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Infectious Dz - Fungal Flashcards

1
Q

Where is blastomycosis distributed?

A

On the eastern half of the US, especially in the Mississippi, Ohio, and Saint-Lawrence River values

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2
Q

What type of fungi is Blastomyces dermatitidis?

A

Dimorphic

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3
Q

In what form is Blastomyces dermatitidis in the host?

A

yeast

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4
Q

In what form does Blastomyces dermatitidis exist in the soil as?

A

a fungal hyphae

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5
Q

What form of Blastomyces dermatitidis is infective?

A

only the fungal form

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6
Q

By what route does Blastomyces dermatitidis infection occur?

A

Inhalation (most common) and direct inoculation

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7
Q

What is the incubation time of Blastomyces dermatitidis?

A

Long incubation - 1-3 months

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8
Q

Where does Blastomyces dermatitidis propagate and how does it get there?

A

Via hematogenous spread it propagates to the skin, eyes, lymph nodes, bone, and CNS

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9
Q

What is the ‘poster dog’ for blastomycosis?

A

Young (2-4 years) and large hunting breeds

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10
Q

What are the risk factors for blastomycosis in dogs?

A

living near water and proximity to excavated or disturbed soil

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11
Q

Is blastomycosis found in cats?

A

It is very rare

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12
Q

What are the PE findings associated with blastomycosis?

A 
Non-specific signs of fever, anorexia, and weight loss
Respiratory signs are common
Ocular manifestations - uveitis
Granulomas
Draining lesions
Lameness
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13
Q

What will you find on CBC in a patient with blastomycosis? Chemistry?

A

CBC - inflammatory leukogram

Chemistry (from most to least common)- Low albumin, high globulin, and hypercalcemia

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14
Q

What will you find on cytology in patients with blastomycosis?

A

Broad-based budding yeast and pyogranulomatous inflammation with concurrent presence of neutrophils with activated macrophages, lymphocytes, and plasma cels

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15
Q

What will you see on rads in a patient with Blastomycosis?

A

Variable lung pattern - classically diffuse miliary to nodular
Tracheobronchial enlargement in 25% of cases
Osteolysis with periosteal reaction in bones

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16
Q

What does serology detect for in a suspected Blasto case?

A

antibodies

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17
Q

What is the gold standard diagnostic test for blastomycosis?

A

Galactomannan cell wall test

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18
Q

What is the Galactomannan cell wall test?

A

It is an antigen test with very high sensitivity. Urine is more sensitive than serum
There is some cross-reactivity with Histoplasma so a cytology will need to be done to confirm

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19
Q

What diagnostic test is not recommended for blastomycosis?

A

Culture - because it reverts to the fungal form and there is a potential danger for lab personnel

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20
Q

How is blastomycosis treated?

A

Triazoles - Itraconazole is the drug of choice but Fluconazole may have similar efficacy and Fluconazole and voriconazole achieve better CNS/ocular penetration than itraconazole

Amphotericin B may be warranted in more aggressive/extensive disease

Glucocorticoids for decreasing pulmonary inflammation associated with the fungal die off - avoid high doses

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21
Q

When is surgery indicate to treat blastomycosis?

A

If there is severe panuveitis that requires enucleation

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22
Q

Is blastomycosis treatment long or short term? When do you know when to stop treatment?

A

Long term

Use Galactomannan assay results to determine presence of fungi

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23
Q

What is the prognosis of blastomycosis?

A

Variable cure rates - 50-75%

Relapses are common within 2 years

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24
Q

What are the negative prognostic factors of blastomycosis?

