pulm fungal diseases Flashcards
consider ______when patient has exposure to bird droppings or spend time where birds roost (construction workers, cave divers, demolition teams)
histoplasmosis
histoplasma exhibits ______, in that it is in mycelial phase @ rt, at _____phase in human body
histoplasma exhibits thermal dimorphism, in that it is in mycelial phase @ rt, at yeast phase in human body
infxn with histoplasmosis occurs following inhalation of? (2)
mycelia or conidia
when does histoplasmosis dissemination lead to infxn?
- large inoculum
- extremes of age
- impaired CMI
what is the most common manifestation of histoplasmosis?
asymptomatic pulm histo
sx of subacute histo infxn?
fever, chills, cough, chest pain, myalgias, HA
imaging w/ unilateral hilar and mediastinal lymphadenopathy w/ focal infiltrates, noduels are 1-5 cm, multiple
histoplasmosis
chronic pulm histo occurs most often w/ underlying_____
COPD
apical infiltrates with cavitation, fevers, chills, chest pain, productive cough
chronic pulm histo w/ underlying COPD
reticulonodular or miliary infiltrates, chance of respiratory failure assc’d with?
acute diffuse pulm histo
erythema nodosum or etythema multiforme assc’d with?
histo
tx for histo?
amphotericin B, the -azoles
inhalation of spores from mold that grows in the soil in lower desert areas: CA, AZ, NM, TX
coccidiomycosis
what type of coccidio is endemic to CA?
C. immitis
what season is highest risk for coccidio?
peaks during dry season following a rainy season
what are common sites of dissemination for coccidio?
- skin/soft tissue
- meninges of brain or SC
- skeleton
serological tests for coccidiomyosis?
immunodiffusion, precipitin Ab, complement fixation, ELISA
does valley fever with residual nodules require tx?
typically no
does valley fever with hemopytsis and chest pain require tx?
yes, tx with itraconazole or fluconazole
coccidio with chronic fibrocavitary disease requires what sort of tx?
12 months of azole
coccidio with diffuse reticulonodular pneumonia requires what sort of tx?
amphotericin + azole for at least 12 mon
systemic pyorgranulomatous infxn due to inhalation of mycelial conidia of?
blastomycosis
where is blastomycosis most commonly seen?
North Am (great lakes) or Afr
where is blastomycosis most commonly seen (environ type)
moist wooded areas & in areas with decaying vegetation of decomposed wood
like histo, blastomycosis is ______
dimorphic: changes into yeast in body
skin lesions that are verrucous with irregular borders and gray-violet color?
blastomycosis
unlike histo and coccidio, tx is required for blasto - what is it?
moderate-severe disease: amphotericin
mild disease: azole
how does pneumocystis typically present in non HIV patient?
fulminant respiratory failure w/ fever+ productive cough, ground glass changes
HIV susceptibility, bilateral interstitial infiltrates, pneumothorax
pneumocystis
tx of pneumcystis in non HIV patients?
TMP-SMX
how to tx severe cases of pneumocystis?
IV pentamidine
tx of pneumocytsis in HIV+ patients?
mild-moderate: oral TMP-SMX
severe: IV TMP/SMX or pentamidine
what is special about tx of HIV+ patients with moderate to severe pneumocytis?
tx with systemic steroids
