pulm fungal diseases

Question 1

consider ______when patient has exposure to bird droppings or spend time where birds roost (construction workers, cave divers, demolition teams)

Answer 1

histoplasmosis

Question 2

histoplasma exhibits ______, in that it is in mycelial phase @ rt, at _____phase in human body

Answer 2

histoplasma exhibits thermal dimorphism, in that it is in mycelial phase @ rt, at yeast phase in human body

Question 3

infxn with histoplasmosis occurs following inhalation of? (2)

Answer 3

mycelia or conidia

Question 4

when does histoplasmosis dissemination lead to infxn?

Answer 4

1. large inoculum
2. extremes of age
3. impaired CMI

Question 5

what is the most common manifestation of histoplasmosis?

Answer 5

asymptomatic pulm histo

Question 6

sx of subacute histo infxn?

Answer 6

fever, chills, cough, chest pain, myalgias, HA

Question 7

imaging w/ unilateral hilar and mediastinal lymphadenopathy w/ focal infiltrates, noduels are 1-5 cm, multiple

Answer 7

histoplasmosis

Question 8

chronic pulm histo occurs most often w/ underlying_____

Answer 8

COPD

Question 9

apical infiltrates with cavitation, fevers, chills, chest pain, productive cough

Answer 9

chronic pulm histo w/ underlying COPD

Question 10

reticulonodular or miliary infiltrates, chance of respiratory failure assc’d with?

Answer 10

acute diffuse pulm histo

Question 11

erythema nodosum or etythema multiforme assc’d with?

Answer 11

histo

Question 12

tx for histo?

Answer 12

amphotericin B, the -azoles

Question 13

inhalation of spores from mold that grows in the soil in lower desert areas: CA, AZ, NM, TX

Answer 13

coccidiomycosis

Question 14

what type of coccidio is endemic to CA?

Answer 14

C. immitis

Question 15

what season is highest risk for coccidio?

Answer 15

peaks during dry season following a rainy season

Question 16

what are common sites of dissemination for coccidio?

Answer 16

1. skin/soft tissue
2. meninges of brain or SC
3. skeleton

Question 17

serological tests for coccidiomyosis?

Answer 17

immunodiffusion, precipitin Ab, complement fixation, ELISA

Question 18

does valley fever with residual nodules require tx?

Answer 18

typically no

Question 19

does valley fever with hemopytsis and chest pain require tx?

Answer 19

yes, tx with itraconazole or fluconazole

Question 20

coccidio with chronic fibrocavitary disease requires what sort of tx?

Answer 20

12 months of azole

Question 21

coccidio with diffuse reticulonodular pneumonia requires what sort of tx?

Answer 21

amphotericin + azole for at least 12 mon

Question 22

systemic pyorgranulomatous infxn due to inhalation of mycelial conidia of?

Answer 22

blastomycosis

Question 23

where is blastomycosis most commonly seen?

Answer 23

North Am (great lakes) or Afr

Question 24

where is blastomycosis most commonly seen (environ type)

Answer 24

moist wooded areas & in areas with decaying vegetation of decomposed wood

Question 25

like histo, blastomycosis is ______

Answer 25

dimorphic: changes into yeast in body

Question 26

skin lesions that are verrucous with irregular borders and gray-violet color?

Answer 26

blastomycosis

Question 27

unlike histo and coccidio, tx is required for blasto - what is it?

Answer 27

moderate-severe disease: amphotericin

mild disease: azole

Question 28

how does pneumocystis typically present in non HIV patient?

Answer 28

fulminant respiratory failure w/ fever+ productive cough, ground glass changes

Question 29

HIV susceptibility, bilateral interstitial infiltrates, pneumothorax

Answer 29

pneumocystis

Question 30

tx of pneumcystis in non HIV patients?

Answer 30

TMP-SMX

Question 31

how to tx severe cases of pneumocystis?

Answer 31

IV pentamidine

Question 32

tx of pneumocytsis in HIV+ patients?

Answer 32

mild-moderate: oral TMP-SMX

severe: IV TMP/SMX or pentamidine

Question 33

what is special about tx of HIV+ patients with moderate to severe pneumocytis?

Answer 33

tx with systemic steroids