Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonology > Fungus, Immunocompromised Pneumonia > Flashcards

Fungus, Immunocompromised Pneumonia Flashcards

1
Q

define endemic mycoses

A

caused by dimorphic fungi; can cause serious disease in both healthy and immunocompromised pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

define opportunistic mycosis

A

can cause life threatening disease in immunocompromised pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the most common etiologic agents of pulmonary infection by fungi in healthy hosts, cause over 1 million infections/year in the US

A

dimorphic fungi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how and in what form do dimorphic fungi grow, including where

A

grow as yeast in human tissue and as mold under some laboratory conditions (typically room temperature)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

after inhalation of dimorphic fungi, what happens to the shit? what do they differentiate into

A

within the lungs, the spores differentiate into yeasts or spherules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

are most fungus lung infections self limited or disseminated?

A

most lung infections are self-limited and even asymptomatic, however all can cause pneumonia and disseminate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the 4 dimorphic fungi that we talked about?

A

1 - Blastomyces dermatitidis
2 - Histoplasma capsulatum
3 - Coccidioides immitis
4 - Paracoccidioides brasiliensis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is some of the epidemiology for histoplasma capsulaturm? - where is it found and in what mediums does it grow

A

endemic in Mississippi and Ohio River valleys

grows in soil and bird droppings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

For Histo, what is commonly the presenting symptoms

A

asymptomatic pulmonary infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

For Histo with intense exposure, what is the common presenting symptoms?

A

respiratory infection - fever, chills, cough, chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If you have an AIDS pt w/ suspected histo, what are you worried about them developing and what are the manifestations of this?

A

severe disseminated disease
pancytopenia (due to bone marrow infiltration)
Mouth/ GI ulcers
Skin rash (pustules, nodules)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the mortality rate of disseminated histo in AIDS pts

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how do you make the dx of histo based on tissue biopsy?

A

tissue biopsy will show oval yeast cells w/in macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

other than tissue biopsy, what are other ways of making dx of histo?

A

serology
urinary antigen
CXR - variable - infiltrates, mediastinal LAD, cavitary lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the treatment for Histo? one for severe disease, one for otherwise

A

Amphotericin for severe disease

Itraconazole otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what clinical finding in Histo indicates a good prognosis? is it specific for Histo?

A

Erythema nodosum manifests as red, tender nodules (“desert bumps”) on extensor surfaces such as the skin over tibia and ulna - it is delayed cell mediated hypersensitivity that indicates a good, active cell mediated immunity - not specific for Histo - seen in other granulomatous diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what fungus is endemic in Ohio/Mississippi River Valley and Missouri and Arkansas River Basins?

A

Blastomyces dermatitidis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

where does Blasto grow?

A

moist soil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is the common clinical manifestation of Blasto

A

asymptomatic respiratory illness -

50% will have cough, chest pain, sputum production, fever/night sweats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How does Blasto usually resolve

A

spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

in what pt populations can disseminated blasto infection be seen? what are the clinical manifestations of dissemination?

A

disseminated disease can be seen in both immunocompetent and immunocompromised
results in ulcerated granulomatous lesions of the skin (70%), bone (33%), GU tract (35%), and CNS (10%)
CNS manifestations can help diff from Histo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you make diagnosis of Blastomyces on tissue biopsy? This is high yield

A

Broad Based Bud
Thick-walled yeast cells a single broad based bud
looks like snowman

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What other means of dx Blasto?

A

CXR - variable, but can see lobar consolidation, multilobar infiltates, multiple nodules, etc
serology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the treatment of blasto? one for severe dz, one in general

A

Amphotericin for severe dz

Itaconazole otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

describe the cutaneous lesions seen in Blasto

A

verucous (wart like lesion), can be ulcerated, gray to violet colored

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what fungus is endemic in Southwestern US and Latin America

A

Coccidioides Immitis (this is one of the most defining features)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what is the pathogenesis of coccidioides (what happens in the lung)

A

in the lungs, large spherules form and are filled w/ endospores. Upon rupture of spherule wall, endospores are released and differentiate to form new spherules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

what is the most common clinical manifestation of Coccidioides?

A

most infections asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

For symptomatic Coccidioides infxns, what will you see

A

mild influenza-like illness w/ fever and cough (“valley fever”) in 10%
can see erythema nodosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what popoulations are more susceptible to dissemination by Coccidioides, and what are the most common sites of dissemination

A

African Americans, Filipinos, and women in 3rd trimester of pregnancy
Bone, meninges, skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

For Coccidioides, what is the most distinguishing dx feature

A

eosinophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what are other means of diagnosing Coccidioides

A

serology
spherules seen microscopically
skin test reativity (not very common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is the treatment for Coccidioides with persistent lung lesions of disseminated disease

A

Amphotericin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the treatment for Coccidioides meningitis

A

Fluconazole - can cross BBB

also use in long term suppression to prevent recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

what fungal infxn is common in rural latin America, especially Brazil?

