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Flashcards in Systemic Fungal Infections Deck (42):
1

Systemic candidiasis may be difficult to isolate. What may we isolate organisms from?
2

May isolate organisms from urine or sputum
--Treatment individualized (infection vs. colonization)

2

Isolated candida from blood cultures is considered a sign of what?

Why would we need to do a fundoscopic exam in systemic candidiasis?

serious disease until proven otherwise

exclude endophthalmitis

3

Hepatosplenic candidiasis
is secondary to what? 2

What symtpoms may be present? 2

Its an invasive disease. WHere can it affect? 9

Mortality rate?

Treatment?

Secondary to
1. aggressive chemotherapy and
2. prolonged neutropenia

1. Fever and
2. variable abdominal pain may be present

Invasive disease
1. Skin (rash),
2. brain,
3. meninges,
4. myocardium,
5. eyes,
6. muscles,
7. kidney,
8. liver,
9.spleen

Mortality around 30%

IV antifungal treatment such as fluconazole

4

Histoplasma capsulatum is found naturally where?

How is it transmitted?

Infection occurs how many days after exposure?

How does it become systemic?

Found in the soil
from bird or bat droppings
Endemic along major river valleys
Especially Ohio and Mississippi rivers

Inhalation of the spores

Infection occurs 7-21 days post exposure

Lymphatogenous spread to other organs

5

How do we detect histoplasmosis?

HOw do we detect past infections?
2

Many cases are asymptomatic and detected incidentally on xray (find nodules)

Past infection may be noted by calcifications on routine xrays
-Lungs
-Spleen

6

Describe the severity of acute pulmonary histoplasmosis 2

Duration of infection?

Mortality rate?

Can be relatively severe
-Severe fatigue, fever

Duration 1 week to 6 months

Rarely fatal

7

Chronic pulmonary histoplasmosis is found in what kind of pts?

The patient usually has what?

What would we find on the chest Xray?
3

Older patients

Underlying chronic lung disease

CXR
1. Apical cavities
2. Infiltrates
3. Nodules

8

Progressive disseminated histoplasmosis can be associated with what disease?

What is it characterized by? 2

Clinical presentation may present like what?

Symtpoms? 4

Mortality?

1. Can be associated with underlying HIV (CD4 count

9

Progressive disseminated histoplasmosis:

What would you see in the oropharynx?

What organs would we often see involved?

What does GI symtpoms in this disease mimic?

WHat does the CXR show?

Ulcers in the oropharynx

Hepatosplenomegaly

GI involvement mimics inflammatory bowel disease

CXR shows a miliary pattern

10

Diagnostic studies for Progressive disseminated histoplasmosis? 8
(Whats the most important?)


What test is most likely to be negative in acute and positive in chronic?

1. Chest xray
2. CBC, CMP
3. Alkaline phosphatase,
4. lactate dehydrogenase and
5. ferritin are all elevated
6. Bronchoalveloar lavage antigen testing
7. Urine antigen test (> 90% sensitivity)*****
8. Blood cultures

Sputum culture most likely to be negative in acute disease and positive in chronic disease


11

Treatment of histoplasmosis? 2

Duration?

IF its more severe?

How should we treat AIDS related histoplasmosis?

Refer to Infectious disease specialist
Itraconazole 200-400 mg/d

Duration: weeks to months

Severe illness: IV amphoteracin B

AIDS related histoplasmosis
Lifelong suppressive therapy with itraconazole

12

Coccidioidomycosis infection occurs secondary to what?

Where is it endemic? 4

Other names it is called? 2

More severe cases are seen in what pts?

occurs secondary to inhalation of molds from endemic areas.

Endemic
Southwestern US, Mexico, Central America, South America

AKA Valley Fever, San Joaquin valley fever

More severe cases in the immunocompromised patient

13

Coccidioidomycosis May present with a variety of symptoms?
10

Whats the most important to remember?

1. Asymptomatic
2. Pedal edema
3. Chest pain
4. Cough with blood tinged sputum
5. Fever, night sweats
6. Headache
7. Joint stiffness
8. Muscle pain
9. Anorexia
10. Erythema nodosum***

14

Erythema Nodosum may occur how long after the onset of respiratory symptoms?

May occur 2-20 days after the onset of respiratory symptoms
(swollen, painful, red)

15

Coccidioidomycosis Disseminated disease might show what?
6

1. Skin
2. Lungs
3. Bones
4. Soft tissues
5. Lymph nodes
6. Meningitis

16

Coccidioidomycosis Disseminated disease:

Skin Symptoms? 2

Lung symptoms? 4

Bone symptoms? 1

Soft tissue symtpoms?

Lymph node involvement? 3

1. erythema nodosum,
2. verrucous skin lesions

1. cavities,
2. infiltrates,
3. empyema,
4. pleural effusion

1. lytic lesions

1. abcesses

1. hilar and/or mediastinal lymphadenopathy
2. lymphadenitis and
3. abscess formation

17

Coccidioidomycosis Disseminated disease will most commonly present with what?

Most common presentation is acute pneumonia

18

Coccidioidomycosis lab findings? 3

Tests?
4

1. Leukocytosis
2. Eosinophilia
3. Spores in biopsy

1. ELISA for IgM and IgG antibodies
2. Tissue or bone biopsy may reveal spores
3. Blood cultures rarely positive
4. Spinal fluid

19

What would we look for in the CSF in Coccidioidomycosis?
5

1. Complement fixing antibodies (diagnostic in 90%)
2. Increased cell count,
3. lymphocytosis,
4. reduced glucose,
5. culture positive in only 30%

20

What would the CXR show in Coccidioidomycosis?

