Viral and Fungal Infections

Question 1

Incubation and shedding duration of influenza

Answer 1

Incubation: 1-4 days

Shedding: 0-10 days

Question 2

3 antivirals for influenza

Answer 2

Oseltamivir

Zanamivir (inhaled)

Peramivir (IV)

Question 3

Antiviral in influenza not recommended in asthma/COPD

Answer 3

Zanamivir

Question 4

Difference between CMV infection and CMV disease

Answer 4

Infection: lab confirmed virus, regardless of signs/symptoms

Disease: signs and symptoms of disease

Question 5

Most common forms of aspergillus in humans

Answer 5

Aspergillus fumigatus

Aspergillus flavus

Question 6

Clinical spectrum after aspergillus spore inhalation

Answer 6

Question 7

Fungal tests affected by antibiotics

Answer 7

Beta Glucan and Galactomannan (also by pasta and rice)

Question 8

First line treatment of invasive pulmonary aspergillosis

Answer 8

Voriconazole

Question 9

Drug for IPA prophylaxis in AML, MDS, and GVHD

Answer 9

Posaconazole

Question 10

Medications to treat chronic necrotizing pulmonary aspergillosis

Answer 10

Voriconazole

Itraconazole

Ampho B

Caspofungin

Question 11

Treatment options for aspergilloma

Answer 11

Observation if asymptomatic

Itraconazole (only 60% effective)

Surgical resection

Bronchial artery embolization

Question 12

Criteria for ABPA

Answer 12

Must have either asthma or CF

Aspergillus skin test or IgE against A. fumigatus

TOTAL IgE > 1000

Question 13

Treatment for severe blastomycosis

Answer 13

Ampho B 1-2 weeks, then itraconazole

Question 14

Treatment for mild to moderate blastomycosis

Answer 14

Itraconazole 6-12 months

Question 15

Treatment for blasto with CNS disease

Answer 15

Ampho B

Question 16

Treatment for blasto in pregnancy

Answer 16

Ampho B (No Azoles)

Question 17

Treatment for invasive candidemia

Answer 17

Echinocandins over azoles initially, can switch later

If candidemia alone, 2 weeks from negative culture

If endopthalmitis, 4-6 weeks

Question 18

Percentage of coccidioidomycosis that are asymptomatic

Answer 18

60%

Question 19

Clues for coccidioidomycosis over CAP

Answer 19

Hilar adenopathy

Eosinophilia

Erythema nodosum

Question 20

Diagnosis of coccidioidomycosis

Answer 20

Antibody testing or isolation of spherules from culture

Question 21

Treatment for coccidioidomycosis

Answer 21

• Immunocompetent: observation (90% self limited)
• If sxs > 6 weeks, consider treatment
• Immunosuppressed
  
  • Fluconazole
  • Amphotericin

Question 22

Treatment of cryptococcus

Answer 22

Lung: Fluconazole

CNS: Ampho + flucytosine

Question 23

Treatment for histoplasmosis

Answer 23

• Mild or chronic: Observation
• Moderate: Itraconazole
• Severe: Ampho

Question 24

2 complications of histoplasmosis infection

Answer 24

Broncholithiasis and fibrosing mediastinitis

Question 25

Answer 25

Aspergillus

Question 26

Answer 26

Mucormycosis

Question 27

3 species of mucormycosis causing disease in humans

Answer 27

rhizopus

lichtheimia (absidia)

Mucor

Question 28

Classic presentation of pulmonary mucor

Answer 28

Sputum can be bloody

Will have multiple nodules WITH effusion (as opposed to IPA without)

Question 29

Histology of mucor

Answer 29

Pauci-septated (ribbon) hyphae

Branch at right angles

Question 30

Fungus NOT detected by beta glucan or galactomannan test

Answer 30

Mucor

Question 31

Drug that must be stopped in mucor infection

Answer 31

deferoxamine

Question 32

First line treatment of mucor

Answer 32

Ampho B with surgical resection

Question 33

Treatment for PCP pneumonia

Answer 33

Bactrim for 21 days if HIV +

Add steroids if A-a gradient is > 35

Question 34

Alternative regimens for PCP if not HIV

Answer 34

• Severe disease
  
  • Clindamycin + primaquine
  • IV pentamidine
• Mild disease
  
  • Trimethoprim + dapsone
  • Atovaquone

Question 35

Answer 35

Blastomycosis