histococci (fungal PNA) Flashcards
what is the etiology of histoplasma capsulatum?
soil contaminated with bird/bat droppings
what are the different forms of histoplasmosis?
asymptomatic primary histoplasmosis acute diffuse pulmonary disease acute localized pulmonary disease chronic cavitary pulmonary histoplasmosis disseminated histoplasmosis
which form of histoplasmosis is the most common?
asymptomatic primary histoplasmosis (may see residual granuloma on CXR)
which form of histoplasmosis lasts 1 week - 6 months?
acute diffuse pulmonary disease (can occur in healthy people, few complaints, can have fever and marked fatigue)
which form of histoplasmosis presents like PNA?
acute localized pulmonary disease (cough, fever, possible dyspnea and local infiltrates)
which form of histoplasmosis usually occurs in older COPD pts?
chronic cavitary pulmonary histoplasmosis (lungs show apical cavities)
which form of histoplasmosis is often fatal?
disseminated histoplasmosis (fever, marked fatigue and cough, dyspnea, and weight loss)
what does CXR show in histoplasmosis?
hilar adenopathy, patchy or nodular infiltrates in lower lung fields
when are cultures useful in histoplasmosis?
chronic disease
can you treat asymptomatic pts with histoplasmosis?
no
does acute pulmonary infection need treatment?
usually not but you could use ORAL itraconazole or ketoconazole
how to treat severe histoplasmosis infection?
amphotericin B IV
how to treat chronic histoplasmosis infection?
amphtericin B or itraconazole
how to treat AIDS pt with histoplasmosis?
amphotericin B
maintenance therapy with itraconazole
what is the etiology of coccidioidomycosis?
coccidioides immitis or coccidioides posadasii
what is the incubation period for coccidioidomycosis?
7-21 days
what is the clinical presentation of coccidioidomycosis?
fever cough pleuritic chest pain H/A arthralgias marked fatigue rash
what types of pts are at increased risk for disseminated cocci?
HIV/immunocompromised
African Americans
Asians
women in 3rd trimester of pregnancy
immunocompromised due to?
pt with solid organ transplant high-dose glucocorticoids chemotherapy immunosuppresant meds pre-existing cardiopulmonary conditions frail eldery
what might you find on CXR for pt with coccidioidomycosis?
hilar adenopathy
patchy, nodular pulmonary infiltrates
miliary infiltrates
thin-walled cavities
what might you find in lab findings for pt with coccidioidomycosis?
eosinophilia/high WBC count
when treating a pt with coccidioidomycosis, what must you not give?
steroids
majority of coccidioidomycosis cases will resolve ______ antifungal therapy
without
what are indications for treating pt with coccidioidomycosis?
> 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
what medication would you give to a pt with coccidioidomycosis for 3-6 months
fluconazole
severe cases of coccidioidomycosis or pregnancy, what medication do you give?
amphotericin B IV
how often do you monitor a pt with coccidioidomycosis?
everyone for 1 year, initially q2-4weeks
what are common ADR with antifungal meds?
GI upset
hepatotoxicity
what are ADR of amphotericin B IV?
encephalopathy seizures cardiomyopathy Ventricular arrhythmias renal failure cardiac arrest pulmonary edema electrolyte imbalance hepatotoxicity agranulocytosis
what disease must you be careful with when giving itraconazole?
CHF
what symptoms associated with both cocci & histo?
arthralgias
erythema nodosum
erythema multiforme
think cocci when pt has pulmonary complaints and one or more of the 3 Es
erythema nodosum
erythema multiforme
eosinophilia
what organism is most commonly associated with AIDS?
pneumocystis jiroveci (airborne fungus)
what is the clinical presentation of pneumocystis jiroveci?
pneumoia (severe SOB)
severe hypoxemia
CXR shows diffuse perihilar infiltrates
when to think “maybe fungal PNA?”
pneumonia with hilar or mediastinal lymphadenopathy or masses
pulmonary nodules suggestive of malignancy
cavitary lung disease that looks like TB
presentation looks like sarcoidosis
