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Infectious Disease > Systemic Fungal Diseases > Flashcards

Systemic Fungal Diseases Flashcards

1
Q

Systemic candidiasis dx?

A
  • may be difficult to isolate
  • blood cultures are positive about 50% of the time
  • May isolate organisms from urine or sputum (tx individualized (infection vs. colonization)
  • isolated candida from blood cultures is considered a sign of serious disease until proven otherwise
  • Fundoscopic exam to exclude endophthalmitis
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2
Q

Hepatosplenic candidiasis?

A
  • secondary to aggressive chemotherapy and prolonged neutropenia
  • fever and variable abdominal pain may be present
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3
Q

Invasive disease of systemic candidiasis?

A
  • skin, brain, meninges, myocardium, eyes, muscles
  • mortality is around 30%
  • tx: IV antifungal tx such as fluconazole
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4
Q

What can be seen in disseminated candidiasis?

A
  • tiny pustular lesions due to hematogenous dissemination of Candida albicans can be seen in pt also will see fever -> sepsis
  • Can see large erythematous, nodular lesions with central necrosis in a pt with acute leukemia and disseminated candidiasis.
  • Muscle abscess containing yeast
  • go to the kidney: see abscesses in the kidney
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5
Q

Where is histoplasmosis found in the United states?

A
  • Major river valleys: In Ohio and Mississippi river valleys
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6
Q

What is the source of histoplasmosis?

- How are humans infected?

A
  • found in the soil: from bird or bat droppings
  • inhalation of spores
  • infection occurs 7-21 days post exposure
  • lymphatogenous spread to other organs
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7
Q

What is the fungus that causes histoplasmosis?

A
  • Histoplasma capsulatum
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8
Q

How are many cases of histoplasmosis detected?

A
  • incidentally on X-ray because most cases are asymptomatic
  • past infection may be noted by calcifications on routine X-rays: lungs and spleen
  • This can’t reactivate but a lot of people from this regions will have nodules in lungs
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9
Q

What is acute pulmonary histoplasmosis?

A
  • infection of the lungs
  • can be relatively severe: severe fatigue and fever
  • duration is 1 week - 6 months
  • rarely fatal
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10
Q

Who does chronic pulmonary histoplasmosis effect? what will you see on a CXR?

A
  • older pts and pts with underlying chronic lung disease

- CXR: apical cavities, infiltrates, nodules

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11
Q

What os progressive disseminated histoplasmosis and what can it be associated with?

A
  • can be assoc. with underlying HIV (CD4 count hx is key)
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12
Q

Presentation of progressive disseminated histoplasmosis?

A
  • may be similar to septic shock
  • will have a fever, dyspnea, cough, and wt loss
  • can be fatal within 6 weeks or less
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13
Q

What organs are involved in progressive disseminated histoplasmosis?

A
  • ulcers in oropharynx
  • hepatosplenomegaly
  • GI involvement mimics inflammatory bowel disease
  • CXR shows a miliary pattern (small lesions everywhere)
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14
Q

Dx studies for Histoplasmosis?

A
  • CXR
  • CBC, CMP
  • alkaline phosphate, lactate dehydrogenase, and ferritin will all be elevated
  • Sputum culture most likely to be negative in acute disease and positive in chronic disease.
  • Bronchoalveolar lavage Ag testing
  • **urine Ag test (>90% sensitivity)
  • blood cultures: may takes weeks
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15
Q

What is the most helpful test in dx histoplasmosis?

A
  • urine ag test (>90% sensitivity)
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16
Q

Tx of histoplasmosis

A
  • refer to ID specialist
  • Itraconazole 200-400 mg/d
  • duration: weeks to months
  • severe illness: IV amphoteracin B
  • AIDS related histoplasmosis: lifelong suppressive therapy with itraconazole
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17
Q

Where is coccidioidomycosis endemic?

A
  • Southwestern US, Mexico, Central America, South America
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18
Q

How does coccidioidomycosis occur?

Also called?

A
  • infection occurs secondary to inhalation of molds from endemic areas
  • Valley fever, San Joaquin valley fever
    • more severe cases in immunocompromised pt
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19
Q

pt with coccidioidomycosis presents with what sxs?

A 
- variety:
can be asymptomatic
pedal edema
chest pain
cough with blood tinged sputum
fever, night sweats
HA
joint stiffness
muscle pain
anorexia
erythema nodosum ****(hallmark)
20
Q

When does erythema nudism occur with coccidioidomycosis?

A
  • may occur 2-20 days after onset of respiratory symptoms

these are swollen red nodules

21
Q

disseminated coccidiodomycosis can affect what?

A
  • skin (erythema nudosum, verrucous skin lesions)
  • lungs (cavities, infiltrates, empyema, pleural effusion)
  • Bones (lytic lesions)
  • soft tissues (abscesses)
  • lymph nodes (hilar and/or mediastinal lymphadenopathy, lymphadenitis and abscess formation)
  • meningitis
22
Q

Most common presentation of coccidioidomycosis?

A

acute pneumonia

23
Q

What will labs look like in coccidioidomycosis?

