HistoCocci Flashcards
What are lab findings/dx tests in coccidioidomycosis?
- Eosinophilia, leukocytosis
- Serology: IgM, IgG antibodies
- Culture
What populations are at an increased risk for complications of coccidioidomycosis?
- HIV
- African Americans & Asians
- 3rd trimester
What is the px of coccidiodomycosis?
- Limited disease = good (fatigue may persist)
- Disseminated & meningeal = High mortality
Is coccidioidomycosis reportable?
YES!
Where is histoplasmosis common?
Midwestern states, in Ohio & Mississippi river valleys
Histoplasmosis infection is secondary to what?
Inhalation of fungal spores
–> proliferation in lungs –> spreads to other organs via blood
What is histoplasma capsulatum isolated from?
soil contaminated w/ bird/bat droppings
What is the most common form of histoplasmosis in otherwise healthy people?
Asx primary histoplasmosis
In asx primary histoplasmosis, what can you see on CXR?
Residual granuloma
Describe diffuse pulmonary disease
- Form of histoplasmosis
- Can occur in healthy people w/ intense exposure (inhalation of many spores)
How does diffuse pulmonary disease present?
- Fever, fatigue
- Pulmonary complaints
- Lasts 1wk-6mos
Describe acute localized pulmonary disease
- Form of histoplasmosis
- Presents like pneumo
- local infiltrates
Describe chronic cavitary pulmonary histoplasmosis
- Occurs in older COPD pts
- Lungs show progressive changes (apical cavities)
Describe disseminated histoplasmosis
- Rare in immunocompetent host
- Multiple organ involvement, often fatal
How does disseminated histoplasmosis present?
- Fever, fatigue
- Cough, dyspnea
- Wt loss
What do you need to distinguish histoplasmosis from?
- Sarcoidosis*
- TB
- Malignancy
What type of imaging can you use for dx of histoplasmosis?
- CXR: hilar adenopathy, patchy or nodular infiltrates in lower lung
What labs are used for dx of histoplasmosis?
- Antigen detection
- Serology
- Biopsy
- Cultures (useful in chronic dz only)
How do you tx histoplasmosis in asx pts?
None!
How do you tx acute histoplasmosis?
- Often don’t need tx
- Can use itraconazole
How do you tx severe histoplasmosis?
Amphotericin B IV
How do you tx chronic histoplasmosis?
Amphotericin B or itraconazole
How do you tx histoplasmosis in AIDS pts?
Amphotericin B & maintain w/ intraconazole
What organisms cause coccidioidomycosis? Where are they found?
- Coccidioides immitis
- Coccidioides posadasii
- In soil, semiarid areas
Coccidioidomycosis infection is secondary to what?
Inhalation of spores
What is the incubation period for coccidioidomycosis?
7-21 days
What % of people experience sx of coccidioidomycosis? What is the usual manifestation?
- 40%
- Pneumo
What sx/characteristics does coccidioidomycosis share w/ histoplasmosis?
- HA, arthralgias
- Fatigue
- Disseminated extrapulmonary infection
- Granuloma on CXR
What sx is unique to coccidioidomycosis?
Rash (erythema multiforme), erythema nodosum
What complications are seen in the disseminated form of coccidioidomycosis?
- More pronounced lung findings (abscess, miliary infiltrates)
- Lymphadenitis, meningitis
- Bone lesions
What type of immunocompromised pts are affected by coccidioidomycosis?
- Pts w/ organ transplant
- Pts taking glucocorticoids or immunosuppressant meds
- Chemo pts
- Those w/ pre-existing cardiopulmonary conditions
- Elderly
What type of imaging is used to dx coccidioidomycosis?
CXR
- hilar adenopathy
- patchy, nodular infiltrates
- thin walled cavities
What warrants tx for coccidioidomycosis?
- 10% wt loss
- Night sweats > 3wks
- Infiltrates involving > 1/2 of a lung
- Hilar adenopathy
- Inability to work
- Sx > 2 months
How do you tx coccidioidomycosis?
- Fluconazole 3-6mos
- Thoracic surgery
- Monitor for 1 yr, initially every 2-4 wks
