Lung infections

Question 1

Histoplasmosis- Eti

Answer 1

• Fungus: Histoplasma capsulatum
• Bird or bat droppings in soil in endemic areas
• Immunocompromised
• Endemic areas- most prevalent: Ohio/Mississippi, E.Canada, Mexico, C & S America, Africa, SE Asia

Question 2

Histoplasmosis- Sx

Answer 2

• Mild- flu like sx 1-4 days
• Most asymptomatic
• More severe- fever, cough, headache, central chest pain 5-15 days
• Progressive: wt loss, dyspnea, cough, hepatosplenomegaly, adrenal insufficiency, GI sx

Question 3

Histoplasmosis- Dx

Answer 3

• First AM urine & serum antigen assay

- CXR- Typically normal- hilar lymphadenopathy, patchy infiltrates

Question 4

Histoplasmosis- Tx

Answer 4

Mild case: dont tx
> 4 weeks-
Itraconazole or amphotericin B

Question 5

Coccidiomycosis- Eti

Answer 5

• Cocidioides immitis or coccidiodes posadasii
• Mold in US- Arizona, Cali & Tx, Mex., C & S America
• Inhalation of contaminated soil

Question 6

Coccidiomycosis- Sx

Answer 6

• Flu like- malaise, fever, backache, headache, productive cough
• Erythema nodosum
• Meningitis, arthralgias- swelling of knees & ankles, bone lesions, skin & soft tissue abscess

Question 7

Coccidiomycosis- Dx

Answer 7

• Serology
• CXR: nodular & lobar infiltrates, hilar lymphadenopathy
• Spherules with endospores in sputum

Question 8

Coccidiomycosis- Tx

Answer 8

Pulm: Ketoconazole
Meningitis: Fluconazole

Question 9

Psittacosis- Eti

Answer 9

• Bacteria- Chlamydophelia psittaci
• Gram -
• Dried feces inhalation
• Contact with psittacine (parrots, parakeets, pigeons, chickens, ducks) bird 7-15 days previously

Question 10

Psittacosis- Sx

Answer 10

• Rapid onset of fever, chills, myalgia, cough, pronounced HA
• Rales most common
• Dullness to percussion/ consolidation
• Heptosplenomegaly
• Pleural rub
• Culture negative endocarditis
• Temperature pulse dissociation

Question 11

Psittacosis- Dx

Answer 11

• Serology- Ab testing

- CXR: Unilateral lower lobe consolidation moves to bilateral

Question 12

Psittacosis- Tx

Answer 12

First line: Doxycycline

Second line: Macrolide

Question 13

Aspergillosis- Eti

Answer 13

Fungus- aspergillus fumigatus- Sx due to abnormal immune response

• In food, water, soil
• Stem cell and organ transplant patients, leukemia & HIV

Question 14

Aspergillosis- Sx

Answer 14

• Allergic bronchopulmonary aspergilosis- bronchospasm (asthma, CF, lung disease)
• Invasive: SOB, hemoptysis, cough chest pain

Question 15

Aspergillosis- Dx

Answer 15

• Culture
• Serology- galactomannan- alveolar lavage
• Histology
• Tissue infarction

Question 16

Aspergillosis- Tx

Answer 16

• Voriconozole
• Itraconazole
• Amphitericin B

Question 17

SARS- Eti

Answer 17

• Cornoavirus- person to person spread

- Travel to endemic area: china, hong kong, singapore, taiwan, vietnam, toronto

Question 18

SARS- Sx

Answer 18

Phase 1: flu like illness- fever, HA, chills, myalgia
Phase 2- lower resp tract- dry cough, dyspnea
- Persistant fever, chills, rigor, cough, SOB, rales and rhonchi
- Watery diarrhea

Question 19

SARS- Dx

Answer 19

• Serology- PCR

- PCR for RNA detection

Question 20

SARS- Tx

Answer 20

Supportive treatment

Question 21

Hantavirus- Eti

Answer 21

• Hemorrhagic fever associated with rodents

- Inhalation from feces

Question 22

Hantavirus- Sx

Answer 22

• Fever, tachypnea, tachycardia
• 40% mortality rate
• Pulmonary vascular leakage- pulmonary edema, cough,
• Prodrome- myalgia, malaise, fever
• GI, HA, chills

Question 23

Hantavirus- Dx

Answer 23

• Serology
• CXR: pum. edema
• Immunoblasts in blood, lungs, kidney, bone marrow, liver and spleen

Question 24

Hantavirus- Tx

Answer 24

• Supportive care & isolation

- Ribavirin