Systemic Fungal Infections Flashcards
Histoplasma capsulatum
Found in the soil (from bird or bat droppings)
Endemic along major river valleys
Especially Ohio and Mississippi rivers
Calcifications on lungs and Spleen
Progressive disseminated histoplasmosis
Can be associated with underlying HIV or immunosuppression
Fever and multiorgan system involvement
Ulcers in the oropharynx
Hepatosplenomegaly
GI involvement mimics inflammatory bowel disease
CXR shows a miliary pattern
histoplasmosis Treatment
Itraconazole 200-400 mg/d
Severe illness: IV amphoteracin B
AIDS related histoplasmosis:
Lifelong suppressive therapy with itraconazole
Coccidioidomycosis
Infection occurs secondary to inhalation of molds from endemic areas
Erythema Nodosum
Cryptococcus (Cryptococcus neoformans)
Yeast that is found in the soil and on dried pigeon poop
Most common cause of fungal meningitis
Risk factors: chemotherapy for hematologic cancer, Hodgkin lymphoma, corticosteroid therapy, transplant recipients, TNF inhibitor therapy, HIV
Cryptococcus Diagnosis
Crytococcal antigen can be found in the infected organ and often in the serum of AIDS patients
Respiratory (Sputum culture or pleural fluid)
Lumbar puncture for meningeal involvement
Cryptococcus Treatment
Amphotericin B IV x 2 weeks
Followed by fluconazole x 8 weeks
Aspergillosis
Tissue invasion occurs with Immunosuppression Treatment for autoimmune disease Severe and prolonged neutropenia High dose glucocorticoids Allergy Airway or lung invasion (most common)
Aspergillosis Diagnosis
Allergic disease: high levels of IgE and IgG Aspergillus percipitins in the blood
Galactomannan antigen from serum or bronchioalveolar lavage fluid
Beta-d-glucan assay
PCR for aspergillus
Systemic candidiasis
Hepatosplenic candidiasis
Secondary to aggressive chemotherapy and prolonged neutropenia
Fever and variable abdominal pain may be present
