

50
Q

mucormycosis is strongly associated with

A

diabetes mellitus and diabetic ketoacidosis

51
Q

certain species of Rhizopus are

A

common bread molds

52
Q

Mucor spp. and Rhizopus spp. enter the body through

A

inhalation

53
Q

mucormycosis caused by Rhizopus spp. is strongly associated with

A

diabetic ketoacidosis (likely due to ketone reductase activity of Rhizopus spp., which allows for survival in an acidic environment)

54
Q

_____ _____ of Mucor spp. and Rhizopus spp. form nonseptate hyphae that branch at right angles (90°)

A

mold forms

55
Q

Mucor spp. and Rhizopus spp. proliferate in

A

blood vessel walls

56
Q

Mucor spp. and Rhizopus spp. can enter the brain via the

A

cribriform plate

57
Q

rhinocerebral mucormycosis can lead to

A

necrosis of the nasal cavity, presenting as a black eschar on the palate or turbinates

58
Q

treatment of mucormycosis includes

A

amphotericin B and surgical debridement

59
Q

Pneumocystis jirovecii pneumonia is the most prevalent opportunistic infection in

A

HIV patients and is an AIDS-defining illness

60
Q

Pneumocystis jirovecii is an opportunistic fungi and affects

A

immunocompromised patients almost exclusively

61
Q

disease caused by Pneumocystis jirovecii in immunocompetent patients is

A

extremely rare (immunocompetent individuals may be asymptomatic carriers of P. jirovecii)

62
Q

HIV patients with a CD4+ count <200 are at risk of developing

A

Pneumocystis jirovecii pneumonia

63
Q

“ground glass” infiltrates on chest X-ray are a feature of

A

Pneumocystis jirovecii pneumonia

64
Q

microscopic examination or PCR of bronchoalveolar lavage fluid or induced sputum sample can be used to

A

diagnose Pneumocystis jirovecii pneumonia

65
Q

methenamine silver stain of lung biopsy or bronchoalveolar lavage fluid shows

A

disc-shaped yeast-like cells in Pneumocystis jirovecii pneumonia

66
Q

yeast-like cells of Pneumocystis jirovecii have

A

an ovoid or “crushed ping pong ball” appearance on microscopic examination of methenamine silver stained lung tissue or bronchoalveolar lavage fluid

67
Q

______ is used in HIV patients for prevention (given prophylactically when CD4+ count is <200) and treatment of Pneumocystis jirovecii pneumonia

A

Bactrim (trimethoprim-sulfamethoxazole)

68
Q

_______ is used in HIV patients for prevention (given prophylactically when CD4+ count is <200) and treatment of Pneumocystis jirovecii pneumonia

A

trimethoprim-sulfamethoxazole

69
Q

________ 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

A

pentamidine

NBME Micro (36 decks)

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