A
  • leukocytosis
  • eosinophilia
  • ELISA fro IgM and IgG abs
  • Tissue or bone bx may reveal spores (pleural lesion: empyema, or lymph node)
  • blood cultures rarely positive
  • spinal fluid: complement fixing abs (dx in 90%), increased cell count, lymphocytosis, reduced glucose, culture positive in only 30%
24
Q

If you see multiple thin walled cavities, and patchy areas with ill defined borders on CXR what would be your differential?

A
  • Coccidioidomycosis, lung abscesses, chronic pulmonary tb, chronic pulmonary histoplasmosis
25
Q

Tx of coccidioidomycosis?

A
  • Refer to ID specialist
  • Fluconazole or itraconazole daily for months
  • Amphotericin B IV for severe disseminated cases
  • may required prolonged therapy
  • surgical incision and drainage of abscess formation
26
Q

What causes Cryptococcosis?

A
  • caused by Cryptococcus neoformans

yeast that is found in the soil and on dried pigeon poop

27
Q

What is cryptococcus neoformans the most common cause of?

A
  • most common cause of fungal meningitis
28
Q

RFs of cryptococcosis?

A
  • chemo for hematologic cancer, Hodgkin lymphoma, corticosteroid therapy, transplant recipients, TNF inhibitor therapy, HIV (immunocompromised pts)
  • rare in immunocompetent persons
29
Q

3 forms of cryptococcosis infection?

A
  • cutaneous
  • respiratory
  • meningeal
30
Q

Signs and sxs of cryptococcosis?

A
  • pulmonary: can lead to respiratory failure
  • any organ can be infected
  • CNS predominates: (meningitis)
    HA usually first sx
    confusion
    mental status changes
    cranial nerve abnormalities
    N/V, fever
31
Q

Dx of cryptococcosis?

A
  • cryptococcal antigen can be found in the infected organ and often in the serum of AIDS patients
  • resp: sputum culture or pleural fluid
  • lumbar puncture for meningeal involvement: increased opening pressure, increased protein, decreased glucose
    • india ink prep shows budding, encapsulated fungal cells: meningitis
  • *cryptococcal capsular antigen testing (dx)
32
Q

Tx of cryptococcosis?

A
  • referral to ID specialist
  • Amphotericin B IV x 2 weeks
  • followed by fluconazole x 8 weeks
33
Q

Sxs of cryptococcosis?

A

HA, abnormal mental status, meningismus, respiratory sxs

34
Q

Dx test for cryptococcosis?

A
  • capsular polysaccharide Ag in CSF, sputum or urine is diagnostic
35
Q

where is Aspergillosis found?

A
  • in dead leaves (or other decaying vegetation), compost piles, stored grain, and on marijuana leaves
36
Q

What is usually the cause of Aspergillosis?

A
  • Aspergillus fumigatus

- ubiquitous in nature

37
Q

When would tissue invasion of Aspergillus fumigatus occur?

A 
- with immunosuppression:
tx for autoimmune disease
cancer
bone marrow transplant 
solid organ transplant
HIV 
- severe and prolonged neutropenia 
- high dose glucocorticoids
38
Q

What is the most common cause of non-candidal invasive fungal infection in bone marrow and solid organ transplant pts?

A
  • Aspergillus fumigatus
39
Q

Manifestations of Aspergillosis?

A
  • allergy (chronic allergic response)
  • airway or lung invasion (most common): tracheobronchitis, rhinosinusitis
  • cutaneous
  • extrapulmonary dissemination: brain, eyes, kidney, liver, heart, GI
40
Q

What does aspergillosis most commonly affect and what are the sxs assoc’d with this?

A
  • most commonly affects the lungs

- sxs: fever, chest pain, SOB, cough, hemoptysis

41
Q

What will you see on a CXR of aspergillosis?

A
  • single or multiple nodules with or w/o cavitation, patchy or segmental consolidation, peribronchial infiltrates
42
Q

Dx of aspergillosis?

A
  • allergic disease: high levels of IgE and IgG Aspergillus precipitins in the blood
  • Galactomannan Ag from serum or bronchioalveolar lavage fluid (parts of cell wall of Aspergillus sp)
  • beta-d-glucan assay (new): part of cell wall of mult types of fungus, use for invasive candidial infections and Aspergillus
  • ***PCR for aspergillus
  • culture
  • Bx
  • CT scan of lungs: ground glass infiltrates with “halo sign” then development of a cavitary lesion, converts to air-crescent sign after neutrophil recovery
43
Q

When does allergic bronchopulmonary aspergillosis occur?

A
  • with preexisting asthma and worsening bronchospasm and pulmonary infiltrates
  • waxing and waning course
  • may result in bronchiectasis and fibrotic lung disease
  • will see high levels of IgE and IgG Aspergillus
44
Q

Tx of Allergic bronchopulmonary aspergillosis?

A
  • antifungals and steroids (would generally want to stay away from steroids but since it involves airway we want to decrease inflammation and ease breathing)
45
Q

What are some features of invasive life-threatening aspergillosis?

A
  • seen in profound immunodeficiency
  • pulmonary manifestations: patchy infiltrates, necrotizing pneumonia
  • sinus invasion
  • multi-organ involvement: tissues infarct as organism grows into blood vessels
  • ## Hematogenous spread is possible
46
Q

Tx of invasive life-threatening aspergillosis?

A
  • high dose multiple agent anti fungal therapy

- systemic azole, amphotericin B

Infectious Disease (27 decks)

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