A

Paracoccidioides brasiliensis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

what are the clinical manifestations of Paracoccidioides

A

mild respiratory infection which can progress w/ dissemination
development of oral, nasal, and facial nodular ulcerated lesions and submandibular LAD ***
This is much more extensive lesions than a blasto disseminated infxn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

what is the Dx for paracoccidioides? tissue biopsy and serology

A

tissue biopsy shows yeast cells w/ multiple buds

serology (looks like the wheel of a ship)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

what is the tx for Paracoccidioides

A

several months of Itraconazole

Amphotericin for severe disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

what is the buzzword for the microscopic appearance of Paracoccidioides

A

pilot wheel configuration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

where do you find Aspergillus fumigatus?

A

Mr. Worldwide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what type of fungi (morphology?) is Aspergillus, and where does it grow

A

mold with septate hyphae

grow on decaying vegetation producing chains of conidia

42
Q

what are some of the features of an Aspergillus infection?

1) something that produces hempotysis
2) something you can detect via a titer,
3) appearance of expactorations
4) disease process

A

1) fungus ball formed within cavities of the lungs, can produce hemoptysis
2) allergic infection of the bronchi that produces asthmatic symptoms and high IgE titer
3) allergic infection of bronchi - causes expectoration of brownish bronchial plugs containing hyphae
4) invasive PNA producing hemmorrhage, infarction, and necrosis

43
Q

What pt population is highest risk factor for Aspergillus? esp producing hemorrhage and shit

A

those with hematologic malignancies and neutropenia - invasive PNA producing hemorrhage is common cause of death in these pts

44
Q

how do you make dx of Aspergillus via tissue biopsy? this is high yield

A

septate, acute angle branching hyphae

radiating chains of conidia

45
Q

what is a dx feature of Aspergillus seen on CT scan?

A

halo sign - areas of focal hemorrhage around the lesion

can see single or multiple nodules with or without cavitation

46
Q

what is the first line treatment of Aspergillus

A

Voriconazole

47
Q

if pts do not tolerate Voriconazole well, what is alternative tx for Aspergillus

A

Amphotericin or echinocandins

48
Q

what do you need to do in Aspergillus pts to control the hemoptysis

A

remove the fungus balls

49
Q

what do you use to treat ABPA? (allergic bronchopulmonary Aspergillosis)

A

steroids and antifungal agents

50
Q

what are opportunistic infections caused by bread mold?

A

Mucormycosis

51
Q

give 4 examples of Mucormycetes

A

Mucor, Rhizopus, Cunninghamella, Lictheimia

52
Q

what are 5 risk factors for Mucormycosis

A 
Diabetes
neutropenia 
iron overload 
burns/surgical wounds 
corticosteroid use
53
Q

how is mucormycosis transmitted? what does it invade in host?

A

transmitted by airborne spores

invades tissue and angioinvasive - pts w/ reduced host defenses

54
Q

besides penumonia, what are 2 clinical manifestations of Mucormycosis

A

1) invasive rhinocerebral sinusitis, frontal lobe abscesses

2) cutaneous infections

55
Q

describe the pathogenesis of invasive rhinocerebral sinusitis and frontal lobe absceses seen in mucormycosis

A

it originates in the paranasal sinuses and spreads tothe orbit, hard palate and brain

56
Q

what is the presentation of a pt w/ mucormycosis w/ the rhinocerebral shitusitis and front lobe asses? mortality rate

A

headache and facial pain

carries a high mortality rate

57
Q

what are the defining features of mucormycosis on biopsy? high yield, must know

A

nonseptate broad hyphae with frequent right angle branching
spores in a sporangium
(as oppo to conidia for aspergillus)

58
Q

what is the treatment for Mucormycosis? what is an alternate?

A

treat the underlying disorder
Amphotericin + surgical resection of necrotic infected tissue
alternate - Posaconazole can also be used

59
Q

what kind of organism is Pneumocystic jiroveci?

A

yeast

60
Q

what are the most common symptoms of Pneumocystis infxn

A

most infxns are asymptomatic

61
Q

Pneumocystis and immunosuppressed patients - what are we worried about?

A

PCP - pneumocystis carinii pneumonia

carinii = jiroveci

62
Q

what pt population specifically are we worried about Pneumocystis in?

A

AIDS pts

common opportunistic infxn, one of leading causes of death in AIDS pts

63
Q

What is the pathogenesis of Pneumocystis jiroveci?

A

cysts in alveoli produce inflammatory responses, resulting in forthy exudate that blocks oxygen exchange

64
Q

how does the Pneumocystis organism get into tissue?

A

Pneumocystis does not invade lung tissue

65
Q

How does the immune system clear the pneumocystis organism? What is the importance of this?

A

CD4+ T cells recruit monocytes and macrophages which are responsible for clearance of the organism
AIDS pts - a CD4 count less than 200 is main risk factor for getting pneumocystis infxn

66
Q

what are 5 clinical manifestations of PCP

A 
dry cough 
dyspnea that is progressive
Fever
tachypnea 
hypoxemia
67
Q

What are CXR findings in PCP?

