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Micro Unit 4 > Pulmonary Fungal Infections 2 > Flashcards

Pulmonary Fungal Infections 2 Flashcards

1
Q

under what kinds of circumstances are opportunistic fungal pathogens dangerous or life threatening?

A

Prolonged neutropenia, uncontrolled DM, profound T-cell suppression, HIV

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2
Q

Effective tx of opportunistic fungal pathogens must address the ______ ______ and the _______ problem.

A

current infection

underlying problem

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3
Q

What does it mean that candida is multimorphic?

A

it has yeastlike, pseudohyphal, and hyphal forms that may ALL be present in the same infection at the same disease site

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4
Q

Describe the presentation of candidiasis

A 
thrush
vaginitis
diaper rash
chronic mucocutanteous 
disseminated
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5
Q

How do you diagnose cadidiasis?

A

exam, biopsy, +/- CT

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6
Q

How do you treat cadidiasis?

A

azole appropriate to site of infection, few types require amphotericin B

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7
Q

T/F: Candida is very unlikely to develop drug resistance

A

FALSE! candida may develop resistance and should be tested for sensitivity

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8
Q

Where do you find cryptococcus?

A

widespread in the environment, soil from bird and bat feces

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9
Q

Where is candida normally found?

A

NORMAL FLORA

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10
Q

What is unique about candida gram stain?

A

it is gram +

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11
Q

What predisposes a person to cryptococcal infection?

A

reduced CMI

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12
Q

What is unique about the cryptococcal effect on the host?

A

it suppresses the host inflammatory response

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13
Q

T/F: cryptococcus is dimorphic

A

FALSE - looks like oval budding yeast

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14
Q

How does cryptococcus present?

A

late in disease (presumably because of reduced inflammatory response) –> meningitis, skin nodules, pulm sx

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15
Q

how do you diagnose cryptococcus?

A

biopsy, CSF, crag

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16
Q

what is “crag”

A

serologic test for cryptococcal infection: CRyptococcal AntiGen

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17
Q

How is cryptococcus transmitted?

A

inhalation

18
Q

What form does aspergillus take?

A

Not dimorphic, ONLY MOLD: septate hyphae with V-shaped branches

19
Q

where is aspergillus found?

A

widespread on decaying vegetation worldwide

20
Q

how is aspergillus transmitted?

A

inhalation of infectious conidia:

colonize abraded skin, burns, cornea, ear, sinuses

21
Q

What virulence factors are present in aspergillus?

A

gliotoxin (immunosuppressive)
toxic metabolites
proteases

22
Q

What are the four presentations of aspergillus?

A

ABPA= allergic bronchopulmonary aspergillosis
Aspergilloma
CNPA= chronic necrotizing pulm aspergillosis
Invasive

23
Q

Which of the four presentations of aspergillus is a hypersensitivity rxn to infection that complicates asthma of CF? and how do you dx this form? Tx?

A

ABPA
dx on exam
tx: itraconazole, sinus surgery, Xolair

24
Q

Name this form of aspergillus: fungus ball complicating cavitary lung disease
dx?
tx?

A

aspergilloma

dx: air crescent on CT
tx: itraconazole +/- surgery

25
Q

Which form of aspergillus mimics TB? dx? tx?

A

CNPA
air crescent on scan, needle biopsy for histology
tx; amphotericin b, immune reconstitution, surgical resection
prognosis POOR

26
Q

how does CNPA present?

A

resp distress with hx of profound immunosuppression

27
Q

how do you treat invasive aspergillus?

A

same as CNPA:
amphotericin b, immune reconstitution, surgical resection
prognosis POOR

28
Q

Name this infection: very rare, deadly invasive vasculitis caused by environmental mold that causes infarction and invades the brain from the sinuses?

A

mucormycosis

29
Q

what are some predisposing factors for mucormycosis?

A

uncontrolled DM, iron overload, immunosuppresion

30
Q

tx and dx for mucormycosis?

A

dx: biopsy–> histo
tx: amphotericin b and aggressive surgical removal of diseased tissue
POOR prognosis

31
Q

name this infection: ubiquitous environmental mold, infection rare but fatal in predisposed pop.
may cause local infection or deadly disseminated infection

A

fusarium

32
Q

what is mycotoxicosis?

A

fusarium infection from contaminated grain
serious toxicity
may be lethal
alimentary toxic aleukia

33
Q

fusarium local infections tend to occur in what areas of the body?

A

burns, prosthetic joints, contaminated contact lens solution (cornea)

34
Q

mucormicosis is caused by what three organisms?

A

mucor, rhizopus, absidia

35
Q

what are the deadly disseminated forms of fusarium infection?

A

occurs in immunosuppressed: prolonged neutropenia, HSCT recipients (bone marrow transplant)

36
Q

How do you dx fusarium infection?

A

blood culture, histo

37
Q

how do you treat fusarium infection?

A

aggressively with surgery, amphotericin B, voriconazole, poor prognosis

38
Q

describe the entry of fusarium into its human host

A

enters from sinus or wound, circulates in blood, reaches skin, eye, or lung where sx occur

39
Q

are positive blood cultures more common in fusariosis or aspergillosis??

A

fusariosis

40
Q

out of the oportunistic mycoses we have studied, which two are most concerning in terms of antifungal resistance?

A

candidiasis and fusariosis

Micro Unit 4 (8 decks)

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