A

CNS involvement, severity of lung disease, and high band count on CBC

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25
What are the differentials to be considered with blastomycosis?
Neoplasia, other systemic mycoses, and systemic protozoal infections
26
Where is histoplasmosis distributed?
Similar to blasto - north of the equator and in the eastern US in the Ohio and Mississippi river valleys
27
What causes histoplasmosis?
Histoplasma capsulatum
28
What type of fungus is histoplasmosis?
Dimorphic
29
How does histoplasmosis infection occur?
It is inhaled or ingested by the host from avian and/or bat guano
30
Where does Histoplasma capsulatum replicate/dissemiate?
In macrophages
31
What age of dogs does histoplasmosis commonly occur in?
young patients (median age is 3 years)
32
What physical/clinical findings are associated with histoplasmosis in dogs?
GI signs are seen in 50-60% of cases, respiratory signs in 10% of cases, and can have ocular, skin, and CNS signs
33
How does histoplasmosis present in cats?
Often non-specific signs - respiratory (40%), ocular manifestations, lymphadenopathy, skin involvement, bone marrow involvement
34
What disease is co-infected with histoplasmosis in cats in 28% of cases?
FeLV
35
How is histoplasmosis diagnosed?
minimum database, imaging, cytology, and galactomannan test
36
What will you find on CBC in patients with histoplasmosis? Chemistry?
CBC - non-regenerative anemia +/- other cytopenias, high/low WBC counts Chemistry - increased liver values, low albumin, high globulin
37
How does histoplasmosis look on thoracic rads?
Classic diffuse interstitial miliary to nodular pattern | Tracheobronchial lymphadenopathy
38
How does histoplasmosis look on abdominal rads?
Hepato/splenomegaly | Thickened intestinal wall with disruption of layering
39
How will the skeletal system look on radiographs in patients with histoplasmosis?
osteolysis with periosteal reaction
40
How can you get samples for cytology in histoplasmosis cases?
Impression smears, fine needles aspirates, lung washes, and rectal scraping
41
What will histoplasmosis look like on cytology?
Granulomatous/pyogranulomatous inflammation
42
Can you find Histoplasma in blood?
yes - in 20% of dogs and cats
43
Is serology recommended for diagnosis of histoplasmosis?
No - it has poor sensitivity/specificity
44
How is histoplasmosis treated?
Azoles - Itraconazole is the azole of choice In severe disseminated cases - Amphotericin B Glucocorticoids - to decrease pulmonary inflammatory reaction associated with fungal die off
45
What is the prognosis of histoplasmosis?
Good to poor prognosis based on the location
46
What are the positive prognostic factors for histoplasmosis?
presence of diarrhea
47
What are the negative prognostic factors for histoplasmosis?
need for oxygen supplementation, icterus, and abdominal organomegaly
48
Is histoplasmosis treatment short or long term? When do you know when to stop therapy?
Long term - 6-12 months | End based on clinical signs, resolution of radiographic signs, and negative urine galactomannan antigen test
49
What are the differentials for histoplasmosis?
Other systemic mycoses, IBD, and cancer
50
Where is Coccidioidomycosis?
Coccidioides immitis is distributed on the Southwestern US | Coccidioides posadasii is in South America, Mexico, and part of the west coast
51
What type of fungi is Coccidioides?
a dimorphic
52
What does Coccidioides exist as in the environment?
a mycelium
53
How does Coccidioides infection occur?
Inhalation of Arthroconidia
54
What form is Coccidioides in the host?
spherules
55
What is the typical signalment of coccidioidomycosis in the dog?
Younger, active large breed dogs
56
What are the risk factors for coccidioidomycosis?
Being housed outdoors, walks in the desert, roaming large areas, and living in an endemic area
57
What is the most common systemic signs in patients with coccidioidomycosis?
fever
58
What other physical and clinical findings are associated with coccidioidomycosis?
Respiratory signs, bone involvement, CNS, skin, and repro involvement Pericardial effusion and right sided heart failure
59
How is coccidioidomycosis diagnosed?
Cytology or serology
60
How do you acquire samples for a coccidioidomycosis cytology?
FNA, lung wash, pericardial fluid
61
What will you see on cytology in a patient with coccidioidomycosis?
Pyogranulomatous inflammation
62
What is the specificity and sensitivity of serology for coccidioidomycosis diagnosis?
Specific but not very sensitive
63
How is coccidioidomycosis treated medically?
Azoles - fluconazole or itraconazole | In refractory/severe cases - Amphotericin B, Posaconazole or Voriconazole
64
How is coccidioidomycosis treated surgically?
Limb amputation, enucleation, and pericardectomy
65
What is the prognosis for coccidioidomycosis?
Guarded to good
66
Is treatment for coccidioidomycosis short or long term? When do you know when to stop?
long term - > 6 months | Length of therapy is based on resolution of lesions and serology of less than 1:2
67
What are the prognostic factors for coccidioidomycosis?
CNS involvement is associated with worse prognosis
68
What are the differentials for coccidioidomycosis?
Other systemic mycoses, IBD, and cancer
69
What type of fungi is Cryptococcus?
dimorphic
70
What are the two main species that cause cryptococcus?
