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Senior - ID 2 > 7 - Mycotic Diseases > Flashcards

7 - Mycotic Diseases Flashcards

(73 cards)

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1
Q

Mycotic diseases include:

A 
Endemic mycotic mycotic illness 
- blastomycocsis
- coccidioidomycosis
- histoplasmosis
Cryptococcosis
Candiadiasis 
- superficial fungal
- systemic infections
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2
Q

Mycoses are?

A

Fungal infections

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3
Q

Mycoses transmission?

A

No evidence of transmission among humans or animals

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4
Q

Where is blastomycosis found

A

North America

  • mississippi and ohio rivers
  • midwest
  • great lakes
  • new york/canada
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5
Q

Who gets blasto (MC)

A

Males - “because they hunt and fish”

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6
Q

Environments where blasto is found?

A

Occupational and recreational activities

Along streams or rivers

Moist soil enriched w decaying vegetation

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7
Q

Blasto types of infection?

A

Asymptomatic (50%)

Primary - inhalation (pneumonia)

Cutaneous

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8
Q

Primary blastomycosis phases

A

Acute: similar to bacterial pneumonia

Chronic: looks like TB

Can resolve spontaneously

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9
Q

Cutaneous blasto presentation?

A

Verrucous, nodular, or ulcerative lesions

Face>extremities>neck>scalp

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10
Q

What organs/systems are involved with blastomycosis?

A

Almost any organ can be involved

  • Osteoarticular
  • Genitourinary
  • CNS
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11
Q

Test/studies for blasto?

A

Microscopic

  • KOH
  • culture

Serology

  • immunodiffusion test
  • ELISA

Skin test
- blastomycin antigen (useless)

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12
Q

Preferred blasto test?

A

Immunodiffusion test

ELISA

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13
Q

Temperatures for growing blastomyces?

A

Mold: 77*F

Yeast 98.6*F

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14
Q

Treatment modalities for blastomycosis?

A 
Liposomal amphotericin B
- life threatening
Itraconazol (sporanox)
- mild-moderate
Fluconazole (diflucan)(6-12 mo)
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15
Q

Coccidiomycosis aka?

A

San Joaquine valley fever

Valley fever

Coccidioides immitis

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16
Q

Where do you find coccidiomycosis?

A

Arizona
Central cali
Southern NM
West Texas

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17
Q

Lab nerd concerns for coccidiomycosis?

A

It is highly infectious

- Hazard for the lab folks

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18
Q

Who is at the highest risk for coccidiomycosis?

A

Filipinos

Pregnant

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19
Q

CAP in arizona?

A

Coccidiomycosis accounts for 15-29% of cases of CAP in arizona

  • put it in your differential
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20
Q

Presentations for coccidiomycosis?

A

Pulmonary disease
- 60% asymptomatic

  • acute pneumona - look like pneumonia

Cnronic pneumona

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21
Q

Chronic pneumonia for coccidioidomycosis presentation?

A

TB-like disease

Thin walled cavities

Nodules

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22
Q

Disseminated/secondary coccidioidomycosis?

A 
Fulminant disease
Skin
Bone
Vertebrae 
Meningeal
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23
Q

MC pts who get secondary/disseminated coccidiomycosis?

A

Immunocompromised

High risk

  • filipino
  • preggo
  • AA)
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24
Q

Coccidioidomycosis test and diagnostic procedures?

A

Direct - smear, tissue

Culture (biohazard)

