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Micro Exam 3 > Opportunistic Mycoses > Flashcards

Opportunistic Mycoses Flashcards

1
Q

Opportunistic mycosis

A

a fungal disease occurring in an animal/human with a compromised immune system

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2
Q

Opportunistic organisms

A

part of the body’s normal resident flora that become pathogenic only when host’s immune defenses are low

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3
Q

Reasons for altered immune system

A
  • Immunosuppressive drug therapies
  • Chronic diseases like diabetes mellitus
  • steroid or antibacterial drug usage
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4
Q

Five types of opportunistic fungus

A

1) candidiasis
2) cryptococcosis
3) aspergillosis
4) mucormycosis
5) pneumocytosis

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5
Q

What is the “most important cause” of opportunistic fungal infection?

A

Candidiasis

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6
Q

Another name for Candida is…

A

yeast-like fungus

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7
Q

Candida is a normal flora to __, __, __, and ___. Colonization increases with __, __, and __.

A
  • mouth, GI, vagina and skin in 20%

- age, pregnancy, hospitalization

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8
Q

Most common form of candida infection?

A

Candida albicans (75%). 5 other species have been isolated from humans.

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9
Q

Candida is unique because it grows as yeast at all temperatures, but at 37C it can form…

A

pseudohyphae and chlamydospores

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10
Q

There are 11 different kinds of candidiasis infection. Try to name 6.

A

1) Oropharyngeal
2) Cutaneuous
3) Onychomycosis
4/5) Vulvovaginal/balanitis (penile glands)
6) Oesophageal
7) GI
8) Bronchopulmonary
9) Peritonitis
10) Urinary tract
11) CANDIDEMIA/disseminated

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11
Q

Another name for oropharyngeal candidiasis:

A

Thrush

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12
Q

3 manifestations of oropharyngeal candidiasis

A

1) Pseudomembranous- white/grey scrapable plaque on hard palate and tongue
2) Erythematous/atrophic- on hard palate and tongue
3) Angular cheilitis- burning, sores at corners of the mouth with dry mouth, loss of taste, painful swallowing
* ** DD: oral HSV ***

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13
Q

2 manifestations of cutaneuous candidiasis

A

1) Intertriginous (very common)- moist, macular erythematous rash with typical satellite lesions present
2) Diaper candidiasis- erythematous lesions with erosions and satellite pustules. Begin in perianal area and spread toward genitalia

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14
Q

Risk factors for intertriginous candidiasis:

A
  • areas of moisture and heat- axillae, groin, sub-mammary folds, intergluteal folds…
  • especially with frequent friction, obesity, diabetes mellitus, and broad-spectrum abx.
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15
Q

Progression of candidal onychomycosis

A

Start as paronychia (whitlow = soft tissue around nail)

Difference between this and dermatophytic onychomycosis (starts under nail)

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16
Q

Predisposing factors for C. onychomycosis

A

-continuous wetting especially w/sugar solutions/flour

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17
Q

Symptoms of C. onychomycosis

A
  • Painful, erythematous swelling around nail

- chronic cases can progress to onychoLYSIS- total detachment of cuticle from nail plate

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18
Q

Vulvovaginal candidiasis is common in women and associated with… (5 things)

A

1) Broad-spectrum abx
2) Low vaginal pH
3) Diabetes mellitus
4) Sexual activity
5) Oral contraception

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19
Q

Symptoms of vulvovaginal candidiasis

A

Intense vulvar pruritis–> itchy vag
Burning, erythematic
Dyspareunia = painful sex
… also a creamy white, curd-like discharge

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20
Q

Oesophageal candidiasis is associated with…

A

AIDS (an AIDS defining illness)
Severe immunosuppression following tx for leukemia or tumors
… can lead to septicemia and disseminated candidiasis

