Opportunistic Mycoses

Question 1

In a previously healthy patient, what kind of symptoms do opportunistic fungal pathogens cause?

Answer 1

Local symptoms

Question 2

Typically you need specific predispositions for opportunistic fungal pathogens to be dangerous. What kind of predispositions?

Answer 2

Prolonged neutropenia, uncontrolled HIV or diabetes, T-cell suppression

Question 3

Generally, how do you effectively treat opportunistic fungal infections?

Answer 3

Treat the current infection and the underlying problem

Question 4

What form can candida take?

Answer 4

Multimorphic- yeastlike, pseudohyphal, and hyphal forms. All can be present at the same disease site

Question 5

How does candidiasis present?

Answer 5

Thrush, vaginitis, diaper rash, chronic mucocutaneous, disseminated, and more

Question 6

How do you diagnose candidiasis?

Answer 6

Exam, biopsy, and CT

Question 7

Treatment for candidiasis?

Answer 7

azole appropriate to the site. Amphotericin B for a few types

Question 8

Can candidiasis become drug resistant?

Answer 8

Yes

Question 9

How do you guard against drug resistance in candidiasis?

Answer 9

Culture it and check!

Question 10

Where is cryptococcosis found?

Answer 10

It’s a widespread environmental pathogen found worldwide in soil

Question 11

What predisposes someone to infection by cryptococcosis?

Answer 11

A reduced CMI

Question 12

How does cryptococcosis impact the immune system?

Answer 12

It acts as an immune modulator to suppress to the host inflammatory response. Little inflammation is seen!

Question 13

How does cryptococcosis present?

Answer 13

Meningitis, skin nodules, pulmonary symptoms

Question 14

How do you diagnose cryptococcosis?

Answer 14

CSF- India Ink, biopsy, serological test for “crag” (cryptococcal antigen)

Question 15

Treatment of Cryptococcosis

Answer 15

Combination of azoles and amphotericin B

Question 16

What are the four presentations of aspergillosis?

Answer 16

ABPA,, aspergilloma, Chronic necrotizing pulmonary aspergillosis, Invasive aspergillosis

Question 17

What is ABPA?

Answer 17

A hypersensitivity reaction to infection, complicating asthma or CF

Question 18

How do you diagnose ABPA?

Answer 18

Exam

Question 19

Treatment of ABPA?

Answer 19

Itraconazole, sinus surgery, xolair

Question 20

What is aspergilloma?

Answer 20

A fungus ball complicating cavitary lung disease

Question 21

How to diagnose aspergilloma?

Answer 21

Look for air crescent on scan. Can see it on xray

Question 22

Treatment for aspergilloma?

Answer 22

Itraconazole and/or surgery

Question 23

What does CNPA mimic?

Answer 23

Tb

Question 24

How do you diagnose CNPA?

Answer 24

Diagnose by air crescent on scan and use a needle biopsy for histology

Question 25

How does invasive aspergillosis present?

Answer 25

Respiratory Distress

Question 26

Do you have to be severely immunocompromised to get invasive aspergillosis?

Answer 26

Yes

Question 27

How do you diagnose invasive aspergillosis?

Answer 27

Look for halo sign on scan, use needle or lung tissue biopsy for histology (Acute angles)

Question 28

How do you treat CNPA and invasive aspergillosis?

Answer 28

Voriconazole + Amphotericin B (poor prognosis though)

Question 29

What does mucormycosis infect?

Answer 29

Blood vessels- it's a vasculitis

Question 30

What does mucormycosis arise from?

Answer 30

Environmental mold

Question 31

Effects of mucormycosis

Answer 31

Causes infarction and necrosis of tissue downstream of blocked vessel- invades brain from sinuses

Question 32

What predisposes someone to get mucormycosis?

Answer 32

Uncontrolled diabetes, iron overload, immune suppression

Question 33

How do you diagnose mucormycosis?

Answer 33

Biopsy for histology- hyphae branch at right angles

Question 34

How do you treat mucormycosis?

Answer 34

Use amphotericin B and surgically remove dead tissue- poor prognosis though

Question 35

Where is fusarium in the environment?

Answer 35

A mold

Question 36

In predisposed populations in fusarium fatal?

Answer 36

Yes

Question 37

What are the 3 presentations of fusarium?

Answer 37

1) Mycotoxicosis- contaminated grain 2) Local infection- burns, implants 3) Disseminated infection- neutropenia

Question 38

How does fusarium enter the body and where does it cause symptoms?

Answer 38

Enters through sinus or wound site, circulates in the blood, symptoms in skin, eye, and lung.

Question 39

How do you diagnose fusarium

Answer 39

Blood culture and histology

Question 40

How do you treat fusarium?

Answer 40

Surgery, amphotericin B, and/or voriconazole- poor prognosis though