Toxoplasmosis, MAC, Fungal Diseases

Question 1

What causes toxoplasmosis

Answer 1

protoxoa: toxoplasma gondii

Question 2

animal that T. gondii completes its reproductive cycle

Answer 2

cat

Question 3

where does toxoplasma live, when is it not dormant

Answer 3

nucleated cells, when immunosuppressed

Question 4

4 ways of infection by toxoplasmosis

Answer 4

contaminated meat, produce, water; ingestion cat feces/soil, vertically (mother-fetus), organ transplant

Question 5

How many in US are seropositive for T. gondii

Answer 5

11% age 6-49

Question 6

most common mode of transmission in us of toxoplasmosis

Answer 6

consumption undercooked meat

Question 7

climate preferred by toxoplasmsois

Answer 7

hot humid (SW USA)

Question 8

what is third most common cause of lethal foodborne disease in US

Answer 8

toxoplasmosis

Question 9

S/S toxoplamsosi (4)

Answer 9

fevers/chills/sweats, cervical lymphadenopathy, myalgia/arthralgia/HA/sore throat/rash, chorioetinitis (inflam eye)

Question 10

diagnosis of toxoplasmosis

Answer 10

serologic testing with toxoplasmosis IgM antibody levels

Question 11

treatment of toxoplasmosis

Answer 11

3 drug regimen: pyrimethamine, sulfasalazine, leucovorin calcium
competent pts = 2-4wks, immunocompromised = longer

Question 12

Congenital toxoplasmosis risk vs severity

Answer 12

1st trimester 15% low risk, disease most severe

3rd trimester 60% high risk, disease sublcinial/symp not at birth

Question 13

Do congenital toxoplasmosis children present at birth

Answer 13

2/3 DON’T

Question 14

classic traid of congenital toxoplasmosis

Answer 14

retinochorionitis, intracranial calcifications, hydrocephalus (tirad rarely seen)

Question 15

50% of immunocompromisd pts get what with toxoplasmosis

Answer 15

CNS involvement: sz, blance changes, cranial nerve deficits, focal deficits, AMS, HA

Question 16

T/F immunocompromised pts will get flulike symp and lymphadenopathy like comp pts

Answer 16

true

Question 17

MRI with contrast might show wat in immunocmprised pts with toxopalsmosis

Answer 17

encephalitis, mass lesions or meningoencephalitis

Question 18

how does histoplasmosis infect

Answer 18

inhalation of fungal spores (bird droppings, contaminated soil aersolizes during construction)

Question 19

pathophys of hisoplasmosis

Answer 19

pulmonary macrophages ingest it but can’t kill it, fungus grows and divides inside, macrophage takes it through blood to lungs, spleen, liver, fungus trapped in fibrotic, calcified caseating granuoloma

Question 20

What type of hypersensitivity reaction occurs with histoplasmosis

Answer 20

delayed-type hypersensitity rxn (t-lymph develops immunity for macrophages and lymphocytes to sterilize granulomas)

Question 21

how common is asymptomatic histoplasmosis

Answer 21

90% of competent w/ low exposure are asymp; others flu-like for 1-4 wks

Question 22

If pt has calcifications on incidental CXR what might they have

Answer 22

might have had asymptomatic histoplasmosis years ago

Question 23

acute/subsactute pum histopalsmosis S/S, who gets it, recovery prognosis

Answer 23

fever, myalgia, abd pain, rales, heavy exposure competent or less in immunocompromised; ill wks-months; almost never fatal

Question 24

chronic pulmonary histoplasmosis; S/S; who gets it

Answer 24

older pts with COPD, progressive apical cavitary lesions, weight loss, productive cogh, fever, lasts 3+ months, (possible TB b/c apical)

Question 25

Progressive disseminated histoplasmosis

Answer 25

immunocomprimsed (like pts on TNF inhibitors), develop fever, cough, dyspnea, 20% AMS, pericardial effusions, ulcerative lesions of mucous memb and viscera; fatal w/in weeks

Question 26

3 main and 3 other S/S that indicate histoplasmosis

Answer 26

pneumonia with lymphadenopathy, cavitary lung disease, pulm manifestations w/ arthritis or arthragai plus erythema nodosum
minor: mediastinal or hilar masses, pericarditis w/ mediastinal lymphadenopathy, suspected sacroidosis

Question 27

systemic manifestations with pts with disseminated histoplasmossi

Answer 27

pancytopenia, LFT abn, erythema nodosum

Question 28

how to diagnose histoplasmosis

Answer 28

blood cutlures, complement fixation antibody titer, serum or urine antigen detection assay (none close to 100% sensitive)
CT or MRI to see extenet of disease

Question 29

2 invasive procedures and 2 meds for histoplasmosis

Answer 29

bronchoscopy, pericardial window

itraconazole for wks up to a year; if severe: amphotericin B used briefly