Infection

Question 1

A young woman from southwest USA with macular rash and erythema nodosum, c/o fever, diaphrosesis and productive cough. CXR shows a small nodule. Ddx? Next step?

Answer 1

Coccidioidomycosis (valley fever, san joaquin valley fever) caused by coccioides immits, a dimorphic fungus. Next step serology testing. Can also obtain histology of tissue or culture.

Question 2

Tx for IgG 4 related sclerosing pseudotumor.

Answer 2

Steroids

Question 3

Risk factors for mucormycosis (9)

Answer 3

Hematologic cancer w/ or w/o stem cell transplant
Neutropenia
poorly controlled DM
Iron overload
Major trauma
Steroids
IV drug use
neonatal prematurity
malnourished

Question 4

IDDM with cough and hemoptysis, CT shows large lesion on RUL. Biopsy is consistent with mucomycosis. Next Step?

Answer 4

Anatomic lung resection –> followed by amphotericin B.

** Voriconazole (tx for aspergillosis) is not effective on mucorales

Question 5

What is considered early, intermediate or late bronchopleural fistulas

Answer 5

early: < 1 week
intermediate: within 1 week to 1 month
late: >1 month

Question 6

Key principles of Initial management of bronchopleural fistula

Answer 6

immediate drainage of the pneumonectomy space to protect the contralateral lung from soilage through the BPF.

Maintain position with infected pleural space dependent (including chest tube placement)

Antibiotic therapy

Remove infected material from the pleural space. This may include creation of window (eloesser flap) to facilitate mechanical debridement and prepare of stage closure. Buttress the bronchial stump and obliterate space with either latissmus or serratus.