Mycosis II

Question 1

What is the most common fungus found in bone marrow transplant patients?

Answer 1

Aspergillus (mold)

Question 2

What is the most common fungus found in solid organ transplants?

Answer 2

Candida (Yeast)

Question 3

T/F Candida is a human commensal organism?

Answer 3

TRUE

Question 4

what is considered the leading cause of opportunistic fungal infections?

Answer 4

Candida

Question 5

what 3 general areas are usually attacked by candida?

Answer 5

1) skin and nails
2) mucosa (vagina, esophagus)
3) blood

Question 6

What is thrush?

Answer 6

A common HIV disease that is a mucosal candida infection mainly affecting the esophagus.

Question 7

what is candidiasis?

Answer 7

blood stream infection of candida

Question 8

T/F candida is the 3rd most common cause of central line associated infections?

Answer 8

TRUE

Question 9

How does candida usually get into the blood stream?

Answer 9

usually catheter related.

Question 10

what is hepatosplenic candidaisis?

Answer 10

microabscesses in liver/spleen from candida that is unique to cancer patients with prolonged neutopenia.

Question 11

what are the 6 major risk factors for candida infection?

Answer 11

immunocompromized with:

1) antibiotic use
2) catheter
3) abdominal surgery
4) TPN
5) In the hospital
6) Neutopenia

Question 12

what are the two most common types of candida?

Answer 12

1) candida albicans

2) candida glabrata

Question 13

What is this describing? budding yeast that can form pseudohyphae and rarely may form true septate hyphae?

Answer 13

All candida species

Question 14

what is chromogenic media? why is it used?

Answer 14

It is media that turns different colors depending on the type of candida grown. Great for identification.

Question 15

why is early diagnosis of candida difficult?

Answer 15

1) lack of inflammatory response
2) Diagnostic procedures are risky
3) lack of sensitive assays

Question 16

How do you treat skin and mucosal candida disease?

Answer 16

topical medications such as “-azoles”

Question 17

How do you treat invasive candida disease?

Answer 17

Oral therapy such as “-azoles”, and amphotericin B.

Also, pull any indwelling catheters.

Question 18

what is considered to be the most common cause of invasive mold infection?

Answer 18

Aspergillus

Question 19

Over 95% of human disease caused by a mold is caused by which 3 organisms?

Answer 19

1) A. fumigatus
2) A. flavus
3) A. niger

Question 20

T/F Aspergillus routinely colonize healthy individuals?

Answer 20

False, but candida does

Question 21

what is allergic aspergillosis?

Answer 21

Airway colonization of aspergillus with allergic reaction. Associated with bronchospasm and scarring.

Question 22

what is Aspergilloma in pre-existing cavity?

Answer 22

Secondary colonization of the lung with a fungus ball. Frequently associated with hemoptysis

Question 23

what is semi-invasive aspergillosis?

Answer 23

Chronic cavitary, chronic fibrosing, chronic invasive

Question 24

what is invasive aspergillosis?

Answer 24

Life threatening and rapid spreading mold that is angioinvasive causing infaction.
Risk factors: neutropenia, immunosuppression, transplant

Question 25

What do you see with an MRI when looking at the lungs of someone with allergic bronchopulmonary aspergillosis?

Answer 25

thickening of the airways (bronchiectasis) and pleura

Question 26

where does invasive aspergillosis usually begin?

Answer 26

in the lungs

Question 27

T/F Mortality associated with Aspergillosis in increasing as we advance in modern medicine?

Answer 27

False. The mortality rate is slowly declining.

Question 28

Which type of organism has septate hyphae that branch at 45 degrees?

Answer 28

Aspergillis

Question 29

How do you diagnose aspergillis?

Answer 29

1) 45 degree branching hyphae that are septated | 2) Antigen detection (Galactomannan in the blood)

Question 30

Which 3 underlying diseases make you have the highest risk of invasive aspergillosis?

Answer 30

1) Bone marrow transplant 2) Neutropenia 3) Hemotologic cancer

Question 31

what is Galactomann?

Answer 31

a polysaccaride cell wall component of aspergillus. It serves as an antigen for monitoring hematologic malignancy in patients. (NOTE: it is not helpful with patients receiving antifungal therapy or certain antibiotics because it gives a false negative)

Question 32

How do you treat allergic bronchopulmonary aspergillosus?

Answer 32

corticosteroids

Question 33

How do you treat an aspergilloma?

Answer 33

combined surgical and medical therapy

Question 34

how do you treat semi-invasive and invasive aspergillosus?

Answer 34

1) Voriconazole is first line therapy | 2) Amphoteracin B would follow

Question 35

Which group of organisms are characteristically classified by broad hyphae without septate?

Answer 35

Zygomycosis

Question 36

Rhizopus, Mucor, and Rhizomucor all belong to which group?

Answer 36

Zygomycosis

Question 37

What diseases does zygomycosis usually cause?

Answer 37

1) Rhinocerebral DZ 2) pulmonary DZ 3) Disseminated DZ in immunocompromized

Question 38

What are the 3 main risk factors for zygomycosis infections?

Answer 38

1) Diabetes with hyperglycemia 2) acidosis 3) Hematologic malignancies

Question 39

what is the treatment for zygomycosis?

Answer 39

Amphoteracin B and surgical debridment

Question 40

T/F If you have a coinfection of zygomycosis and aspergillus and you knock out aspergillus with treatment, zygomycosis infection will increase?

Answer 40

TRUE

Question 41

When tying to identify zygomycosis, you should mince rather than crush of ground the hyphae. Why?

Answer 41

This is to minimize the damage done to the hyphae. Recall identification of zygomycosis is by identifying broad non-septate hyphae.

Question 42

T/F you can detect zygomycosis by D-glucan or galactomannan assays?

Answer 42

False. Both of these will not help detect zygomycosis

Question 43

what type of fungus is known as lid lifters?

Answer 43

zygomycosis grows so quickly that if you leave it, it will overgrow its container.

Question 44

T/F Pneumocytis jeroveci = P. carinii?

Answer 44

TRUE

Question 45

In which patients do you generally see P. Jeroveci?

Answer 45

AIDS patients with <200 CD4 level

Question 46

why has the incidence of P. Jeroveci decreased in AIDS patients over the last decade?

Answer 46

Introduction of the HAART therapy

Question 47

What has a ground glass infiltrate appearance on CXR?

Answer 47

Interstitial pneumonia from Pneumocystis Jeroveci

Question 48

what is the most common clinical syndrome for pneumocystis?

Answer 48

interstitial pneumonia

Question 49

What is the best way to diagnose pneumocystosis?

Answer 49

It is almost entirely through microscopic examination of sputum of bronchial samples.

Question 50

what is the best treatment for Pneumocystosis (jeroveci)?

Answer 50

#1 bactram (Trimethoprim-sulfamethoxazole)

Question 51

T/F Patient receiving treatment for pneumocystosis using bactram get worse before they get better?

Answer 51

True. This is because with treatment a large antigen load is released from the lysing organisms.