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Random infectious dz (inpt) > immunocompromised infections/fungal > Flashcards

immunocompromised infections/fungal Flashcards

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1
Q

candidiasis?

A

candida albicans, yeast like fungi

-opportunistic

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2
Q

what are RF for Candida?

A

immunosuppressed, antibiotic use, diet stress

-those at extremes of age

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3
Q

how can candidiasis present?

A

Superficial mucocutaneous: oral candidiasis, vaginal candidiasis, diaper area candidiasis, etc.

Can also be invasive, esophageal candidiasis in AIDS, systemic dissemination, etc

May involve virtually any organ

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4
Q

where are most candida infections?

A

mucocutaneous and relatively treatable

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5
Q

what is the prognosis for disseminated candida infxn?

A

30-40% mortality

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6
Q

how is candida diagnoses?

A

superficial: wet mount, looking for hypae, pseudohyphae, or budding yease

0also blood cultures, urin cultures, biopsies

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7
Q

what is the tx for superficial candida infxn?

A

topical antifungal agents:

clotrmazole, econazole (ecoza), ciclopirox, miconazole, ketoconazole, nystatin

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8
Q

azole antifungals

A

fluconazole,

increases permeabiliity of cell membrane resulting in cell death

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9
Q

ADR of azole antifungals?

A

AT prolongation and arrhythmias

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10
Q

how do you tx candida infections?

A

parenteral antifungals such as fluconazole (IV or IM)

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11
Q

histoplasmosis?

A

fungus that grows as a yeast at body temp

hisoplasma capsulatum

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12
Q

where is histoplasmosis endemic?

A

OH, MO, MS river valley: acidic soil

-associated with renovation, construction actvities

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13
Q

what mammal can spread histoplasmosis?

A

bats!

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14
Q

what may you see on a CXR of a healthy person affected with histoplamsosis?

A

chronic granulomas (white areas, scar tissue)

-typically asymptomatic

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15
Q

what may you see on a CXR of an immunocompromised pt infected with histoplasmosis?

A

calcified nodes and nodules

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16
Q

what are sx of histoplasmosis infxn? (initially)

A

initally-pulmonary, that is often flu like and of a limited duration

Fever & chills, inspiratory chest pain (stabbing pain) and cough, joint pain, mouth sores & erythema nodosum (this is not specific only to this disease) on lower legs

but may get systemic spread and manifestations such as CNS, liver, spleen, rheumatologic, ocular, and hematologic

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17
Q

what are the sx of chronic phase histoplamsosis?

A

chest pain, cough, SOB, fever, sweating

-can cause inflammation in pericarddium, meninges, high fever

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18
Q

how do you dx histoplasmosis?

A 
CXR, chest CT
Bronchoscopy  (get a biopsy)
Biopsy
Blood/urine for antigens or antibodies
Spinal Tap if suspect infected CSF
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19
Q

what is the treatment of histoplasmosis?

A

usually clears up w/o tx

if sx > 1 mnth, need antifungal therapy:
Amphotericin B, itraconazole, and ketoconazole

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20
Q

CMV

A

very common, nearly everyone is infected but most ppl are asx

lifetime infxn once infected, virus dormant in most cases

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21
Q

how is CMV spread?

A

via body fluids: blood, saliva, urine, semen, and breast milk, respiratory drops

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22
Q

when is CMV concerning?

A

immunocompromised

or prego- passit on to infant via congenital or perinatal

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23
Q

what are clinical findings of CMV congenital infection?

A

(CMV inclusion disease)

  • may be asx until later in life
  • Jaundice, rash, low birth weight, splenomegaly, hepatomegaly & hepatic dysfunction, seizures, mental retardation, pupura, periventricular CNS calcification
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24
Q

what are the sx of acute acquired CMV?

