immunocompromised infections/fungal Flashcards
candidiasis?
candida albicans, yeast like fungi
-opportunistic
what are RF for Candida?
immunosuppressed, antibiotic use, diet stress
-those at extremes of age
how can candidiasis present?
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
where are most candida infections?
mucocutaneous and relatively treatable
what is the prognosis for disseminated candida infxn?
30-40% mortality
how is candida diagnoses?
superficial: wet mount, looking for hypae, pseudohyphae, or budding yease
0also blood cultures, urin cultures, biopsies
what is the tx for superficial candida infxn?
topical antifungal agents:
clotrmazole, econazole (ecoza), ciclopirox, miconazole, ketoconazole, nystatin
azole antifungals
fluconazole,
increases permeabiliity of cell membrane resulting in cell death
ADR of azole antifungals?
AT prolongation and arrhythmias
how do you tx candida infections?
parenteral antifungals such as fluconazole (IV or IM)
histoplasmosis?
fungus that grows as a yeast at body temp
hisoplasma capsulatum
where is histoplasmosis endemic?
OH, MO, MS river valley: acidic soil
-associated with renovation, construction actvities
what mammal can spread histoplasmosis?
bats!
what may you see on a CXR of a healthy person affected with histoplamsosis?
chronic granulomas (white areas, scar tissue)
-typically asymptomatic
what may you see on a CXR of an immunocompromised pt infected with histoplasmosis?
calcified nodes and nodules
what are sx of histoplasmosis infxn? (initially)
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
what are the sx of chronic phase histoplamsosis?
chest pain, cough, SOB, fever, sweating
-can cause inflammation in pericarddium, meninges, high fever
how do you dx histoplasmosis?
CXR, chest CT Bronchoscopy (get a biopsy) Biopsy Blood/urine for antigens or antibodies Spinal Tap if suspect infected CSF
what is the treatment of histoplasmosis?
usually clears up w/o tx
if sx > 1 mnth, need antifungal therapy:
Amphotericin B, itraconazole, and ketoconazole
CMV
very common, nearly everyone is infected but most ppl are asx
lifetime infxn once infected, virus dormant in most cases
how is CMV spread?
via body fluids: blood, saliva, urine, semen, and breast milk, respiratory drops
when is CMV concerning?
immunocompromised
or prego- passit on to infant via congenital or perinatal
what are clinical findings of CMV congenital infection?
(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
what are the sx of acute acquired CMV?
fever malaise, myalagia, arthralgias, splenomegaly, abnormal liver enzyme, leukopenia, and atypical lymphocytes
*similar to EVB but no pharyngitis, respiratory sx, or heterophil antibodies
what do you think with a CMV infxn?
visual, pneumonia, GIT and hepatitic, nervous system
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
what would an exam reveal of a pt with CMV retinitis?
neovasculariztion and proliferative lesion “pizza pie”
aggressive HIV tx can reduce this
what are CMV GI manifestations?
esophagitis, odynophagia, small bowel inflammatory ulcer, D, hematochezia, abdominal pain, weight loss, and chlangiopathy
what are neurologic CMV manifestations?
polyradiculopathy, transverse myelitis, encephalitis
what other disease may CMV infection play a role in?
IBd, atherosclerosis, breast cancer
what may be seen on diagnostic studies of pts with CMV?
lymphocytosis or leukopenia
what is the definitive diagnostic test for CMV?
culture, but its very difficult
-antigens can be deteced in blood, urine, CSF via PCR
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)
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
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
