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Small Animal Medicine > Infectious Dz - Fungal > Flashcards

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
Q

What are the differentials to be considered with blastomycosis?

A

Neoplasia, other systemic mycoses, and systemic protozoal infections

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26
Q

Where is histoplasmosis distributed?

A

Similar to blasto - north of the equator and in the eastern US in the Ohio and Mississippi river valleys

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27
Q

What causes histoplasmosis?

A

Histoplasma capsulatum

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28
Q

What type of fungus is histoplasmosis?

A

Dimorphic

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29
Q

How does histoplasmosis infection occur?

A

It is inhaled or ingested by the host from avian and/or bat guano

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30
Q

Where does Histoplasma capsulatum replicate/dissemiate?

A

In macrophages

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31
Q

What age of dogs does histoplasmosis commonly occur in?

A

young patients (median age is 3 years)

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32
Q

What physical/clinical findings are associated with histoplasmosis in dogs?

A

GI signs are seen in 50-60% of cases, respiratory signs in 10% of cases, and can have ocular, skin, and CNS signs

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33
Q

How does histoplasmosis present in cats?

A

Often non-specific signs - respiratory (40%), ocular manifestations, lymphadenopathy, skin involvement, bone marrow involvement

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34
Q

What disease is co-infected with histoplasmosis in cats in 28% of cases?

A

FeLV

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35
Q

How is histoplasmosis diagnosed?

A

minimum database, imaging, cytology, and galactomannan test

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36
Q

What will you find on CBC in patients with histoplasmosis? Chemistry?

A

CBC - non-regenerative anemia +/- other cytopenias, high/low WBC counts
Chemistry - increased liver values, low albumin, high globulin

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37
Q

How does histoplasmosis look on thoracic rads?

A

Classic diffuse interstitial miliary to nodular pattern

Tracheobronchial lymphadenopathy

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38
Q

How does histoplasmosis look on abdominal rads?

A

Hepato/splenomegaly

Thickened intestinal wall with disruption of layering

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39
Q

How will the skeletal system look on radiographs in patients with histoplasmosis?

A

osteolysis with periosteal reaction

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40
Q

How can you get samples for cytology in histoplasmosis cases?

A

Impression smears, fine needles aspirates, lung washes, and rectal scraping

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41
Q

What will histoplasmosis look like on cytology?

A

Granulomatous/pyogranulomatous inflammation

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42
Q

Can you find Histoplasma in blood?

A

yes - in 20% of dogs and cats

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43
Q

Is serology recommended for diagnosis of histoplasmosis?

A

No - it has poor sensitivity/specificity

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44
Q

How is histoplasmosis treated?

A

Azoles - Itraconazole is the azole of choice
In severe disseminated cases - Amphotericin B
Glucocorticoids - to decrease pulmonary inflammatory reaction associated with fungal die off

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45
Q

What is the prognosis of histoplasmosis?

A

Good to poor prognosis based on the location

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46
Q

What are the positive prognostic factors for histoplasmosis?

A

presence of diarrhea

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47
Q

What are the negative prognostic factors for histoplasmosis?

A

need for oxygen supplementation, icterus, and abdominal organomegaly

48
Q

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

A

Long term - 6-12 months

End based on clinical signs, resolution of radiographic signs, and negative urine galactomannan antigen test

49
Q

What are the differentials for histoplasmosis?

A

Other systemic mycoses, IBD, and cancer

50
Q

Where is Coccidioidomycosis?

A

Coccidioides immitis is distributed on the Southwestern US

Coccidioides posadasii is in South America, Mexico, and part of the west coast

51
Q

What type of fungi is Coccidioides?

A

a dimorphic

52
Q

What does Coccidioides exist as in the environment?

A

a mycelium

53
Q

How does Coccidioides infection occur?

A

Inhalation of Arthroconidia

54
Q

What form is Coccidioides in the host?

A

spherules

55
Q

What is the typical signalment of coccidioidomycosis in the dog?

A

Younger, active large breed dogs

56
Q

What are the risk factors for coccidioidomycosis?

A

Being housed outdoors, walks in the desert, roaming large areas, and living in an endemic area

57
Q

What is the most common systemic signs in patients with coccidioidomycosis?

A

fever

58
Q

What other physical and clinical findings are associated with coccidioidomycosis?

A

Respiratory signs, bone involvement, CNS, skin, and repro involvement
Pericardial effusion and right sided heart failure

59
Q

How is coccidioidomycosis diagnosed?

A

Cytology or serology

60
Q

How do you acquire samples for a coccidioidomycosis cytology?

A

FNA, lung wash, pericardial fluid

61
Q

What will you see on cytology in a patient with coccidioidomycosis?

A

Pyogranulomatous inflammation

62
Q

What is the specificity and sensitivity of serology for coccidioidomycosis diagnosis?

A

Specific but not very sensitive

63
Q

How is coccidioidomycosis treated medically?

A

Azoles - fluconazole or itraconazole

In refractory/severe cases - Amphotericin B, Posaconazole or Voriconazole

64
Q

How is coccidioidomycosis treated surgically?

A

Limb amputation, enucleation, and pericardectomy

65
Q

What is the prognosis for coccidioidomycosis?

A

Guarded to good

66
Q

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

A

long term - > 6 months

Length of therapy is based on resolution of lesions and serology of less than 1:2

67
Q

What are the prognostic factors for coccidioidomycosis?

A

CNS involvement is associated with worse prognosis

68
Q

What are the differentials for coccidioidomycosis?

A

Other systemic mycoses, IBD, and cancer

69
Q

What type of fungi is Cryptococcus?