A

fever malaise, myalagia, arthralgias, splenomegaly, abnormal liver enzyme, leukopenia, and atypical lymphocytes

*similar to EVB but no pharyngitis, respiratory sx, or heterophil antibodies

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25
what do you think with a CMV infxn?
visual, pneumonia, GIT and hepatitic, nervous system
26
what are sx that may present in an immunocompromsised pt?
(think HIV comorbidity) - CMV retinits (CD4 less than 50) - GI manifestations - Pulmonary manifestations (bone marrow transplant pts) - neurological
27
what would an exam reveal of a pt with CMV retinitis?
neovasculariztion and proliferative lesion "pizza pie" aggressive HIV tx can reduce this
28
what are CMV GI manifestations?
esophagitis, odynophagia, small bowel inflammatory ulcer, D, hematochezia, abdominal pain, weight loss, and chlangiopathy
29
what are neurologic CMV manifestations?
polyradiculopathy, transverse myelitis, encephalitis
30
what other disease may CMV infection play a role in?
IBd, atherosclerosis, breast cancer
31
what may be seen on diagnostic studies of pts with CMV?
lymphocytosis or leukopenia
32
what is the definitive diagnostic test for CMV?
culture, but its very difficult -antigens can be deteced in blood, urine, CSF via PCR
33
what if CMV IgM and IgG are both negative?
No current or prior infection; no immunity, person is susceptible to primary infection Symptoms due to another cause OR immune system cannot produce adequate amount of antibody (immunocompromised)
34
what if CMV IgM is positive and IfG is negative?
Recent active primary infection OR person re-exposed to CMV OR reactivation of latent CMV *Result is NOT diagnostic of primary infection
35
what if IgM is postivie and IgG is positive w/ a four fold increase in titer btw acute adn convalescent samples?
-likely active primary or reactivated latent infection
36
what if CMV IgM is negative and IgG is postive
Past exposure, person is immune from primary infection; latent infection
37
what is CMV treatment?
key is prevention: limitin blood transfusions, filtering to remove elukocytes, and restricting the organ donor pool to sernegative dones
38
what can be give to bone marrow transplant recipients to decrease the risk of CMV?
CMVimmunoglobulin and IV ganciclovir
39
what are antivirals that can be given to immunocompormised pts dx with CmV?
ganciclovir, valganciclovier, foscarnet, and cidofoir
40
what may be seen on a a tissue biopsy of a pt with CMV?
intracytoplasmic inclusions "Owls' eyes"
41
what is foscavir?
tx for CMV and HSV/VZV -works by inhibiting viral DNA polymerase
42
what are ADRs of foscavir?
depletion of electrolytes (think K, Mg, Ca, Ph) granulocytopenia, thrombocytopenia,myelosuppression
43
cryptococcus sp.?
-crypococcus neoformans is an encapsulated budding yeast found in soil contaminated with dried pigeon dung
44
how is cryptococcus transmitted?
through inhalation and causes illness in pts with cellular immune deficiency such as HIV, cancer, long-term croticosteroid therapy
45
what are clinical findings of Cryptococcus?
- pulmonary dz - CNS dz - cryptococcoma - disseminated dz
46
what are features of pulmonary cryptococcus?
- fever, cough, dyspnea | - COPD, chronic steroid use, posttransplan
47
what would CXR of cryptococcus reveal?
nodules or pneumonitis (lung inflammation)
48
what are features of cryptococcal CNS dz?
- HA, meningeal sings - occurs with CD4 count less than 50 - mental status change, cranial nerve or visual abnormalities
49
what is a cryptococcoma?
rare, intracerebral mass lesion that causese obstructive hydrocephalus
50
what are features of a disseminated cryptococcal dz?
rare, but may affect the skin, prostate, osteoarticular surface, eye, lymph tissue, or other sites
51
dx studies of cryptococcal dz?
- CSF - culture - antigen assay - CT/MRI if suspected cryptococcoma
52
what would a CSF sample show if infected with cryptococcus?
variable pleocytosis (predominantly lympocytes) - increased opeing pressure - increased protein - decreased glucose
53
what would culture show in cryptococcal dz?
budding, encapsulated fugus
54
what are antigen detecting asssas for cryptococcal dz?
- latex agglutination assay: india ink stain or serology - cryptococcal antigen assay (CRAG) - cryptococcal antigen can be detected in CSF and serum
55
what is the tx for cryptococcal infxn (HIV pts)
oral fluconazole for 10 wks
56
what isthe tx for severe cryptococcal infexxn in HIV pts
amphotericin B for the first 2 weks, the oral fluconazone
57
what can also be added to tx severe cryptococcal da?
flucytosine
58
wht is also recommended for tx in immunocompormised pts with severe cryptococcal dz?
