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Respiratory Exam II > Fungi & Parasites > Flashcards

Fungi & Parasites Flashcards

1
Q

what are the 2 bugs that cause “Valley Fever?”

A
  • Coccidioides immitis

- C. posadasii

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2
Q

which coccidioides bug is more common and what geographical area is it in?

A
  • C. immitis

- SW US –> San Joaquin Valley

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3
Q

how do you get C. immitis? what is the yeast form called? mode of infection?

A
  • inhale from the soil
  • yeast form = spherule = BUZZ
  • spherule contains endospores; it ruptures and the endospores go and form new spherules
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4
Q

what is weird about the C. immitis spherules?

A
  • the spherules don’t actually infect the cells; they cause pain because they are pushing around the lung tissue
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5
Q

C. immitis clinical ds

A
  • 60-65% of infections are asymptomatic
  • mainly a pulmonary infection if it is symptomatic
  • can disseminate in immunocompromised pts
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6
Q

what labs can dx C. immitis?

A
  • KOH prep = dissolves cells EXCEPT fungal cells
  • grows on Sabouraud dextrose agar in 3-4d
  • serology and CXR
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7
Q

tx for c. immitis?

A
  • DOC = ketoconazole; alternative = fluconazole
  • for prego pt = amphotericin B b/c -azoles are teratogenic
  • for IC pts use amphotericin B followed by 1 year of fluconazole; use lifelong fluconazole if there is a CNS infection
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8
Q

Blastomyces dermatitidis: appearance of mold vs. yeast forms

A
  • mold = hyphae w/ nondescript conidia

- yeast = broad-based budding yeast = BUZZ

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9
Q

geography for Blastomyces? associated with?

A
  • found in Ohio and Mississippi river valleys and Great Lakes
  • assoc w/ decaying matter (soil and leaf litter), rotting wood (beaver dams)
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10
Q

Blastomyces dermatitidis clinical manifestations

A
  • 50% = flu-like or asymptomatic
  • pneumonia in severe ds = acute onset, lobar infiltrates, high fever, cough
  • can disseminate to skin and bones rarely
  • can go to CNS in AIDS pts
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11
Q

dx and tx for Blastomyces dermatitidis

A
  • dx = microscopy followed by culture; serology can be done but not helpful
  • tx = amphotericin B for severe ds; can use itraconazole in immune competent adults
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12
Q

Histoplasma capsulatum: mold v. yeast appearance

A
  • mold = hyphae w/ microconidia and tuberculate macroconidia

- yeast = intracellular, infects WBC

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13
Q

epidemiology for histoplasma?

A
  • Ohio, Missouri, and Mississippi river basins
  • found in bird and bat droppings
  • risk factors = bird roosts, spelunking, building demolition = BUZZ
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14
Q

histoplasma clinical ds?

A
  • pulmonary sx will vary based on inhaled inoculum
  • low intensity = 90% are asx
  • high intensity can be acute or progressive; acute = flu-like, cough, chest pain and CXR = patchy infiltrates; progressive = IC pts = destruction and fibrosis of pulmonary tissue
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15
Q

histoplasma dx and tx

A
  • dx: microscopy of stained smears = intracellular yeast in WBC (macrophage); ELISA of plasma; culture on Sabouraud dextrose agar but only + in 30-60% of pts
  • tx: for severe acute ds = IV amphotericin B followed by 12 weeks itraconazole; mild pulmonary ds = intraconazole
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16
Q

how do you get Paracoccidioidomycosis? where? buzz word? treatment?

A
  • inhaled from the soil
  • found in central and S. America
  • BUZZ = “pilot’s wheel” = multiple budding yeast
  • tx = itraconazole
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17
Q

most common species of Aspergillosis?

A
  • A. flavus
18
Q

possible ways to get Aspergillosis?

A
  • conidia are inhaled
  • get it from air, soil, decaying matter
  • can be inhaled nosocomially from shower heads, water tanks, plants
19
Q

what are the 3 categories of ds possible in Aspergillosis?

A
  • allergic
  • noninvasive
  • invasive
20
Q

what are the 3 types of allergic Aspergillosis?

A
  • IgE-mediated asthma (type 1 HS)
  • allergic bronchopulmonary aspergillosis (ABPA)
  • extrinsic allergic alveolitis AKA farmer’s lung
21
Q

IgE-mediated asthma

A
  • type 1 HS rxn
  • allergic rxn to inhaled spores
  • sx = asthma, pulm infiltrates, eosinophilia, elevated serum IgE
  • hypersensitivity to Aspergillus antigens (skin test)
22
Q

ABPA: allergic bronchopulmonary aspergillosis

A
  • growth in bronchial tree secretion
  • HS pneumonitis (Types I, III, and IV)
  • occurs in pts w/ asthma or CF; rarely happens in absence of clinical asthma
23
Q

Farmer’s lung

A
  • type of HS pneumonitis (type III HS)
  • immunologic response to an inhaled agent
  • exposure to moldy hay or contaminated compost
  • acute damage caused by cytokines
  • sx resolve when you remove the irritant
24
Q

what are some other types of hypersensitivity pneumonitis? common thread to these case scenarios?

