Immunocompromised Patients

Question 1

Dx of Mycobacterium Avium in ICP

Answer 1

large number of acid fast bacilli w/in macrophages

Question 2

Dx of pnemocystis Jirovecii

Answer 2

1. Foamy pink exudate (“cotton candy”)

2. Silver stain: Yeast as round “cysts” with intracystic bodies

Question 3

Dx of Cryptococcus neoformans

Answer 3

1. Yeast with no hyphae and a clear “halo” on H&E
2. Thick gelantinous capsule
3. CNS involvement

Question 4

Dx of Aspergillosis

Answer 4

1. Septated hyphae

2. Round foci w/ hyperemic edges (target lesion)

Question 5

Dx of Mucormycosis

Answer 5

1. Common in diabetics

2. Wide, non-septated hyphae with right angle branching

Question 6

Dx of CMV

Answer 6

1. Most common primary infection in AIDS patients.

2. Large atypical cells w/ large nuclei and basophilic nuclear inclusions (Owl eye)

Question 7

Extrathoracic exam of ICP

Answer 7

1. Cutaneous papules = Cryptococcus
2. Retinal lesions = CMV
3. CNS = crytococcus
4. Necrotizing nasal lesions = Mucormycosis, Aspergillus

Question 8

Distinguish types of infiltrates

Answer 8

Lobular = Bacterial
Cavitation = Anaerobic bacteria, TB, SCC, infarctions
Diffuse = Viral