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Micro Unit 4 > Pulmonary Fungal Infections 1 > Flashcards

Pulmonary Fungal Infections 1 Flashcards

1
Q

Coccidioidies is thermally dimorphic, what are the two forms it takes? And in what environment does it take these forms?

A

Mold in soil: hyphae with alternating arthrospores and empty cells
Spherule in lung tissue

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2
Q

Where is coccidioides endemic?

A

US SW, latin america

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3
Q

In wet weather wha does coccidioides do? dry?

A

grows in wet, releases infectious arthrospores in dry

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4
Q

How is coccidioides transmitted?

A

Inhaled arthrospores, NOT P2P

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5
Q

How does coccidioides present?

A

60% asymptomatic/ flu-like: clearance by innate or containment by CMI
Moderate: valley fever/ desert rheumatism: pulm. + Erythema nodosum
severe: major pneumonia or dissemination (bare or hidden in macrophages)

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6
Q

What factors put you at risk for coccidioides?

A

age, race, preg, immunocompromise, occupational exposure

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7
Q

How do you diagnose coccidioides?

A

exam, hx, PPD, biopsy spherules, culture (look for dimorphism), serology in dissemination

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7
Q

How do you treat coccidioides?

A

mild: NA
persistent lung lesions/ dissemination: Amphotericin B
meningitis: oral azoles long-term, may add intrathecal amphotericin B
Pregnant: amphotericin B

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7
Q

what form does histoplasma take?

A

THERMALLY DIMORPHIC: mold, yeast

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7
Q

Where is histoplasma endemic?

A

Ohio, Missouri, Mississippi river valley

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7
Q

How is histoplasma transmitted?

A

spores are inhaled

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7
Q

How does histoplasma present in previously-healthy?

A

Pulm sx, granulomas, high does exposure may mimic TB

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7
Q

How does histoplasma present in CMI-deficient host?

A

it disseminates in macrophages, look for pancytopenia and ulcerations on tongue

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7
Q

What are immunosuppressed patients exposed to blastomyces at risk for?

A

hematogenous spread

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7
Q

How does blastomyces present?

A

Moderate acute: pneumonia + purulent sputum
Moderate chronic: Mimics TB
Severe acute: ARDS

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7
Q

What skin sx may be present in blastomyces infection?

A

erythema nodosum, ulcerating skin lesions

7
Q

How do you diagnose blastomycosis?

A

sputum microscopy–> yeast
culture–> hyphae with pear-shaped conidia
biopsy–> yeast with suppurating (NONCASEATING) GRANULOMAS

7
Q

how do you treat blastomyces?

A

itraconazole, amphotericin B if severe, combine with healthier lifestyle (semi-opportunistic)

7
Q

Where is paracoccidioides endemic?

A

rural latin america

7
Q

Who is at risk for severe paracoccidioides infection?

A

children and immunocompromised

men in agriculture or construction who have large exposure are also at risk for moderate infection

7
Q

Transmission of paracoccidioides

A

inhalation of conidia which grows in wet soil

7
Q

tx for paracoccidioides

A

itraconazole, Amphotericin B if severe, semi-opportunistic so combine with healthier lifestyle

7
Q

What aspects of the history are important to dx histoplasma?

A

exposure to birds, bats, endemic area travel, immunocompromised, occupation

7
Q

What tests should performed to diagnose histoplasma?

A

biopsy: yeast in macrophages
cultures: dimorphism
ELISA: histoplasma polysaccharide antigen

7
Q

How do you treat histoplasma?

A

mild: NA
Lung infection: itraconazole
meninigitis: fluconazole
disseminated: Amphotericin B

7
Q

What form does blastomyces take?

A

thermally dimorphic: mold/ yeast

7
Q

Where is blastomyces endemic?

A

Eastern US

7
Q

What does the blastomyces mold form look like?

A

hyphae with small pear-shaped conida

7
Q

What form of blastomyces is infectious?

A

conida

7
Q

what is unique about the yeast form of blastomyces?

A

round with doubly refractive wall and a single broad-based bud

7
Q

Is blastomyces mold or yeast form easier for innate immunity to destroy?

A

the conidia form is easily killed but the yeasts are harder to kill (BAD1)

7
Q

Paracoccidiodes has two forms, what are they?

A

Thermally dimorphic: mold and multibud yeast

7
Q

Describe the adult form of paracoccidioides infection?

A

long latency, skin lesions, mucus membrane lesions

7
Q

Describe the juvenile form of paracoccidioides?

A

more severe lymphadenopathy and hepatosplenomegaly

7
Q

How do you dx paracoccidioides?

A

pus or tissue KOH mount for multiple buds, culture

36
Q 
Which are intracellular pathogens?
		A. Rotavirus
		B.  Histoplasma
		C.  Legionella
		D.  Poxvirus
		E.  Blastomyces
		F.   Borrelia
A

ABCD
All viruses are obligate intracellular parasites. Legionella survives within alveolar macrophages by the fairly common route of endosome subversion; histoplasma survives by the much rarer route of endolysosomal survival.

Micro Unit 4 (8 decks)

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