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21
Q

Symptoms of oesophageal candidiasis

A

Burning pain in the substernal area
Dysphagia
Nausea/vomiting

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22
Q

GI candidiasis

A
  • from hematogenous spread
  • patients with acute leukemia or other hematological malignancies might have stomach/gut ulcerations that allow for perforation –> peritonitis –> spread to liver, spleen, etc.
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23
Q

Causes of candidiasis peritonitis

A

Colonization of indwelling catheters for:

  • peritoneal dialysis (CAPD)
  • GI perforation due to ulcers, colitis, surgery ect.
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24
Q

Symptoms of candidiasis peritonitis

A
  • Cloudy peritoneal dialysate containing greater than 100 leuko/mmcubed
  • Fever, abdominal pain and tenderness
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25
Q

UTI candidiasis

A

Transient/asymptomatic candiduria during abx or corticosteroid use

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26
Q

Candida cystitis or bladder colonization can be caused by…3 ish things

A

1) prolonged catheterization while on abx
2) diabetes/glycosuria
3) previous bladder endoscopy or surgery

27
Q

Candidemia

A

The presenece of yeasts in the blood with or without visceral involvement that can then disseminate to other organ systems –> endocarditis and hepatosplenic candidiasis

15% of hospital patient septicemias

28
Q

Diagnosis by scrapings and microscopic observation:

A

Scrapes: skin, mucosal, vaginal
Culture blood and other body fluids
Observe purple yeast cells after gram stain

29
Q

Candidiasis treatments

A

Topical: Nystatin and miconazole

Then, of course, itraconazole, fluconazole, Amph B

30
Q

Two causes of cryptococcosis

A

Cryptococcus neoformans= var. neoformans (3 serotypes)

Cryptococcus bacillospora = var. gatti (serotype B and C)

31
Q

General progression of cryptococcosis

A

Lungs –> resolve or brain (meningitis), skin, bones, organs

32
Q

Cryptococcus structure is characterized by…

A

thick polysaccharide capsule; deposit melanin in cell wall when grown in catechols = presence of phenol oxidase

33
Q

Pulmonary cryptococcosis can manifest as…

A

acute respiratory distress syndrome= fever, malaise, cough with very little sputum, pleurisy

34
Q

CNS cryptococcosis

A
  • Most diagnosed dissemination
  • Meningitis and meningoencephalitis
  • Death may occur 2 weeks to several years after onset, but is inevitable without treatment… also inevitable with treatment, but.. ya know.
  • symptoms are typical increased intracranial pressure type things
35
Q

Cutaneous cryptococcosis

A
  • in 10-15% of cases
  • present as just about every kind of lesion (papule, pustules, nodules, ulcers, draining sinuses) often with a block spot on top
36
Q

Pathogenesis of cryptococcosis

A

Spores inhaled from eucalyptus tree (gatti) or bird poop (neo)–>survive neutral/alkaline pH and CO2 –>deposited in pulmonary alveoli/phagocytosed by alveolar MQ –>capsule is antiphagocytic/immunosuppressive and melanin protects from oxidative damage –> Host response: humoral and cellular –> Tissue destruction from “organisms burden” (no necrosis, inflammation, or fibrosis

37
Q

Characteristic lesion of cryptococcosis

A

cystic cluster of yeast with no well-defined inflammatory response

38
Q

Diagnosing cryptococcosis

A

Specimens in CSF, sputum, blood, urine
View with INDIA INK
Serology: capsular antigen; gram positive in 90% cases
Cultures in a few days

39
Q

Treatment for cryptococcosis

A

Immune competent: fuconazole, itraconazole
Immune deficient: Amph B, flu cytosine
… avoid contact with birds

40
Q

Most common organism for aspergillosis?

A

90% are aspergillus fumigatus

41
Q

Describe aspergillus fumigatus, please.

A

Thin, septated hyphae, typically branch at 45 degree angles… sorta look like asparagus. Not so sure about the angle thing though.

42
Q

What is the most common infection with aspergillus fumigatus?