lifelong fluconazole tx
59
what is recommended for non-HIV immunocompromised pts?
*mortality rate is much higher | tx with amphotericin B
60
what is fluctyosine?
Pyrimidine antifungal MOA Converted to 5-FU in the fungal cell Inhibits fungal protein and DNA syntises
61
what are ADRs of flucytosine?
leukopenia and thrombocytopenia underlying hematological disorder, radiation treatment or drugs that injure the bone marrow rash, nausea, vomiting, diarrhea Elevated LFTs
62
how does amphotericin B work?
Binds ergosterol in fungal cells, damaging cell membranes Can bind cholesterol in mammalian cells Static or cidal depending on concentration in tissues and susceptibility of organism
63
what must you be very cautious with when prescribing amphotericin B?
confusing the preparations | Conventional ampho B and liposomal (Ambisome) have different dose ranges
64
why is it called amphoterrible
Infusion reactions: Acute reactions (eg, fever, shaking chills, hypotension, anorexia, nausea, vomiting, headache, tachypnea) may occur 1-3 hours after starting infusion usually more common with the first few doses and generally diminish with subsequent doses Avoid rapid infusion to prevent hypotension, hypokalemia, arrhythmias, and shock Give small test dose first
65
what are other bad ADR of amphotericin?
-nephrotoxicity -anaphylaxis -leukoencephalopathy -hypotension -hypoK, hypoMg -anorexia, N, V, D, anemia
66
Pneumocystis jiroveci? general features
PJP - fungus found in the lungs of humans and many animals - evidence of infection can be found in almost all pple - prolly transmitted through the air and lies latent in alveoli
67
what pt population is more likely to be affected by PJP?
premature of dbilitated infantes in underdeveloped areas during epidems -sporadic cases in pts w/ abnormal cellular immunity: CA, severe malnutrition, immunosuppressive drugs, irradiation, or in thouse w/ HIV/AIDs and CD4 < 200
68
what is the most commmon opportunistic infxn in HIV dz?
PJP
69
what are clinical findings of PJP?
fever, shortness of breath, nonproductive cough - fatigue, weakness, weight loss - may have spontaneous pneumothorax
70
what is the cause of recurrent pneumothorax?
previous pentamidine use
71
what is pentamidine?
s an antimicrobial medication used to treat African trypanosomiasis, leishmaniasis, babesiosis, and to prevent and treat pneumocystis pneumonia (PJP)-nebulized ofrm in people with poor immune function
72
what are other side effects of pentamidine?
``` rash neutropenia abnormal liver fxn serum folate deficiency calcium imbalance hypoglycemia hyperglycemia hyponatremia nephrotoxicity fatal pancreatits ```
73
what may a PE and CXR reveal in a pt with PJP?
PE findings are disproportionate to imaging results, which show diffuse intersitial infiltrates that may be heterogeneous, miliary, or patchy *btw 5-10% of pts have normal xray
74
what are dx studies done for PJP?
-blood gas -LDH CBC
75
what may blood gas levels show in pt with PJP
hypoxia, hypocapnia, reduced CO diffusion
76
what are LDH levels?
lactate dehydrogenase: usually found in heart, liver, skeletal muscles: nay damage, and LDH will be released into the blood stream
77
what will LDH levels look like in a pt with PJP
will be increased
78
what will a CBC show in pts with PJP
low WBC
79
can this organism be identified in PJP?
yes, with specfic stains of induced sputum or via bronchoalveolar lavage
80
what is tx of PJP
TMP-SMX; recommended for pts presenting with cough or dyspnea
81
what is the clinical course follwing bactrim tx of PJP
-pts often get worse at the start of tx
82
when do you add steroids to the tx of PJP?
when PaO2 is less than 70; prevents deteriorration and promotes oxygenations
83
what are hypersensitivity rxns to TMP-SMX?
(bc of sulfa) - fever - rash - malaise - neutropenia - hepatitis, - nephritis - thrombocytopenia - hyperbilirubinemia *systematic desensitization is often successful
84
what is a good alternative to TmP-SMX tx?
dapsone (can also tx leprosy, dermatitis herpetiformis, toxoplasmosis
85
what are side effects of dapsone?
- anemia - rash - fever
86
what is a contraindication for dapsone?
do not take with didanosine (antiretroviral)
87
what can be used for pts that can't tolerate bactrim or pentamidine?
atovaquone
88
what must you educate patients on who take atovaqoune
- take with fatty meal | - limited side effects (SJS)
89
PJP prophylaxis
even after a pt is successfully treated all pts with a CD4 count of less than 200 cells should receive prophylactic treatment bactrim

Random infectious dz (inpt) (8 decks)

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