A
  • winemaker’s lung = Botrytis cinerea
  • coffee worker’s lung = coffee bean dust
  • poultry worker’s lung = Avian antigens
  • lab worker’s lung = rodent antigens
  • common thread = the symptoms come back when you get re-exposed; improve when stimulus removed
25
Q

fungal ball - aspergilloma

A
  • noninvasive pulmonary ds
  • spherical mass of intertwined septate hyphae
  • usually underlying ds = CF, TB or chronic bronchitis
  • tx not warranted unless massive hemoptysis present –> surgical excision
26
Q

aspergillosis - invasive pulmonary ds

A
  • systemic infection; rapidly fatal unless dx early and tx aggressively
  • IC host = neutropenia and corticosteroid therapy are major risk factors –> AIDS, bone marrow transplants, leukemia, lymphoma
  • clinically = fever, pulm infiltrates, chest pain, hemoptysis; mortality >70%
27
Q

how can you dx Aspergillosis?

A
  • microscopy/culture of sputum: acute angled branching hyphae = BUZZ
  • CXR for fungal ball
  • immunoassays for invasive aspergillosis
28
Q

tx and prevention for Aspergillosis

A
  • allergic aspergillosis tx = oral corticosteroids; oral itraconazole for recurrent or chronic ABPA
  • aspergilloma tx = surgical resection; could use oral itraconazole
  • invasive aspergillosis tx = voriconazole
  • prevention = antigen avoidance and air filtration
29
Q

what is the difference in appearance b/w mucor and aspergillus?

A
  • aspergillus = 45 degree branching hyphae (acute angle = aspergillus)
  • mucor = 90 degree branching hyphae
30
Q

what populations are most susceptible to mucormycosis (zygomycosis)?

A
  • mainly worried about ketoacidotic diabetics
  • could also be pts w/ leukemia, lymphoma, solid transplant pts, extensive burns
  • specifically marrow transplant pts on voriconazole
31
Q

what do you see happen w/ ketoacidotic diabetics that get mucor?

A
  • rhinocerebral zygomycosis

- gross black pus draining out of nose and eyes

32
Q

how do you dx and tx mucor?

A
  • dx = KOH prep and culture; see NONseptate hyphae w/ 90 degree branching
  • tx = tx underlying IC state; systemic amphotericin B; may need surgical debridement
33
Q

what is stachybotrys chartarum? what disease does it cause?

A
  • mold that grows on wet wood and paper

- no specific disease but associated w/ hemoptysis and asthma-like sx

34
Q

what is the #1 cause of atypical pneumonia in AIDS pts?

A
  • Pneumocystis jiroveci
35
Q

what is the pathogenesis of P. jiroveci?

A
  • binds to receptors on alveolar macrophages
  • induces diffuse alveolar damage
  • leakage of exudate
36
Q

is there anything done to prevent AIDS pts from getting P. jiroveci pneumonia?

A
  • AIDS pts usually put on Bactrim to prevent P. jiroveci once their CD count <200
37
Q

how do you dx and tx P. jiroveci pneumonia?

A
  • dx = Giemsa stain for trophic forms (DENTED HELMETS); Gomori methenamine silver stain for cyst wall
  • tx = TMP-SMX (Bactrim) is DOC; alternatives = pentamidine, dapsone
38
Q

Paragonimus westermani is know as ??

A
  • lung fluke

- is a species of trematode

39
Q

what do you get P. westermani from? where is it found? shape of adult fluke?

A
  • larvae eaten in undercooked crab, crayfish –> snail = intermediate host
  • found in Asia, Africa, India, Latin America –> look for hx of travel
  • adult fluke looks like coffee bean shape
40
Q

what signs & sx would you see w/ P. westermani?

A
  • pt travels and comes back and gets TB-like sx
  • start coughing up eggs in sputum
  • “coffee ground” or “rusty colored” sputum
  • assoc w/ bad sushi; usually hx of travel to Japan
41
Q

dx and tx for P. westermani?

A
  • dx = microscopy of sputum and feces; golden brown operculated eggs; CXR = patchy, cloudy infiltrate
  • tx = praziquantel is DOC; alternative = triclabendazole

Respiratory Exam II (7 decks)

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