C. neoformans and C. gattii
71
Who does C. neoformans infect?
immunocompromised dogs and people
72
Who does C. gatti infect?
immunocompetent animals - mostly cats and humans
73
Where is Cryptococcus distributed?
worldwide - more common on the west coast
74
True or False: Cryptococcosis is the second most common systemic mycoses found in cats
False - it is the MOST common
75
What age cats typically get Cryptococcosis?
young age - 4-6 years
76
What is infection of Cryptococcus assocaited with?
Plant material (C. gattii) or pigeon guano (C. neoformans)
77
How do cats become infected with Cryptococcus?
Mainly by inhalation of organisms | Can also occur by direct inoculation
78
How does Cryptococcus spread?
Hematogenous spread - CNS, eyes, skin, lymph nodes, and the abdomen Local - Bone, brain, and eyes
79
How do cats with Cryptococcosis present?
Respiratory (upper is more common) - sneezing, stertor, and discharge CNS - altered mentation, CN deficits, and seizures Ocular - unresponsive pupils, retinal hemorrhage/detachment, and Chorioretinitis/optic neuritis Bone - osteomyelitis and facial swelling (ROMAN NOSE) Subcutaneous masses
80
What is the signalment for a dog with Cryptococcosis?
Young/middle aged, active large breed dogs
81
What is the main difference between Cryptococcosis in dogs vs cats?
Dogs are more likely to have systemic signs such as weight loss, fever, and inappetance
82
What is the most common finding in dogs with Cryptococcosis?
Neurologic signs
83
How is Cryptococcosis diagnosed?
minimum database, imaging, cytology, culture, and serology
84
Where do you get samples for cytology in patients with Cryptococcosis?
Exudate, CSF, and aspirates
85
What will you find on cytology in patients with Cryptococcosis?
Thick-walled organisms - polysaccharide capsule and narrow-based budding
86
What can you get samples from for culture of Cryptococcosis?
Tissue, urine, CSF, and blood
87
What are the benefits to culturing for Cryptococcosis?
It grows as a yeast so it is safer for personnel, allows for species ID, and you can determine antifungal sensitivity
88
What antigen detection test is done for diagnosis of Cryptococcosis?
Latex agglutination test
89
What does the Latex agglutination test test for?
capsular antigen with serum or cerebrospinal fluid
90
What is the sensitivity and specificity for the latex agglutination test?
It is very sensitive and specific
91
When are Latex agglutination false negatives common?
Dogs and patients with localized disease
92
How is Cryptococcosis treated?
Fluconazole and Amphotericin B + 5-flucytosine
93
Is the length of treatment for Cryptococcosis long or short? How do you know when to stop treatment?
Treatment is long term - 2-12 months | Treatment is ceased based on resolution of lesions and antigen titers
94
When should surgery be considered in Cryptococcosis cases?
IF there are large granulomas present
95
What is the prognosis for Cryptococcosis in cats?
Generally good (60-75% cure rate)
96
What forms of Cryptococcosis in cats have a poorer prognosis?
CNS cases
97
What is the prognosis for Cryptococcosis in dogs?
It is more guarded given underlying dysfunction | 30-50% success rate
98
What are the most common clinical signs of Cryptococcosis in cats?
Ulcerative cutaneous lesions and uveitis chorioretinitis
99
What differentials should be considered for Cryptococcosis?
Other systemic mycoses - i.e. sporotrichosis
100
What is the etiologic agent of disseminated aspergillosis?
Aspergillus terreus
101
Who is at risk to develop disseminated aspergillosis?
German shepherds, females, and young/middle age dogs
102
How does Aspergillosis infection occur?
inhalation of conida
103
Is Aspergillosus dimorphic?
no - it produces hyphae not yeast
104
What organs are affected by disseminated aspergillosis?
Bones, spleen, lymph nodes, and kidneys
105
How do patients with disseminated aspergillosis often present?
Lethargy, lameness, and ataxia
106
How is disseminated aspergillosis diagnosed?
Minimum database, imaging, fungal culture, cytology, and ELISA
107
What will you find on minimum database in disseminated aspergillosis patients?
CBC - anemia with leukocytosis Chemistry - Low albumin/high globulin, azotemia UA - hyphae occasionally found
108
What will you find in patients with disseminated aspergillosis on imaging?
Osteolytic lesions, diskospondilitis, and lymph node enlargement
109
What is the positive incidence rate of urine culture? Blood or CSF culture?
Urine - >50% | Blood or CSF - 30%
110
Where should you get samples for cytology for disseminated aspergillosis?
urine, aspirates, and airway washes
111
Is serology dependable for disseminated aspergillosis diagnosis?
No - it is not useful
112
What test is very good for disseminated aspergillosis infection?
Aspergillus galactomannan antigen ELISA - serum or urine
113
How is disseminated aspergillosis treated?
Azoles - fluconazole resistance, possible response with posaconazole Combination therapy is often necessary - Amphotericin B and Terbinafine
114
What is the prognosis for disseminated aspergillosis?
Poor diagnosis due to systemic immune dysfunction | Survival is less than 40% 1 week post-diagnosis
115
What are the differentials for disseminated aspergillosis?
other deep mycoses and neoplasia

Small Animal Medicine (100 decks)

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