Opportunistic Fungal Infections (2)

Question 1

Opportunistic fungal pathogens cause local symptoms in previously healthy symptom but seldum dangerous symptoms in certain predispositions, what are these?

Answer 1

• prolonged neutropenia
• uncontrolled HIV or diabetes
• profound T cell suppression

Question 2

In order to effectively treat an opportunistic fungal infection, what is key?

Answer 2

treating the underlying problem

Question 3

What enables crypto infections?

Answer 3

reduced CMI

Question 4

What is the presentation of crypto?

Answer 4

LATE presentation with meningitis and skin nodules or pulmonary symptoms

Question 5

How do you diagnose a crypto infection?

Answer 5

biopsy, CSF, CRAG

india ink

Question 6

What is the treatment for crypto?

Answer 6

combos of azoles and amphotericin B

Question 7

What are the four presentations of aspergillosis?

Answer 7

1. ABPA
2. Aspergilloma
3. CNPA
4. Invasive

Question 8

What causes ABPA presentation of aspergillosis?

Answer 8

hypersensitivity reaction to infection complicating asthma or CSF

Question 9

What is the treatment for ABPA?

Answer 9

itraconazole, sinus surgery, xolair

only presentation treated with oral steroids

Question 10

What is an aspergilloma?

Answer 10

fungus ball complicating cavitary lung disease

Question 11

How would you diagnose an aspergilloma?

Answer 11

appears as an air crescent on CT scan

Question 12

What is the treatment for aspergillomas?

Answer 12

itraconazole and or surgery

Question 13

What does CNPA appear like?

Answer 13

TB

Question 14

How is CNPA diagnosed?

Answer 14

air crescent on CT scan

-needle aspirate lung fluid for microscopy

Question 15

How does invasive aspergillosis present?

Answer 15

respiratory distress with history of immunosuppression

Question 16

What is the specific sign of invasive aspergillosis on CT?

Answer 16

halo sign

Question 17

What is the treatment for CNPA and invasive aspergillosis?

Answer 17

voriconazole + ampho B

prognosis is poor

Question 18

What causes this:
“-very rare deadly invasive vasculitis caused by environmental mold, causes infararction
-invades brain from sinuses”

Answer 18

caused by mucor or rhizopus

mucormycosis

Question 19

What are the predispositions that can lead to mucormycosis infection?

Answer 19

uncontrolled diabetes, iron overload, immunosuppression

Question 20

How would you diagnose an infection with mucormycosis?

Answer 20

biopsy - nonseptate hyphate branches at rt angles

Question 21

What is the treatment and prognosis for a mucormycosis infection?

Answer 21

amphotericin B and aggressive surgical removal of diseased tissue - prognosis is poor

Question 22

Is fusarium ubiquitous or only found in certain locations?

Answer 22

ubiquitous

Question 23

What are the three presentations of fusarium?

Answer 23

1. mycotoxicosis
2. local infection
3. disseminated infection

Question 24

how do you get mycotoxicosis?

Answer 24

contaminated grain

Question 25

How do you get local infection with fusarium?

Answer 25

burns, prosthetics, contaminated contact solution

Question 26

How would a patient contract a deadly disseminated infection from fusarium?

Answer 26

prolonged neutropenia, HSCT recipients

Question 27

How do you treat a fusarium infection?

Answer 27

surgery, ampho B, voriconazole

Question 28

Does fusarium spread lymphatically or hematogeneously?

Answer 28

through the bl0o0o0od - fungemia

Question 29

How do you diagnose fusarium infection?

Answer 29

blood culture and histology
(don’t take positive results so seriously though since it is so ubiquitous)
-appears bannana shaped

Question 30

What is the prognosis of a fusarium infection?

Answer 30

poor prognosis

Question 31

How would you distinguish a fusarium from an aspergillosis infection?

Answer 31

if yeast present –> fusarium

aspergillus doesn’t have a yeast form

Question 32

What fungal infection is the most innately resistant to drugs?

Answer 32

fusarium