histococci (fungal PNA)

Question 1

what is the etiology of histoplasma capsulatum?

Answer 1

soil contaminated with bird/bat droppings

Question 2

what are the different forms of histoplasmosis?

Answer 2

asymptomatic primary histoplasmosis
acute diffuse pulmonary disease
acute localized pulmonary disease
chronic cavitary pulmonary histoplasmosis
disseminated histoplasmosis

Question 3

which form of histoplasmosis is the most common?

Answer 3

asymptomatic primary histoplasmosis (may see residual granuloma on CXR)

Question 4

which form of histoplasmosis lasts 1 week - 6 months?

Answer 4

acute diffuse pulmonary disease (can occur in healthy people, few complaints, can have fever and marked fatigue)

Question 5

which form of histoplasmosis presents like PNA?

Answer 5

acute localized pulmonary disease (cough, fever, possible dyspnea and local infiltrates)

Question 6

which form of histoplasmosis usually occurs in older COPD pts?

Answer 6

chronic cavitary pulmonary histoplasmosis (lungs show apical cavities)

Question 7

which form of histoplasmosis is often fatal?

Answer 7

disseminated histoplasmosis (fever, marked fatigue and cough, dyspnea, and weight loss)

Question 8

what does CXR show in histoplasmosis?

Answer 8

hilar adenopathy, patchy or nodular infiltrates in lower lung fields

Question 9

when are cultures useful in histoplasmosis?

Answer 9

chronic disease

Question 10

can you treat asymptomatic pts with histoplasmosis?

Answer 10

no

Question 11

does acute pulmonary infection need treatment?

Answer 11

usually not but you could use ORAL itraconazole or ketoconazole

Question 12

how to treat severe histoplasmosis infection?

Answer 12

amphotericin B IV

Question 13

how to treat chronic histoplasmosis infection?

Answer 13

amphtericin B or itraconazole

Question 14

how to treat AIDS pt with histoplasmosis?

Answer 14

amphotericin B

maintenance therapy with itraconazole

Question 15

what is the etiology of coccidioidomycosis?

Answer 15

coccidioides immitis or coccidioides posadasii

Question 16

what is the incubation period for coccidioidomycosis?

Answer 16

7-21 days

Question 17

what is the clinical presentation of coccidioidomycosis?

Answer 17

fever
cough
pleuritic chest pain
H/A
arthralgias
marked fatigue
rash

Question 18

what types of pts are at increased risk for disseminated cocci?

Answer 18

HIV/immunocompromised
African Americans
Asians
women in 3rd trimester of pregnancy

Question 19

immunocompromised due to?

Answer 19

pt with solid organ transplant
high-dose glucocorticoids
chemotherapy
immunosuppresant meds
pre-existing cardiopulmonary conditions
frail eldery

Question 20

what might you find on CXR for pt with coccidioidomycosis?

Answer 20

hilar adenopathy
patchy, nodular pulmonary infiltrates
miliary infiltrates
thin-walled cavities

Question 21

what might you find in lab findings for pt with coccidioidomycosis?

Answer 21

eosinophilia/high WBC count

Question 22

when treating a pt with coccidioidomycosis, what must you not give?

Answer 22

steroids

Question 23

majority of coccidioidomycosis cases will resolve ______ antifungal therapy

Answer 23

without

Question 24

what are indications for treating pt with coccidioidomycosis?

Answer 24

> 10% loss of body weight
night sweats > 3 weeks
infiltrates involving more than half of one lung or portions of both lungs
prominent or persistent hilar adenopathy
inability to work
symptoms > 2 months

Question 25

what medication would you give to a pt with coccidioidomycosis for 3-6 months

Answer 25

fluconazole

Question 26

severe cases of coccidioidomycosis or pregnancy, what medication do you give?

Answer 26

amphotericin B IV

Question 27

how often do you monitor a pt with coccidioidomycosis?

Answer 27

everyone for 1 year, initially q2-4weeks

Question 28

what are common ADR with antifungal meds?

Answer 28

GI upset | hepatotoxicity

Question 29

what are ADR of amphotericin B IV?

Answer 29

``` encephalopathy seizures cardiomyopathy Ventricular arrhythmias renal failure cardiac arrest pulmonary edema electrolyte imbalance hepatotoxicity agranulocytosis ```

Question 30

what disease must you be careful with when giving itraconazole?

Answer 30

CHF

Question 31

what symptoms associated with both cocci & histo?

Answer 31

arthralgias erythema nodosum erythema multiforme

Question 32

think cocci when pt has pulmonary complaints and one or more of the 3 Es

Answer 32

erythema nodosum erythema multiforme eosinophilia

Question 33

what organism is most commonly associated with AIDS?

Answer 33

pneumocystis jiroveci (airborne fungus)

Question 34

what is the clinical presentation of pneumocystis jiroveci?

Answer 34

pneumoia (severe SOB) severe hypoxemia CXR shows diffuse perihilar infiltrates

Question 35

when to think "maybe fungal PNA?"

Answer 35

pneumonia with hilar or mediastinal lymphadenopathy or masses pulmonary nodules suggestive of malignancy cavitary lung disease that looks like TB presentation looks like sarcoidosis