Mycotic Lung D/o Flashcards
What is the definition of mycosis
Mycosis: a disease caused by infection with a fungus
Common to midwestern states
(Ohio and Mississippi)
Fungus isolated in the soil contamination with bird of bat droppings
Commonly in caves, abandoned buildings
S/s mild influenza like s/s to severe pneumonia,
Fever, Headache, myalgia, cough and pleurtic chest pain
Typically mistaken for CAP or atypical pneumonia
Think? Dx? CXR? Tx?
Histoplasmosis from spore inhalation
Dx: urine and serum antigen
CXR: focal infiltrate or nodular, mediastinal or hilar adenopathy
Can lead to disseminated with multi-organ involvement in HIV pts with a CD4 <100 or on pts taking remicade or Humira
(Hepatosplenomegaly, adrenal enlargement but rarely leads to adrenal insufficiency, GI involvement may mimic IBD)
Tx: mild are self limited and requires no tx Disseminated: - Itraconazole if S/s >4 weeks -Severe illness (meningitis, etc) IV amphotericin B
Common to Southwestern US, Mexico, south and Central America
Frequently presents as CAP in endemic areas
S/s fever Bach ache, cough with arthralgias of the knees and ankles, plus erythema nodosum
Can lead to a disseminated condition more common in Filipinos, blacks, and pregnant pts
-Significantly more pronounced pulmonary sxs, systemic
(increased productive cough and mediastinal enlargement)
Lung abscesses, meningitis common
Skin abscesses, wart like lesions
Think/? Dx? CXR? Tx
Coccidiomycosis
Dx: Serologic testing (IgM and IgG)
-Can have eosinophilia on CBC, but non-diagnostic
CXR unilateral hilar adenopathy
(Compared to sarcoidosis/ Lofgren that also has erythema nodosum and migratory arthralgias but is bilateral hilar)
Disseminated CXR is diffuse miliary pattern
Tx: Mild no treatment necessary
Severe: fluconazole, itraconazole, and Amphotericin B for the most severe cases
Most common to south central and midwestern USA and Canada
Leads to either a primary pulmonary infection or disseminated disease
S/s fever, dyspnea, chest pain, pleurisy, and wt loss
Disseminate- lesions of the skin and bones with urogenital involement
(Prostatitis, epididmytis)
Think? Dx? CXR? tX?
Blastomycosis
Dx: Sputum culture or BAL (bronchoalveolar lavage)
-Calcofluor fluorescent staining of sputum or purulent material
CXR: lesions are cavitary, nodular, fibrotic, or mass-like in appearance
Tx: Mild- Azole anti fungal s
Severe disseminated: Amphotericin B IV
What are the three possible types of aspergillosis
Allergic aspergillosis- consider in asthma hx pts
Invasive aspergillosis -mainly in immuno comp pts -
Aspergilloma -Colonization of pre-existing lung cavities with Aspergillus species
A transplant pts presents with neutropenia what mycotic d/z is high index
Aspergillosis
A pt with a Hx of Asthma
Worsening bronchospasms
+eosinophils and a high level of IgE
With central bronchiesctsasis
That characteristically waxes and wanes with gradual improvement
Think? Dx? CXR? Tx?
Allergic Bronchopulmonary Aspergillosis
CXR: Fleeting pulmonary infiltrates plus Eosinophilia and High level of IgE
Dx: cutaneous reactivity to aspergillus antigens
Tx: Acute exacerbations-
Oral prednisone often controls clinical symptoms
Several weeks to months of txt may be necessary
Bronchodilators often benefit
Mycotic disease that occurs mainly in immunocomp adults
S/s sinusitis, fever, cough, chest pain and hemoptysis
Usually seen post stem cell transplant
Think>?
Tx?
Invasive Aspergillosis
Treatment – Invasive
Long courses of antifungals
High mortality
This is a colonization of pre-existing lung cavities with aspergillosis species
S/s cough, hemoptysis, dyspnea, st loss, fatigue, fever, and chest pain
Think? Dx? CXR? Tx?
Aspergilloma
CXR: Rounded mass in a preexisting pulmonary cavity
Diagnosis: Sputum culture isolates
Aspergillosis
Treatment: Surgical resection
This is the most common cause of pneumonia is HIV pts
In pts with a CD4 less than 200
THink? CXR? Tx?
PCP-Pneumocystitis Pneumonia
CXR: variable from normal to infitrates (unilatreral or bilateral) cavities, nodules, consolidations, pneumothorax
Treatment Usually Bactrim