A

Allergic Bronchopulmonary Aspergillosis (ABPA)

43
Q

Tell me about ABPA.

A

Allergic bronchopulmonary aspergillosis is a Type I hypersensitivity response. Worse in people with asthma.
Symptoms: Wheezing, coughing up blood or characteristic mucous plugs, fever, malaise, cough

44
Q

How do fungus balls form?

A

In pulmonary aspergillom, hyphae collect in pre-existing cavities (perhaps from TB) in the lungs. Results in cough, dyspnea, weight loss, and fatigue

45
Q

What is a specific characteristic of invasive pulmonary aspergillosis? Name some other symptoms while you’re at it…

A

Characterized by invasion of blood vessels=angioinvasive with multifocal infiltrates

  • Progresses fast and is fatal
  • Fever, chills, headaches, cough, shortness of breath, chest pain, INVASIVE SINUSITIS–> necrosis
46
Q

Invasive pulmonary aspergillosis can spread to other organs especially…

A

CNS (causing ring enhancement on MRI)

…also to skin, eyes, heart, kidneys, liver etc.

47
Q

Where is aspergillus fumigatus commonly found?

A

Soil, insulating material, air conditioning and heating, and hospital air control

48
Q

Two most common mycotic infection in bone marrow transplant recipients.

A

Candida and aspergillosis

49
Q

Common genera of mucormycosis are (4). These are all __.

A

1) Rhizopus
2) Mucor
3) Rhizomucor
4) Absidia
= various zygomycetes

50
Q

3 manifestations of mucormycosis

A

1) Rhinocerebral
2) Pulmonary
3) Cutaneous

51
Q

Rhinocerebral mucormycosis originates in (body part).

A

The nose and sinuses (in poorly managed diabetics) and may progress to inflammation of cranial nerves

52
Q

Rhinocerebral mucormycosis may cause blood clots that block vessels to the brain (thrombosis)

A

that’s all I have to say about that.

53
Q

Symptoms of rhinocerebral mucor.

A
  • acute sinusitis
  • eye swelling/protrusion
  • dark nasal scabbing
  • fever
  • redness of skin overlying sinuses
54
Q

Pulmonary mucormycosis

A

Pneumonia that gets worse rapidly can spread to chest cavity, heart, brain

55
Q

Cutaneous mucor.

A

a single, painful, hardened area of skin that may have a blackened center

56
Q

Mucormycosis infection is limited to…

A

immunocompromised (diabetics and trauma)

57
Q

Pathogenesis of mucormycosis

A

Spores inhaled–> germinate–>invade tissues/BLOOD VESSELS–> tissue necrosis
Involves: face, lungs, GI, skin
They really like dem blood vessels…

58
Q

Diagnosing Mucormycosis

A

CT scan and MRI

Tissue specimen for definitive diagnosis

59
Q

Treatment of Mucormycosis

A

SURGERY STAT

60
Q

The most important fungal infection in the era of AIDS is/was:

A

Pneumocystosis. Aid for AIDS!

61
Q

Organism causing pneumocystosis

A

pneumocystis (carinii) jiroveci pneumonia (PCP)

62
Q

Symptoms of pneumocystosis

A

Typical pneumo things

  • cough is often mild and DRY
  • Rapid breathing
  • chest x-ray lungs have “ground glass” appearance`
63
Q

Diagnosis of pneumocystosis

A

Detect with: bronchoalveolar lavage, lung biopsy, sputum sample
Preferred stains: Giemsa, toludine blue, methenamine silver, calcofluor white

64
Q

Treatment of pneumocystosis

A

Actue cases: STX; Cotrimoxazole (TMP-SMX)- Bactrim/Septra
-Pentamidine isothionate is also very effective (pentago ping-pong paddles)
Prophylaxis: Treat with STX and/or aerolized pentamidine (higher concentration in lungs)
**Note: STX is usually antiobacterial **

Micro Exam 3 (11 decks)

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