CHAPTER 15: FUNGI AND YEASTS ( DEEP MYCOSES)

Question 1

Flulike illness
Lung changes on CXR- hilar adenopathy, infiltrate
Generalized maculopapular eruption

Pulmo sx subside within a few weeks
Erythema nodosum over shins then disappear after 3 weeks

Answer 1

Coccidiodomycosis (primary pulmonary coccidioidomycosis)

Question 2

how to diagnose Coccidiodomycosis?

Answer 2

culture ( grown at room air)
PCR test

Question 3

Treatment for coccidiomycosis

Answer 3

Fluconazole 400-800mg/day
Itraconazole 200mg TID

X 12-18 months

Question 4

Inhalation of airborne spores
Asymptomatic or limited lung disease

Immunocompromised/ systemic steroids

Ulcerations/ granulomas of the oronasopharynx

Answer 4

Histoplasmosis

Question 5

Painless, slightly pruritic dome shaped nodular granulomas

Erythema nodosum

Organism found in bat and bird feces

Answer 5

African histoplasmosis

Question 6

Treatment of choice for histoplasmosis

Answer 6

Amphotericin B

Question 7

Begins as a pulmonary infection and remains localized to the lung in 90% of cases

10%- disseminate to CNS and skin
Immunocompromised

Molluscum contagiosum like lesions-50% of px with HIV and disseminated

Answer 7

Cryptococcosis

Question 8

Most common cause of mycotic meningitis

Answer 8

Cryptococcosis

Question 9

4th leading cause of opportunistic infection and 2nd most common fungal opportunist

Answer 9

Cryptococcosis

Question 10

Treatment of cryptococcosis

Answer 10

Amphotericin B IV + oral fluconazole - seriously ill

Fluconazole 400-600mg/day x 8-10 weeks- less severely ill non -AIDS

Question 11

Result from dissemination from a primary pulmonary focus ( upper or middle lobe of the lungs)

Multiple Verrucous, granulomatous lesions with thick crusts, warty vegetations on exposed skin
-thick dirty brown or gray crusts

Answer 11

Blastomycosis (North American)

Question 12

Treatment of choice for North

American blastomycosis

Answer 12

Itraconazole 200-400mg/day x 6 months

Question 13

causative agent of North american balstomycosis

Answer 13

Bastomyces dermatitides

Question 14

Blastomycosis with mucocutaneous involvement

Armadillos may harbor the disease

Answer 14

South American
(Paracoccidiodomycosis)

Question 15

causative agent of South American
(Paracoccidiodomycosis)

Answer 15

Paracoccidiodes braciliences

Question 16

Treatment for south American blastomycosis

Answer 16

Itraconazole 200mg/day x 12 months

Question 17

Usually from direct inoculation by a thorn, cat’s claw
(occupational dse of gardeners, florists and laborers)

Small nodule that disappear before onset of other lesions

After few weeks- painless firm nodules along draining lymphatics

Answer 17

Sporotrichosis

Question 18

Treatment of sporotrichosis

Answer 18

cutaneous and lymphocutaneous: Itraconazole 200mg/day x 2-4 weeks;

cutaneous form when Itraconazole fails: Potassium iodide 3-6 g/day

Question 19

cutaneous form when Itraconazole fails: Potassium iodide 3-6 g/day

Answer 19

chromoblastomycosis

Question 20

Mycetoma triad

Answer 20

1. subcutaneous swelling
2. discharging sinuses / sinus trats
3. granules in sinuses

Question 21

Treatment of mycetoma (maduromycosis)

Answer 21

A. israelii infection: penicillin
N. asteroides or N. brasiliensis: sul- fonamides.
P. boydii: Voriconazole alone or combined with surgical excision

Question 22

Acute rapidly developing fatal infection

Infarction, gangrene, necrotic abscess
Black, necrotic purulent debris

Common in soil, decomposing plant and animal matter

Answer 22

mucormycosis

Question 23

Treatment of mucormycosis

Answer 23

1. surgical excision + liposomal Amphoterin B

Question 24

TOC of Pneumocystosis ( P. jirovecci infection )

Answer 24

TMP-SMX for 3 wks

Question 25

2nd to candidiasis
Opportunistic fungal disease in px with leukemia and other hema neoplasias

Neutropenia- risk factor
Pulmo involvement- invasive disease
Hemorrhagic bullae/ necrotic ulcers

Answer 25

aspergillosis

Question 26

Treatment for chromoblastomycosis

Answer 26

1. cryosurgery
2. itraconazole 200-400 mg/day x 6-12 months
3. terbinafine 500-1000 mg/day +/- itraconazole 200-400 mg/day

Question 27

Treatment of choice for invasive aspergillosis

Answer 27

voriconazole

Question 28

Chronic, granulomatous, subcutaneous inflammatory disease

Triad: progressive subcutaneous swelling
Sinus tracts that discharge grains

Begin in instep or toe webs- nontender firm
Bone and fascia involved also

Answer 28

mycetoma aka madura foot and maduromycosis