A

dimorphic

70
Q

What are the two main species that cause cryptococcus?

A

C. neoformans and C. gattii

71
Q

Who does C. neoformans infect?

A

immunocompromised dogs and people

72
Q

Who does C. gatti infect?

A

immunocompetent animals - mostly cats and humans

73
Q

Where is Cryptococcus distributed?

A

worldwide - more common on the west coast

74
Q

True or False: Cryptococcosis is the second most common systemic mycoses found in cats

A

False - it is the MOST common

75
Q

What age cats typically get Cryptococcosis?

A

young age - 4-6 years

76
Q

What is infection of Cryptococcus assocaited with?

A

Plant material (C. gattii) or pigeon guano (C. neoformans)

77
Q

How do cats become infected with Cryptococcus?

A

Mainly by inhalation of organisms

Can also occur by direct inoculation

78
Q

How does Cryptococcus spread?

A

Hematogenous spread - CNS, eyes, skin, lymph nodes, and the abdomen
Local - Bone, brain, and eyes

79
Q

How do cats with Cryptococcosis present?

A

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
Q

What is the signalment for a dog with Cryptococcosis?

A

Young/middle aged, active large breed dogs

81
Q

What is the main difference between Cryptococcosis in dogs vs cats?

A

Dogs are more likely to have systemic signs such as weight loss, fever, and inappetance

82
Q

What is the most common finding in dogs with Cryptococcosis?

A

Neurologic signs

83
Q

How is Cryptococcosis diagnosed?

A

minimum database, imaging, cytology, culture, and serology

84
Q

Where do you get samples for cytology in patients with Cryptococcosis?

A

Exudate, CSF, and aspirates

85
Q

What will you find on cytology in patients with Cryptococcosis?

A

Thick-walled organisms - polysaccharide capsule and narrow-based budding

86
Q

What can you get samples from for culture of Cryptococcosis?

A

Tissue, urine, CSF, and blood

87
Q

What are the benefits to culturing for Cryptococcosis?

A

It grows as a yeast so it is safer for personnel, allows for species ID, and you can determine antifungal sensitivity

88
Q

What antigen detection test is done for diagnosis of Cryptococcosis?

A

Latex agglutination test

89
Q

What does the Latex agglutination test test for?

A

capsular antigen with serum or cerebrospinal fluid

90
Q

What is the sensitivity and specificity for the latex agglutination test?

A

It is very sensitive and specific

91
Q

When are Latex agglutination false negatives common?

A

Dogs and patients with localized disease

92
Q

How is Cryptococcosis treated?

A

Fluconazole and Amphotericin B + 5-flucytosine

93
Q

Is the length of treatment for Cryptococcosis long or short? How do you know when to stop treatment?

A

Treatment is long term - 2-12 months

Treatment is ceased based on resolution of lesions and antigen titers

94
Q

When should surgery be considered in Cryptococcosis cases?

A

IF there are large granulomas present

95
Q

What is the prognosis for Cryptococcosis in cats?

A

Generally good (60-75% cure rate)

96
Q

What forms of Cryptococcosis in cats have a poorer prognosis?

A

CNS cases

97
Q

What is the prognosis for Cryptococcosis in dogs?

A

It is more guarded given underlying dysfunction

30-50% success rate

98
Q

What are the most common clinical signs of Cryptococcosis in cats?

A

Ulcerative cutaneous lesions and uveitis chorioretinitis

99
Q

What differentials should be considered for Cryptococcosis?

A

Other systemic mycoses - i.e. sporotrichosis

100
Q

What is the etiologic agent of disseminated aspergillosis?

A

Aspergillus terreus

101
Q

Who is at risk to develop disseminated aspergillosis?

A

German shepherds, females, and young/middle age dogs

102
Q

How does Aspergillosis infection occur?

A

inhalation of conida

103
Q

Is Aspergillosus dimorphic?

A

no - it produces hyphae not yeast

104
Q

What organs are affected by disseminated aspergillosis?

A

Bones, spleen, lymph nodes, and kidneys

105
Q

How do patients with disseminated aspergillosis often present?

A

Lethargy, lameness, and ataxia

106
Q

How is disseminated aspergillosis diagnosed?

A

Minimum database, imaging, fungal culture, cytology, and ELISA

107
Q

What will you find on minimum database in disseminated aspergillosis patients?

A

CBC - anemia with leukocytosis
Chemistry - Low albumin/high globulin, azotemia
UA - hyphae occasionally found

108
Q

What will you find in patients with disseminated aspergillosis on imaging?

A

Osteolytic lesions, diskospondilitis, and lymph node enlargement

109
Q

What is the positive incidence rate of urine culture? Blood or CSF culture?

A

Urine - >50%

Blood or CSF - 30%

110
Q

Where should you get samples for cytology for disseminated aspergillosis?

A

urine, aspirates, and airway washes

111
Q

Is serology dependable for disseminated aspergillosis diagnosis?

A

No - it is not useful

112
Q

What test is very good for disseminated aspergillosis infection?

A

Aspergillus galactomannan antigen ELISA - serum or urine

113
Q

How is disseminated aspergillosis treated?

A

Azoles - fluconazole resistance, possible response with posaconazole
Combination therapy is often necessary - Amphotericin B and Terbinafine

114
Q

What is the prognosis for disseminated aspergillosis?

A

Poor diagnosis due to systemic immune dysfunction

Survival is less than 40% 1 week post-diagnosis

115
Q

What are the differentials for disseminated aspergillosis?

A

other deep mycoses and neoplasia

Small Animal Medicine (100 decks)

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