Coccidiomycosis accounts for 15-29% of cases of CAP in arizona - put it in your differential

7 - Mycotic Diseases Flashcards by michael english

Mycotic diseases include:

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

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Mycoses are?

Fungal infections

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Mycoses transmission?

No evidence of transmission among humans or animals

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Where is blastomycosis found

North America

mississippi and ohio rivers
midwest
great lakes
new york/canada

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Who gets blasto (MC)

Males - “because they hunt and fish”

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Environments where blasto is found?

Occupational and recreational activities

Along streams or rivers

Moist soil enriched w decaying vegetation

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Blasto types of infection?

Asymptomatic (50%)

Primary - inhalation (pneumonia)

Cutaneous

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Primary blastomycosis phases

Acute: similar to bacterial pneumonia

Chronic: looks like TB

Can resolve spontaneously

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Cutaneous blasto presentation?

Verrucous, nodular, or ulcerative lesions

Face>extremities>neck>scalp

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What organs/systems are involved with blastomycosis?

Almost any organ can be involved

Osteoarticular
Genitourinary
CNS

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Test/studies for blasto?

Microscopic

KOH
culture

Serology

immunodiffusion test
ELISA

Skin test
- blastomycin antigen (useless)

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Preferred blasto test?

Immunodiffusion test

ELISA

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Temperatures for growing blastomyces?

Mold: 77*F

Yeast 98.6*F

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Treatment modalities for blastomycosis?

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

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Coccidiomycosis aka?

San Joaquine valley fever

Valley fever

Coccidioides immitis

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Where do you find coccidiomycosis?

Arizona
Central cali
Southern NM
West Texas

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Lab nerd concerns for coccidiomycosis?

It is highly infectious

- Hazard for the lab folks

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Who is at the highest risk for coccidiomycosis?

Filipinos

Pregnant

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CAP in arizona?

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

put it in your differential

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Presentations for coccidiomycosis?

Pulmonary disease
- 60% asymptomatic

acute pneumona - look like pneumonia

Cnronic pneumona

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Chronic pneumonia for coccidioidomycosis presentation?

TB-like disease

Thin walled cavities

Nodules

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Disseminated/secondary coccidioidomycosis?

Fulminant disease
Skin
Bone
Vertebrae 
Meningeal

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MC pts who get secondary/disseminated coccidiomycosis?

Immunocompromised

High risk

filipino
preggo
AA)

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Coccidioidomycosis test and diagnostic procedures?

Direct - smear, tissue

Culture (biohazard)

Serology

complement fixation
IgG/IgM

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Acute pulmonary vs severe/disseminated treatments?

Acute: - No antifungal therapy required - Symptomatic therapy only Other/disseminated - severe - ampothericin B - fluconazole or itraconazole

Meningeal treatment?

Life-long fluconazole (not a long life though) Intraventricular amphotericin B

Histoplasmosis aka??

Darling’s disease Histoplasma capsulatum

Where do you find histoplasma capsulatum? | What spreads it?

World wide (molstly ohio/mississippi river valley) Bats, chickens, birds

Who is at a higher risk for histoplasmosis?

Smokers

Skin tests for histoplasmosis?

80-90% of the endemic population will test positive | - not actually infected with it, just exposed

Animinals who spread histoplasmosis?

- Starlings - bats - chickens - other birds

Acute pulmonary histoplasmosis presentation?

- Mild - self limited - Flu like - Hilar or mediastinal lymphadenopathy

Chronic pulmonary histoplasmosis presentation?

- Male smokers - TB like - bullae - granulomas - cavitation

Localized histoplasmosis is found?

Mediastinal disease - stable or progressive Cutaneous

Disseminated histoplasmosis presentation?

Acute, progressive Usually in AIDS pts - low fever - wt loss - anemia - oral lesions - cutaneous lesions

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 ```

Tests/diagnosis studies for histoplasmosis?

Direct - smears of samples Culture - temp depenent Serology - immunodiffusion - complement fixation - antigen testing

Acute pulmonary histoplasmosis tx?

Not usually required | - Unless they have hypoxemia or lasts > 1 mo

Severe/life threatening and moderate histoplasmosis infection treatment?

Severe - Liposomal amphotericin B Mild-moderate - Itraconazole

AIDS histoplasmosis tx?

Life-ling itraconazole

Who gets treated for histoplasmosis?

Acute pulmonary - only if last >1mo Chronic pulmonary Disseminated - aids/non-aids Fibrosing mediastinitis

Cryptococcosis (neoformans) is found?

World wide Immunocompromised Men>women

What spreads cryptococcus neoformans?

Pidgeon droppings

When in the AIDS progression do you see cryptococcus?

CD4<200

MC manifestation of cryptococcosis?

Meningitis

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

Pulmonary cryptococcosis s/s?

Extremely variable - subacute - ARDS Clinically similar to acute pneumonia

Cutaneous manifestations fo cryptococcosis?

``` Papules Pustules Nodules Ulcers Draining sinuses ```

Other sites of infection with cryptococcosis?

Prostate | Medullary cavity of bones

Tests for cryptococcosis?

Culture - urease-producing yeast Direct microscopic- smear Serology - antigen Radiology (not diagnostic) - CT -> LP

What test is most useful for cryptococcosis induced meningitis?

The serology antigen test

Treatment for cryptococcosis?

Immunocompetent - pulmonary - fluconazole - CNS - amphotericin B AIDS - the same except its lifelong

List of other systemic mycotic illness?

Aspergillosis - AIDS Zygomycosis - Diseases Paracoccidioidomycosis - south america Penicillosis - SE asia/southern CHINA (HIV)

MC candidiasis?

Candida albicans

Non-albicans candidal yeasts?

``` Candida tropicalis Candida kruesi Candida paraposilosis Candida lustaniae Candida glabrata ```

Fluconazole resistant candida?

Candida krusei | Candida glabrata

Candida amphoterican B resistant?

Candida lusitaniae

Candida of malignancy?

Candida tropicalis

Superficial and systemic candidiasis presentation?

Superficial - thrush - vaginitis - onychomycosis - esophangitis - intertrigo Systemic - funguria - candidemia

Thrush in a young adult?

AIDS

Thrush is usually found on?

``` Neonates Diabetics on Abx AIDS Inhaled steroids Esophageal diesase ```

Vaginal candidiasis candidates?

Sexually active Pregnant Diabetic Following abx

Diagnosis of vaginal candidiasis?

Usually empiric

Tx for candidiasis?

Vaginal - creams/fluconazole Skin folds - diaper rash cream - nystatin powders

Satellite lesions?

Found in candidiasis | - differentiates from tinea

Where does candiduria (funguria) come from?

Usually its nosocomial

What is candiduria (funguria)?

Its a nosocomial candida that colonizes the bladder

Risk factors for candidiasis?

- Immunosupression (nutropenia) - hematologic malignancy - steroid exposure - disruption of skin/mucuous/GI - indwelling devices - surgery - antibiotic therapy - TPN - Diseases

Survival for blood stream candida?

35% survive hospitalization 30% die of underlying disease 35% die of candidal infection

Systemic deep and disseminated candidiasis?

High mortality Difficult to diagnosis

Test and procedures for candidiasis

Direct - lesions - smears (gram stain, KOH) - tissue (gram, GMS, PAS) Culture - yeast, germ-tube formation Serology (no good ones)

Deep/systemic candidiasis treatment?

IV voriconazole

All fungi are edible

But some are only edible once

7 - Mycotic Diseases Flashcards

(73 cards)