Serology

  • complement fixation
  • IgG/IgM
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25
Acute pulmonary vs severe/disseminated treatments?
Acute: - No antifungal therapy required - Symptomatic therapy only Other/disseminated - severe - ampothericin B - fluconazole or itraconazole
26
Meningeal treatment?
Life-long fluconazole (not a long life though) Intraventricular amphotericin B
27
Histoplasmosis aka??
Darling’s disease Histoplasma capsulatum
28
Where do you find histoplasma capsulatum? | What spreads it?
World wide (molstly ohio/mississippi river valley) Bats, chickens, birds
29
Who is at a higher risk for histoplasmosis?
Smokers
30
Skin tests for histoplasmosis?
80-90% of the endemic population will test positive | - not actually infected with it, just exposed
31
Animinals who spread histoplasmosis?
- Starlings - bats - chickens - other birds
32
Acute pulmonary histoplasmosis presentation?
- Mild - self limited - Flu like - Hilar or mediastinal lymphadenopathy
33
Chronic pulmonary histoplasmosis presentation?
- Male smokers - TB like - bullae - granulomas - cavitation
34
Localized histoplasmosis is found?
Mediastinal disease - stable or progressive Cutaneous
35
Disseminated histoplasmosis presentation?
Acute, progressive Usually in AIDS pts - low fever - wt loss - anemia - oral lesions - cutaneous lesions
36
Disseminated histoplasmosis clinical manifestation
``` Lymph nodes - lymphadenitis Bone marrow - anemia - leukopenia - thrombocytopenia Heart - endocarditis Adrenal - enlargement - addisons CNS - chronic meningitis - cerebritis - Mass GI tract - oral ulcers - small bowel micro/macro ulcers Eyes - Uveitis - choroiditis Skin - Uveitis - choroiditis GU tract - hydronephrosis - bladder ulcers - penile ulcers - prostatitis ```
37
Tests/diagnosis studies for histoplasmosis?
Direct - smears of samples Culture - temp depenent Serology - immunodiffusion - complement fixation - antigen testing
38
Acute pulmonary histoplasmosis tx?
Not usually required | - Unless they have hypoxemia or lasts > 1 mo
39
Severe/life threatening and moderate histoplasmosis infection treatment?
Severe - Liposomal amphotericin B Mild-moderate - Itraconazole
40
AIDS histoplasmosis tx?
Life-ling itraconazole
41
Who gets treated for histoplasmosis?
Acute pulmonary - only if last >1mo Chronic pulmonary Disseminated - aids/non-aids Fibrosing mediastinitis
42
Cryptococcosis (neoformans) is found?
World wide Immunocompromised Men>women
43
What spreads cryptococcus neoformans?
Pidgeon droppings
44
When in the AIDS progression do you see cryptococcus?
CD4<200
45
MC manifestation of cryptococcosis?
Meningitis
46
Cryptococcosis meinigitis/meningoencephalitis s/s?
- Subacute or chronic - HA - personality changes - lethargy - coma - N/V - Fever and stiff neck (less common) - altered mental - confusion - obtundation
47
Pulmonary cryptococcosis s/s?
Extremely variable - subacute - ARDS Clinically similar to acute pneumonia
48
Cutaneous manifestations fo cryptococcosis?
``` Papules Pustules Nodules Ulcers Draining sinuses ```
49
Other sites of infection with cryptococcosis?
Prostate | Medullary cavity of bones
50
Tests for cryptococcosis?
Culture - urease-producing yeast Direct microscopic- smear Serology - antigen Radiology (not diagnostic) - CT -> LP
51
What test is most useful for cryptococcosis induced meningitis?
The serology antigen test
52
Treatment for cryptococcosis?
Immunocompetent - pulmonary - fluconazole - CNS - amphotericin B AIDS - the same except its lifelong
53
List of other systemic mycotic illness?
Aspergillosis - AIDS Zygomycosis - Diseases Paracoccidioidomycosis - south america Penicillosis - SE asia/southern CHINA (HIV)
54
MC candidiasis?
Candida albicans
55
Non-albicans candidal yeasts?
``` Candida tropicalis Candida kruesi Candida paraposilosis Candida lustaniae Candida glabrata ```
56
Fluconazole resistant candida?
Candida krusei | Candida glabrata
57
Candida amphoterican B resistant?
Candida lusitaniae
58
Candida of malignancy?
Candida tropicalis
59
Superficial and systemic candidiasis presentation?
Superficial - thrush - vaginitis - onychomycosis - esophangitis - intertrigo Systemic - funguria - candidemia
60
Thrush in a young adult?
AIDS
61
Thrush is usually found on?
``` Neonates Diabetics on Abx AIDS Inhaled steroids Esophageal diesase ```
62
Vaginal candidiasis candidates?
Sexually active Pregnant Diabetic Following abx
63
Diagnosis of vaginal candidiasis?
Usually empiric
64
Tx for candidiasis?
Vaginal - creams/fluconazole Skin folds - diaper rash cream - nystatin powders
65
Satellite lesions?
Found in candidiasis | - differentiates from tinea
66
Where does candiduria (funguria) come from?
Usually its nosocomial
67
What is candiduria (funguria)?
Its a nosocomial candida that colonizes the bladder
68
Risk factors for candidiasis?
- Immunosupression (nutropenia) - hematologic malignancy - steroid exposure - disruption of skin/mucuous/GI - indwelling devices - surgery - antibiotic therapy - TPN - Diseases
69
Survival for blood stream candida?
35% survive hospitalization 30% die of underlying disease 35% die of candidal infection
70
Systemic deep and disseminated candidiasis?
High mortality Difficult to diagnosis
71
Test and procedures for candidiasis
Direct - lesions - smears (gram stain, KOH) - tissue (gram, GMS, PAS) Culture - yeast, germ-tube formation Serology (no good ones)
72
Deep/systemic candidiasis treatment?
IV voriconazole
73
All fungi are edible
But some are only edible once

Senior - ID 2 (6 decks)

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