Micro - Fungal (histo, blasto, coccidomycoses, aspergillus, zygomycoses, pneumocystis)

Question 1

Systemic mycoses

Answer 1

Histo
Blasto
Cocciodio

Question 2

Opportunistic mycoses

Answer 2

Aspergillus
Zygomycosis
Pneumocystis

Question 3

How are fungal respiratory infections transmitted?

Answer 3

Inhalation of spores

Question 4

Extremely serious fungal infection which must be treated aggressively as soon as suscpected

Answer 4

Aspergillosis

Question 5

Has fungal and protozoal properties

Answer 5

Pneumocystis

Question 6

What causes symptoms of fungal respiratory infections?

Answer 6

Damage from immune response

Question 7

Why are immunocompromised patients at greatest risk for fungal infections (specifically)?

Answer 7

Most fungi can be handled by PMNs but immunocompromised pt ain’t got em

Question 8

Characteristics of the systemic fungi

Answer 8

Dimorphic

Endemic

Question 9

Environmental v. tissue forms of systemic fungi

Answer 9

Tissue form is able to evade immune system, env. form can’t

Question 10

Reservoir for histo

Answer 10

Soil laden with bird and bat feces

Question 11

Endemic region for histo

Answer 11

Ohio-Mississippi River valley

Central America

Question 12

Morphology of histo

Answer 12

Tuberculate (bumpy) conidia

Question 13

Histo/blasto tissue forms vs. coccidioides tissue form

Answer 13

Histo/blasto = yeasts
Coccidioides = spherule

Question 14

Cells targeted by histo

Answer 14

RES

Question 15

Reservoirs of blasto and coccidioides

Answer 15

Soil

Question 16

Morphology of aspergillus

Answer 16

A-shaped (45 degree) branching septate hyphae

Question 17

Where is aspergillus found? Buzz word?

Answer 17

Everywhere

Hospital air ducts

Question 18

Fungus that commonly contaminates cell cultures

Answer 18

Aspergillus

think: it’s ubiquitous

Question 19

Morphology of zygomycetes

Answer 19

Broad, nonseptate hyphae that branch at 90 degree angles

Question 20

When do people develop mucormycosis?

Answer 20

After soil disturbance

think: AIDS pt with pneumonia or rhinocerebral sx after tornado, earthquake

Question 21

Which fungus can’t be grown in culture? How can it be ID’d? Which must be cultures from BAL only?

Answer 21

Pneumocystis - use silver stain to look for cysts

Aspergillus - ubiquitous so it’s a common contaminant

Question 22

What is unique about Pneumocystis structure? Implication?

Answer 22

Has cholesterol instead of ergosterol in membrane; can’t use amphotericin B or azoles

Question 23

Valley Fever

Answer 23

Coccidioidomycosis - found in San Joaquin River Valley in California

Question 24

Sx of most histo infections

Answer 24

None

Question 25

Sx of histo infection in infants/immunocompromised

Answer 25

Disseminated infection leading to renal failure, meningitis, encephalitis

Question 26

Complication of histo in AIDS pt

Answer 26

Abd masses

Question 27

Histo sx in other healthy pt

Answer 27

Chronic and relapsing pneumonia resembling TB

Question 28

Fatality of histoplasmosis

Answer 28

25%

Question 29

Sx of blastomycosis

Answer 29

50% asymptomatic

Acute pneumonia with brown, purulent or bloody sputum

Question 30

Blasto often confused with:

Answer 30

Lung CA or TB because of masses in lung

Question 31

Sx of disseminated blasto

Answer 31

Prostate infection
Warty skin lesions
Meningitis

Question 32

Sx of coccidioidomycosis/Valley fever

Answer 32

Fever, arthralgia, fatigue and rash

Fatigue can last for months

Question 33

Who is most likely to get disseminated coccidioidomycosis/Valley fever

Answer 33

Men
Dark-skinned pts
Immunocompromised

Question 34

Which fungus associated with pre-existing lung disease?

Answer 34

Aspergillosis

think: ABPA in asthma, cystic fibrosis

Question 35

Characteristic lesion of aspergillosis

Answer 35

Fungal ball = aspergilloma

causes severe hemoptysis

Question 36

Fatality of disseminated aspergillosis

Answer 36

Universally fatal

Question 37

Who gets mucormycosis?

Answer 37

Pt in DKA or on corticosteroids

Question 38

Two forms of mucormycosis

Answer 38

Pneumonia

Rhinocerebral form

Question 39

Pneumocystis causes what type of pneumonia

Answer 39

Diffuse interstitial pneumonia

Question 40

What PFT would be lowered in pneumocystis pneumonia?

Answer 40

O2 sat

Question 41

Endemic area for blasto

Answer 41

Mid-south
Southeast
Mid-west

Question 42

Who’s more likely to get blasto?

Answer 42

Middle-aged and older men

Question 43

Endemic area for coccidioidomycetes

Answer 43

Arid climates in southwest US

San Joaquin River Valley in California

Question 44

Which fungal infection is extremely contagious?

Answer 44

Valley fever (coccidiodo)

Question 45

Which fungal infection has widespread seropositivity?

Answer 45

Pneumocystis - most people infected by age 4

however, infections in AIDS pts aren’t reactivation but new infections with different serotypes

Question 46

What has greatly reduced the incidence of pneumocystis pneumonia?

Answer 46

HAART tx

AIDS is #1 predisposing factor

Question 47

First step in culturing fungi

Answer 47

Treatment with KOH to remove everything but fungal cell walls

Question 48

Tuberculate macroconidia

Answer 48

Histo

Question 49

Spherules

Answer 49

Coccidioidomycosis

Question 50

Broad-based budding yeasts

Answer 50

Blasto

Question 51

Tx of healthy pt with fungal systemic infection

Answer 51

Watch for one month
If persists –> azoles for 6-12 weeks
If persists –> ampho B until it’s gone then azoles for 1-2 years

Question 52

Tx of immunocompromised pt with fungal systemic infection

Answer 52

Ampho B until it’s gone then azoles for life

Question 53

Tx of aspergillosis

Answer 53

Ampho B + removal of aspergilloma

Question 54

Tx of mucormycosis

Answer 54

Ampho B + debridement (really disfiguring)

Question 55

Tx of pneumocystis pneumonia

Answer 55

Trimethoprim+sulfamethoxazole (remember no ergosterol so can’t use ampho B or azoles)
Pentamidine (anti-protozoal) 2nd line

Question 56

Most common fungal infection

Answer 56

Candidiasis