Respiratory Fungal Infections (3)-Leah

Question 1

In terms of fungi, what does dimorphic mean?

What do dimorphic fungi cause (in terms of the pulmonary system)

Answer 1

MOLD in the COLD (25C)
Yeast in the heat (37 C)

Acute pulm infection –> chronic granulomas
Or miliary disease. Similar to TB.

Question 2

What areas of the body does blastomycosis effect?

Answer 2

BLAStomycosis:

Bone Lungs And Skin

Question 3

How to distinguish Histo and Blasto?

Why do you need to distinguish them?

Answer 3

Blasto = “Broad Based Budding” yeast (B= BBB) on KOH

Histo= inside macrophages/ histiocytes on enzyme immunoassay

They have similar endemic areas (BOTH Midwest, SE US)

Question 4

How does acute Blasto pneumonia present?

Chronic?

Answer 4

Blasto mimics Bacteria acutely. (Consolidated lobe).
Mimics TB/cancer chronically.

….I’m not sure that this is specific to Blasto. But she mentioned it here. All dimorphic fungi can cause granulomas.

Question 5

What animals spread histo?

Answer 5

Birds and bats

may get a vignette about spelunking on step…..

Question 6

DOC for disseminated fungi?
DOC for localized fungi infection?

–according to first aid–

Answer 6

Systemic: give amp B, note that it may cause drug induced fever
Local: give –Azoles

Question 7

Rare severe outcomes of Histo

Answer 7

-ARDS, inflammatory sequelae, mediastinal fibrosis

Question 8

Coccidomycosis:

Area, time of peak incidence

Answer 8

South west; esp Arizona
Incidence increases during EARTH QUAKE
(Earth quake = in Rx vignette)

Question 9

Appearance of coccidiomycosis?

Answer 9

Big Spherules full of endospores on Saburaud agar at 37 C.

This was an Rx question.

Question 10

Coccidiomycosis symptomatic presentation?

Special populations effected?

Answer 10

“Great imitator”
Commonly self limited but can actually go to any part of the body. Might be mistaken for toxo, syphillis, others.

-more common in males, Immunocompromised, preggos, certain ethnicities (Hispanic, AA, Filipino etc)

Question 11

Paracoccidiosis micro appearance &; location

Answer 11

“Captains wheel”; South America

Question 12

Paracoccidiomycosis symptomatic presentation?

Answer 12

Painful lesions at mucous membranes, lung, skin

*Will spread if left undiagnosed…..like all of the dimorphic fungi. (But she decided to “say” that here.)

Question 13

Penecillin Marneffei is a dimorphic yeast that effects what patients? What might it mimic?

Answer 13

AIDS patients;

TB, Histo, leishmaniasis, toxo

Question 14

Three “opportunistic” fungi and what do they look like?

They USE these buzzwords for presentation on Rx!!!!

Answer 14

• aspergillosis (septate hyphae branching at Acute Angles = 45 degrees!!)
• pneumocystis (cup shaped)
• cryptococcosis: round lesions with clear halo on INDIA INK.