To the side of these light areas are patchy light areas with irregular and poorly defined borders
(Capitavy lesions)

21

Treatment for Coccidioidomycosis?
2

What if its severe?

What might require prolonged therapy?
2

1. Refer to ID specialist
2. Fluconazole or itraconazole daily for months

Amphotericin B IV for severe disseminated cases

May require prolonged therapy:
1. Surgical incision and
2. drainage of abscess formation

22

Cryptococcosis is mainly caused by ?

Where is it most commonly found? 2

What is it the most common cause of?

Risk factors? 6

Who is it rare in?

What are the three forms of infection?

Cryptococcus neoformans

1. Yeast that is found in the soil and on
2. dried pigeon poop

Most common cause of fungal meningitis

Risk factors:
1. chemotherapy for hematologic cancer,
2. Hodgkin lymphoma,
3. corticosteroid therapy,
4. transplant recipients,
5. TNF inhibitor therapy,
6. HIV

Rare in immunocompetent persons

3 forms of infection: cutaneous,
respiratory,
meningeal

23

Signs and symtpoms of Cryptococcosis?
3

1. Pulmonary
Can lead to respiratory failure
2. Any organ can be infected
3. CNS predominates

24

CNS Signs of Cryptococcosis?
5

1. Headache usually first symptom
2. Confusion
3. Mental status changes
4. Cranial nerve abnormalities
5. Nausea, vomiting
(CD4 count under 200?)

25

Diagnosis of Cryptococcosis:

Blood Test?
Respiratory?
CNS?

Crytococcal antigen can be found in the
1. infected organ and
2. often in the serum of AIDS patients

Respiratory
1. Sputum culture or
2. pleural fluid

1. Lumbar puncture for meningeal involvement

26

When would we want to do a LUmbar puncture in Cryptococcosis and what would we find?
6

Lumbar puncture for meningeal involvement

1. Increased opening pressure,
2. increased protein,
3. decreased glucose
4. India ink prep** shows budding,
5. encapsulated fungal cells
6. Cryptococcal capsular***antigen testing (diagnostic)

27

Treament of Cryptococcosis
3

Referral to ID specialist

Amphotericin B IV x 2 weeks

Followed by fluconazole x 8 weeks

28

Diagnosis for cryptococcosis?
3

1. Capsular polysaccharide antigen in CSF
2. sputum or
3. urine is diagnostic

29

Aspergillosis can be found where?

Can be found in dead leaves (or other decaying vegetation), compost piles, stored grain, and on marijuana leaves

30

What fungus is the usual cause of the disease, Aspergillosis?

Aspergillus fumigatus

31

Aspergillosis Tissue invasion occurs with what?

Specifically?2

Immunosuppression

1. Severe and prolonged neutropenia
2. High dose glucocorticoids

32

What specific kinds of immunosuppressed pts is Aspergillosis found in and what is it the most common cause of non-candidal invasive fungal infection?
5 and 2

1. Treatment for autoimmune disease
2. Cancer
3. HIV

4. Bone marrow transplant**
5. Solid organ transplant**

33

Aspergillosis has a variety of manifestations 4

Whats the most common manifestation?

1. Allergy
2. Airway or lung invasion (most common)

3. Cutaneous
4. Extrapulmonary dissemination

34

What are the most common airway or lung invasions for aspergillosis? 2

What are the extrapulmonary manifestations of aspergillosis?
6

1. Tracheobronchitis,
2. rhinosinusitis


1. Brain
2. Eyes
3. Kidney
4. Liver
5. Heart
6. GI

35

Aspergillosis most commonly affects what?

What do the symtpoms include? 5


What will the chest xray show?
3

The lungs

Symptoms include:
1. fever,
2. chest pain,
3. shortness of breath,
4. cough,
5. hemoptysis

Chest xray:
1. single or multiple nodules with or without cavitation,
2. patchy or segmental consolidation,
3. peribronchial infiltrates

36

How would we diagnose aspergillosis?
6

1. Galactomannan antigen from serum or bronchioalveolar lavage fluid

2. Beta-d-glucan assay (new, availability may vary)
3. PCR for Aspergillus
4. Culture
5. Biopsy
6. CT scan of the lungs

37

HOw would we diagnose the allergic form of aspergillosis?

high levels of IgE and IgG Aspergillus percipitins in the blood

38

What will the Galactomannan antigen test show for aspergillosis?

Beta-d-glucan assay will show what for aspergillosis?
Whats it used for?

WHat will the CT scan show?

(Parts of the cell wall of the Aspergillus sp.)


-part of the cell wall of multiple types of fungus,
-use for invasive Candidial infections and Aspergillus

Ground glass infiltrates with a “halo sign” then development of a cavitary lesion

39

Allergic bronchopulmonary aspergillosis occurs in what kind of pts?


How would you describe the course of the disease?

What may it result in? 2

Treatment? 2

Preexisting asthma and worsening bronchospasm and pulmonary infiltrates

Waxing and waning course

May result in bronchiectasis and fibrotic lung disease

Treatment
Antifungals and steroids

40

Invasive life-threatening aspergillosis is found in what kind of pt?

Pulmonary manifestations? 3

Other manifestations? 3

Profound immunodeficiency

Pulmonary manifestations
-Patchy infiltrates,
-necrotizing pneumonia

1. Sinus invasion
2. Multi-organ involvement
3. Hematogenous spread is possible

41

How does aspergillosis affect multiple organs?

Tissues infarct as organism grows into blood vessels

42

How should we treat Invasive life-threatening aspergillosis?

High dose multiple agent antifungal therapy