HistoCocci

Question 1

What are lab findings/dx tests in coccidioidomycosis?

Answer 1

• Eosinophilia, leukocytosis
• Serology: IgM, IgG antibodies
• Culture

Question 2

What populations are at an increased risk for complications of coccidioidomycosis?

Answer 2

• HIV
• African Americans & Asians
• 3rd trimester

Question 3

What is the px of coccidiodomycosis?

Answer 3

• Limited disease = good (fatigue may persist)

- Disseminated & meningeal = High mortality

Question 4

Is coccidioidomycosis reportable?

Answer 4

YES!

Question 5

Where is histoplasmosis common?

Answer 5

Midwestern states, in Ohio & Mississippi river valleys

Question 6

Histoplasmosis infection is secondary to what?

Answer 6

Inhalation of fungal spores

–> proliferation in lungs –> spreads to other organs via blood

Question 7

What is histoplasma capsulatum isolated from?

Answer 7

soil contaminated w/ bird/bat droppings

Question 8

What is the most common form of histoplasmosis in otherwise healthy people?

Answer 8

Asx primary histoplasmosis

Question 9

In asx primary histoplasmosis, what can you see on CXR?

Answer 9

Residual granuloma

Question 10

Describe diffuse pulmonary disease

Answer 10

• Form of histoplasmosis

- Can occur in healthy people w/ intense exposure (inhalation of many spores)

Question 11

How does diffuse pulmonary disease present?

Answer 11

• Fever, fatigue
• Pulmonary complaints
• Lasts 1wk-6mos

Question 12

Describe acute localized pulmonary disease

Answer 12

• Form of histoplasmosis
• Presents like pneumo
• local infiltrates

Question 13

Describe chronic cavitary pulmonary histoplasmosis

Answer 13

• Occurs in older COPD pts

- Lungs show progressive changes (apical cavities)

Question 14

Describe disseminated histoplasmosis

Answer 14

• Rare in immunocompetent host

- Multiple organ involvement, often fatal

Question 15

How does disseminated histoplasmosis present?

Answer 15

• Fever, fatigue
• Cough, dyspnea
• Wt loss

Question 16

What do you need to distinguish histoplasmosis from?

Answer 16

• Sarcoidosis*
• TB
• Malignancy

Question 17

What type of imaging can you use for dx of histoplasmosis?

Answer 17

• CXR: hilar adenopathy, patchy or nodular infiltrates in lower lung

Question 18

What labs are used for dx of histoplasmosis?

Answer 18

• Antigen detection
• Serology
• Biopsy
• Cultures (useful in chronic dz only)

Question 19

How do you tx histoplasmosis in asx pts?

Answer 19

None!

Question 20

How do you tx acute histoplasmosis?

Answer 20

• Often don’t need tx

- Can use itraconazole

Question 21

How do you tx severe histoplasmosis?

Answer 21

Amphotericin B IV

Question 22

How do you tx chronic histoplasmosis?

Answer 22

Amphotericin B or itraconazole

Question 23

How do you tx histoplasmosis in AIDS pts?

Answer 23

Amphotericin B & maintain w/ intraconazole

Question 24

What organisms cause coccidioidomycosis? Where are they found?

Answer 24

• Coccidioides immitis
• Coccidioides posadasii
• In soil, semiarid areas

Question 25

Coccidioidomycosis infection is secondary to what?

Answer 25

Inhalation of spores

Question 26

What is the incubation period for coccidioidomycosis?

Answer 26

7-21 days

Question 27

What % of people experience sx of coccidioidomycosis? What is the usual manifestation?

Answer 27

- 40% | - Pneumo

Question 28

What sx/characteristics does coccidioidomycosis share w/ histoplasmosis?

Answer 28

- HA, arthralgias - Fatigue - Disseminated extrapulmonary infection - Granuloma on CXR

Question 29

What sx is unique to coccidioidomycosis?

Answer 29

Rash (erythema multiforme), erythema nodosum

Question 30

What complications are seen in the disseminated form of coccidioidomycosis?

Answer 30

- More pronounced lung findings (abscess, miliary infiltrates) - Lymphadenitis, meningitis - Bone lesions

Question 31

What type of immunocompromised pts are affected by coccidioidomycosis?

Answer 31

- Pts w/ organ transplant - Pts taking glucocorticoids or immunosuppressant meds - Chemo pts - Those w/ pre-existing cardiopulmonary conditions - Elderly

Question 32

What type of imaging is used to dx coccidioidomycosis?

Answer 32

CXR - hilar adenopathy - patchy, nodular infiltrates - thin walled cavities

Question 33

What warrants tx for coccidioidomycosis?

Answer 33

- 10% wt loss - Night sweats > 3wks - Infiltrates involving > 1/2 of a lung - Hilar adenopathy - Inability to work - Sx > 2 months

Question 34

How do you tx coccidioidomycosis?

Answer 34

- Fluconazole 3-6mos - Thoracic surgery - Monitor for 1 yr, initially every 2-4 wks