A

diffuse, bilateral, interstitial, or alveolar infiltrates

CXR normal in up to 1/4

68
Q

what is another clinical manifestation that can occur from PCP

A

pneumothorax

69
Q

you see an AIDS pt that is dyspnic and hypoxemic, but has a normal CXR - can this be PCP?

A

yes - negative CXR does not rule out

70
Q

what is the O2 sat of a pt w/ PCP, and why

A

O2 sats low, in the 80s - the frothy exudate is blocking gas exchange

71
Q

dx of PCP - what stains can you use to visualize cysts?

A

visualization of cysts by methenamine silver, Giemsa stain or other stains

72
Q

What is the appearnace of PCP on microscopic examination

A

helmet shaped cells

73
Q

what are 2 other dx techniques used in PCP

A

fluorescent antibody staining

PCR on respiratory tract specimens

74
Q

what is the first line treatment for PCP

A

trimethoprim-sulfamethoxazole (Bactrim)

75
Q

what are the 3 options for 2nd line tx of PCP

A

Clindamycin/Primaquine
Atovaquone
Pentamidine

76
Q

PCP prophylaxis in AIDS pts
what level of CD4 count
what 3 medications

A

AIDS pts w/ CD4 count less than 200

Bactrim, Dapsone, Atovaquone

77
Q

in genenral, what is cryptococcus neoformans? and where is it found?

A

yeast present in soil and bird (pigeon) droppings

78
Q

what is the morphology of crypto (high yield)

A

oval budding yeast with wide polysaccharide capsule;

forms narrow-based bud**

79
Q

what specific disease are you worried about in crypto infxn of immunocompromised pts

A

meningitis

most common life-threatening disease in AIDS pts

80
Q

what other disease are you worried about with crypto infxn of either immunocompromised or immunocompetent
what are the symptoms in each case

A

pneumonia
immunocompetent - asymptomatic
immunocmpromised - fever, chest pain, dyspnea, cough, and hemoptysis

81
Q

what is the appearance of crytpo on CXR

A

nodules and or ground glass opacities

82
Q

what is morphology of cytomegalovirus

A

DNA enveloped virus similar in morphology and structure to other Herpes viruses

83
Q

what is pathogenesis of CMV

A

enters latent state primarily in monocytes and can be reactivated when cell-mediated immunity is decreased

84
Q

what common disease process commonly develops in immunosuppressed pts (transplants) w/ CMV

A

pneumonitis

85
Q

what disease processes develop in AIDS pts w/ CMV

A

colitis and retinitis

typically NOT pneumonitis

86
Q

what is the appearance of CMV on CXR?

A

diffuse infiltrates, ground glass opacities

87
Q

What is a characteristic finding of CMV pneumonitis on biopsy of lung tissue

A

viral inclusion body

88
Q

if you see pneumonia and a brain abscess, what bug should you be thinking abou

A

Nocadria asteroides - causing nocardiosis

89
Q 
Nocardia asteroides - aerobic or anaerobic?
where found? 
morphology?
gram stain?
weakly also stain what?
A 
aerobes 
found in the soil 
thin branching filaments 
gram + 
many isolates weakly acid fast
90
Q

Nocardiosis, immunocompromised pt - what disease process and predilection for what tissue

A

produces lung infection and may disseminate, has predilection for brain tissue

91
Q

Nocardiosis - what specific pathologic findings do you see in lungs

A

pneumonia, lung abscesses w/ cavity formation, lung nodules or empyema

92
Q

how do you dx nocardiosis?

A

gram stain/ acid-fast stain

culture

93
Q

tx for nocardiosis

A

Trimethoprim-sulfamethoxazole (Bactrim), sometimes combination therapy is needed, ressitance can occur, sensitivities should be performed

94
Q

Ohio/Mississippi River Valleys, Intracellular, found in phagocytes

A

Histo

95
Q

Ohio/Mississippi River Valleys, Missouri and Arkansas River basins
Broad based bud

A

Blasto

96
Q

“Valley fever” Southwestern US and Latin America
Pregnant Women, African Americans and Filipinos at risk for dissemination to bones and meninges
Eosinophilia

A

Coccidioides immitis

97
Q

yeast w/ multiple buds, “pilot wheel” configuration
Rural Latin America, espp Brazil
Oral, nasal, facial nodular ulcerated lesions

A

Paracoccidioides

98
Q

How often do AIDS pts get Aspergillus infxn? and why?

A

AIDS pts do not get Aspergillus - AIDS pts are lymphopenic and susceptibility to Aspergillus is being neutropenic

99
Q

what is the most common opportunistic infxn in AIDS pts

A

PCP (pneumocystis)

100
Q

why can you not use traditional antifungals on pneumocystis

A

it does not contain ergosterol

101
Q

compare and contrast the morphology of Aspergillus and Mucor on tissue biopsy
1 - septate or non
2 - angle of branching
3 - spores

A

Aspergillus - septate hyphae, acute angle branching, radiating chains of conidia
Mucor - nonseptate hyphae, 90 degree angle branching, spores in sporangium

102
Q

pneumothroax - what fungus are you worried about

A

pneumocystis

Pulmonology (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions