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Infectious Disease > Mycology > Flashcards

Mycology Flashcards

1
Q

Aspergillus fumigatus

A
  • MCC of non-candidal invasive fungal infection post-transplant & other immunosuppressed patients
  • affects lungs, sinuses, brain
  • directly invades the tissue and causes damages OR creates an immunological reaction
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2
Q

Aspergillosis clinical manifestations

A
  • chest pain
  • pneumonia
  • sputum with blood
  • vision difficulties
  • HAs
  • anorexia
  • hematuria
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3
Q

Allergic Bronchopulmonary Aspergillosis (ABPA)

A
  • occur in patients with chronic lung diseases such as asthma or cystic fibrosis
  • bronchospastic exacerbations with fleeting pulmonary infiltrates with eosinophilia, high levels of IgE, and IgG Aspergillus precipitins in the blood
  • sinusitis with chronic inflammation with eosinophilic mucus and noninvasive hyphal elements
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4
Q

Chronic aspergillosis

A
  • Spectrum of disease most commonly noted in chronic lung disease but without immunocompromised state
  • Ranges from aspergillomas (causing lung cavitations) to chronic fibrosing pulmonary aspergillosis (pulmonary parenchyma replaced with fibrosis)
  • Pneumonia like presentation without a response to ABX
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5
Q

Ring enhancing lesion on lung CT

A

Aspergillosis

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6
Q

Invasive Aspergillosis

A
  • MC in severely immunodeficient pts.
  • Pulmonary disease is MC with patchy infiltration progressing to severe necrotizing pneumonia
  • disseminates through blood to brain, skin, heart, and other organs
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7
Q

Definitive Dx of aspergillus

A

Bx of tissue/culture from a sterile site with Aspergillus

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8
Q

CT finding of halo sign

A

invasive aspergillosis

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9
Q

Post organ transplant with a halo sign on CT

A

aspergillosis

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10
Q

immunosuppressed pt. with fever, hemoptysis, pleuritic chest pain

CXR shows a cavitary lesion of a rim of ground glass attenuation surrounding a pulmonary nodule

A

Aspergillosis

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11
Q

Blastomycosis

A
  • dimorphic fungus (yeast in the body)
  • MC in men of occupational/recreational activities outdoors
  • afflicts domestic cats/dogs
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12
Q

Blastomycosis location

A

South central and MW US and Canada

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13
Q

Traveler from Ohio, Mississippi, Great lakes regions

A

Blastomycosis

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14
Q

Clinical manifestations of blastomycosis - pulmonary infection

A
  • MC form of dz is pulmonary infection

- mediastinal lymphadenopathy with purulent cough, pleurisy, fever, weight loss

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15
Q

CXR of Blastomycosis

A

nodules, granulomas, mediastinal LAD, cavitary lesions (mimics TB)

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16
Q

Disseminated (gets into the blood) infection of Blastomycosis

A
  • spread is not uncommon

- osteomyelitis, GU lesions, CNS lesions

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17
Q

Dx testing of blastomycosis

A

fungal cx is gold standard

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18
Q

Coccidioidomycosis AKA

A

San Joaquin Valley fever

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19
Q

Blastomycosis management of mild to moderate disease

A

itraconazole

severe disease is amphotericin B to start and then itraconazole (oral)

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20
Q

Coccidioidomycosis geographic region

A

AZ/CA

desert regions of western hemisphere

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21
Q

Coccidioidomycosis spread

A

via inhalation of molds dispersed with disturbed soil

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22
Q

Disturbed soil

A

dust storm
vigorous hiking
heavy rainstorms
construction

Coccidioidomycosis

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23
Q

Coccidioidomycosis clinical manifestations of primary Coccidioidomycosis

A

erythema nodosum rash, fever, chills, fatigue, chest pain, cough, SOB, migratory arthralgia

usually self-limiting after several weeks

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24
Q

Coccidioidomycosis disseminated cases

A
  • more severe disease in immunocompromised
  • chronic infection in about 5% of cases
  • disseminated dz to meningeal, bone, joint spaces, pericardium, skin
  • meningitis in 30-50% of disseminated cases
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25
Q

Desert Rheumatism Triad of Coccidioidomycosis

A

arthralgia
fever
erythema nodosum

26
Q

Coccidioidomycosis CXR findings

A
  • associated with chronic dz
  • mediastinal LAD
  • nodules
  • granulomas
  • cavitary lesions
  • spontaneous pneumothorax
27
Q

Coccidioidomycosis when to treat

A
  • weight loss >10%
  • night sweats for >3wks
  • significant pulmonary infiltrates
  • prominent hilar LAD
  • titers >1:16
  • inability to work
  • Sx lasting >2months
28
Q

pigeon poop

A

cryptococcosis

29
Q

cryptococcosis distribution

A

Pacific West Coast: WA, OR, CA

30
Q

Where is cryptococcosis found

A

in soil and dried pigeon poop

31
Q

cryptococcosis clinical manifestations

A
  • usually asx in immunocompetent individuals
  • disseminates to organs and CNS the worst
  • HA is first manifestation of meningitis
  • nuchal rigidity
  • meningeal signs
  • communicating hydrocephalus (ventricles in the brain get clogged and CSF cannot circulate)
  • bacterial-like cellulitis
32
Q

Immune reconstitution inflammatory syndrome (IRIS)

A

patient gets worse despite improved immune status in cryptococcosis

33
Q

Dx of cryptococcosis

A
  • india ink stain of CSF

- cryptococcal capsular antigen in CSF and Cx together: Dx in >90% of cases

34
Q

cryptococcosis tx

A
  • liposomal amphotericin B preferred initial medication followed with oral fluconazole
35
Q

When it is ok to switch from amphotericin B to oral fluconazole for cryptococcosis tx

A
  • favorable clinical response (improve in any way)
  • improvement in CSF biochemical profile
  • conversion of CSF cx to negative
36
Q

failure to recognize and correct high intracranial pressure in cryptococcosis

A

leads to increased morbidity and mortality

37
Q

Histoplasmosis locations

A

OH
Mississippi river valley areas

found in soil with bird/bat guano

38
Q

Spelunking and excavation

A

Histoplasmosis

39
Q

Histoplasmosis v. Blastomycosis (as both in the same area)

A

Histoplasmosis is caves/spelunking with bat/bird poop

Blastomycosis is with individuals that work in construction outside

40
Q

Histoplasmosis clinical manifestations

A

inhale the mold and converts to yeast in lungs

spreads to lymph nodes and liver/spleen

41
Q

Acute primary pulmonary histoplasmosis: clinical manifestations

A

Most ASx and almost never fatal

  • prodome like and also have HSM, acute pancreatitis, arthralgias, erythema mulitforme/nodosum
42
Q

Chronic pulmonary histoplasmosis: clinical manifestations and CXR

A
  • Hematemesis
  • most with cavitary lesions have COPD/chronic bronchitis that masks the underlying fungal disease
  • CXR: mediatstinal LAD, apical cavities
43
Q

Progressive disseminated histoplasmosis: risk factors

A
  • AIDS
  • extremes of age
  • immunosuprressive meds
  • MTX
  • Meds for inflammatory - arthritis or Chron’s
44
Q

Progressive disseminated histoplasmosis clinical manifestations (incl. CXR)

A
  • fulminant dz resulting in pulmonary, renal, coagulation complications
  • CXR: miliary pattern
  • CNS: meningitis or focal brain lesions
  • oral mucosal ulcerations
  • HSM
  • adrenal insufficiency
  • GI involvment
45
Q

Histoplasmoma

A

healed area of caseation necrosis surrounded by a fibrous capsule on CXR

46
Q

Mediastinal fibrosis of Histoplasmosis

A
  • rare consequence of a fibroblastic process that encases caseating mediastinal lymph nodes after primary histoplasma bronchopneumonia
  • Constriction of the bronchi results and bronchiectasis, also esophageal stenosis associated with dysphagia, and superior vena cava syndrome
  • Progressive fibrosis producing severe retraction, compression, and distortion of mediastinal structures
47
Q

Presumed ocular histoplasmosis syndrome

A
  • atrophic choroidal scars and maculopathy

- distortion or loss of central vision without pain, redness, or photophobia

48
Q

Mucormycosis: Rhinocerebral disease

A
  • MC form
  • Fever, headache, unilateral facial swelling/pain/numbness, sinus congestion, and unilateral blindness
  • Necrosis is common due to hyphal tissue invasion manifest as ulcerations of the hard palate or nasal plate or hemoptysis
49
Q

Mucormycosis Pulmonary disease

A

Very similar presentation as invasive pulmonary aspergillosis; differentiated by concomitant rhinocerebral symptoms

50
Q

Mucormycosis Cutaneous disease

A
  • Starts as area of erythema that develops into a black eschar
  • Necrotizing fasciitis is possible due to angioinfective properties of the fungi
51
Q

Mucormycosis Disseminated disease

A
  • Organ specific manifestations

- CNS findings of altered mental status and coma

52
Q

Halo vs. reverse halo

A

Halo: aspergillosis

Reverse halo: mycormycosis

53
Q

Sporotrichosis

A

Rose gardener’s disease

54
Q

Rose gardener’s disease

A

Sporotrichosis

55
Q

Sporotrichosis is commonly found where

A

in or on soil, hay, peat moss, plants, and rose thorns

- cats carry on paws and spread via scratching

56
Q

Rose garden and stuck by a thorn

A

Sporotrichosis

57
Q

Sporotrichosis clinical manifestations of cutaneous

A
  • MC form of the infection
  • Starts with hard, non-tender subcutaneous nodules
  • Develop lesions adherent to overlying skin that then ulcerate
  • Occurs on fingers, hand, or arm (where inoculated)
  • Lymphocutaneous disease occurs as infection spreads up lymphatic channels with development of secondary lesions and subsequent ulcerations
58
Q

Sporotrichosis pulmonary form

A
  • rare, occurs in people who inhale spores

- tends to occur in people with preexisting lung dz

59
Q

Sporotrichosis: Disseminated sporotrichosis

A
  • affects cats/dogs
  • occur via hematogenous spread
  • joints
  • lungs
  • CNS
60
Q

Sporotrichosis diagnostic testing

A
  • fungal cx is gold standard
  • Pathologic exam of biopsied lesions:
  • Pyogranulomatous response
  • Classic “cigar body” shaped yeast
61
Q

Sporotrichosis is a ____ fungus

A

dimorphic: mold and yeast

Infectious Disease (8 decks)

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