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Bugs & Drugs > True Fungal Pathogens > Flashcards

True Fungal Pathogens Flashcards

1
Q

valley fever

A

coccidioidomycosis

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2
Q

all 3 deep fungal pathogens are

what form in the env? host?

A

dimorphic, thermally regulated
MOLDS in the environment
Hc/Bd are YEAST in host
Co is an endosporulating spherule

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3
Q

infection occurs via which route (all 3)? primary site of infection?

A

respiratory (inhale molds)

lung, may localize or disseminate

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4
Q

dissemination may result in

A

dermologic manifestations

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5
Q

while these are true pathogens, immunocompromise associated with?

A

greater incidence/severity of infection

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6
Q

which is associated with persistent, clinically inactive infection and potential for reactivation, and acute primary infections (like TB)

A

Histo

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7
Q

moist, high nitrogen soil, guano from birds and bats (caves)

A

histo

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8
Q

mississippi and ohio river valley; midwest and south

A

histo

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9
Q

latin america, africa

A

histo

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10
Q

most common fungal infection in the world, most common systemic mycosis in US

A

histo

most commonly isolated cases

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11
Q

TB CxR signs in PPD negative pts?

A

think histo

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12
Q

histo morphology in environment? host?

A

multinucleate branched hyphae

uninucleate oval budding yeast w/narrow neck; inside MN phagocytes and extracellularly

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13
Q

histo converts to pathogenic yeast form in host and multiplies where?

A

w/in macrophages

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14
Q

immune response to histo

A

containment via CD4 T-mediated activation of MP’s –> fungistatic (restricted replication)

MP’s presnt antigen to T’s –> T’s secrete cytokines that activate MP’s agains Hc

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15
Q

histo syndromes

A 
pulmonary (emphysema pts)
disseminated (sites w/ lots of MN phagocytes)
mucocutaneous
ocular (abnormal neovascularization)
pericarditis
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16
Q

CMI defects that lead to inc risk

A

AIDS, cancer, chemo
anti-TNF
age extremes

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17
Q

fulfills one of the early AIDS criteria

A

histo, coccidio

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18
Q

Histo tx

A

DOC for severe: AmphoB IV

Itraconazole for less severe, after resolution of acute sx in immunocompromised, and prophylaxis in immunocompromised

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19
Q

prominent dog issue

A

blastomyces dermatitidis

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20
Q

decaying vegetation or rich soil with ACIDIC pH by rivers

A

Blasto

21
Q

africa, mississippi, ohio river valleys, missouri river basin
N. MIDWEST (WI, MN)

A

Blasto

22
Q

blasto morphology in env? host?

A

hyphae twd uninucleate microconidia

host: multinucleate large budding yeast

23
Q

common clinical presentations include chronic cutaneous and osseous (disseminated) disease

A

blasto

24
Q

most common sites of dissemination are skin,bone, UG tract

A

blasto

25
Q

Blasto tx

A

ampho B
itraconazole in immunocompetent and less severe in immunocompromised
no prophylaxis (not high enough incidence in AIDS)

26
Q

california isolates

A

C. immitis

27
Q

non-california isolates

A

C. posadasii

28
Q

most severe of the 3 pathogens

A

coccidioides

29
Q

laboratory-acquired infection

A

coccidio

30
Q

central/south america

cali, arizona, texas

A

coccidio

31
Q

coccidia morphology env? host?

A

env: septate hyphae –> arthroconidia separated by VACUOLATED non-viable cells
host: spherule containing endospores

32
Q

late summer and early fall incidence, esp when dusty conditions, rainy winter, soil disruption (earthquake)

A

coccidio

33
Q

cough, fever, chest pain, night sweats, joint pains

A

coccidio

34
Q

frequent sites of coccidio dissemination

A

meninges, bone, skin

35
Q

coccidio tx

A

immcompetent: amphB, fluconazole, itraconazole
not completely effective
more recalcitrant to antifungal tx than other 2

36
Q

dx of systemic dimorphic fungal pathogens

A

gold std: culture (high spec, low sens, slow)

histo: note great but + clinical + failure to respond to abx
serology: sensitivity depends on host immune response

37
Q

test for acute disseminated histo?

A

antigen detection: urine/serum/CSF

38
Q

skin testing

A

only for histo

histoplasmin

39
Q

general SDFP tx

A

mod/severe: amphoB

mild: itraconazole

40
Q

prevention

A

PPE
formalin/bleach
prophylactic antifungals: azoles for pts with deficient CMI, especially in endemic areas

41
Q

are any of these 3 contagious?

A

no

42
Q

roofer, farmer, gardener, demolition, chimney, bridge, roofer, spelunker

A

histo

43
Q

hard to see in sputum due to deep intracellular location in the lungs

A

histo

can see blasto, though

44
Q

early skin manifestations due to dissemination of fungal antigens, not infection (erythematous/macular-papular rash/nodosum/multiforme) hypersensitivity rxns

A

coccidio

45
Q

males and pregnant women at increased risk

A

coccidio

46
Q

intracellular smaller yeast on histology

A

histo

47
Q

greatest sensitivity for testing

A

urine

48
Q

liposomal amphoB

A 
reduced nephrotoxicity (liver clearance)
MP uptake in liver may target IC pathogens (HISTO)
49
Q

how does histo differ from TB?

A

not contagious

myco is bacteria, histo is fungus

Bugs & Drugs (15 decks)

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