Chapter 19 Patho

Question 1

1. Fungal spores

Answer 1

are inhaled, they reach the lungs and germinate. When this happens, the spores produce a frothy, yeast-like substance that leads to an inflammatory response. Polymorphonuclear leukocytes and macrophages move into the infected area and engulf the fungal spores. The pulmonary capillaries dilate, the interstitium fills with fluid, and the alveolar epithelium swells with edema fluid. Because of the inflammatory reaction, the alveoli in the infected area eventually become consolidated. In severe cases, tissues necrosis, granulomas and cavity formation may be seen. During the healing process, fibrosis and calcification of the lung parenchyma ultimately replace the granulomas. The fibrosis and occasional calcification, the lung tissue retracts and becomes firm. FUNGAL DISEASES ARE SIMILAR TO THOSE SEEN IN TUBERCULOSIS.

Question 2

2. What is the most common fungal infection in the US?

Answer 2

histoplasmosis

Question 3

3. Incidence of histoplasmosis is especially high in what areas?

Answer 3

Mississippi

Question 4

4. The condition called ‘desert bumps’, ‘desert arthritis’, or ‘desert rheumatism’ is associated with which fungal disorder?

Answer 4

coccidioidmycosis

California, Arizona, Nevada, New Mexico, Texas, Utuh.

Question 5

5. What is the other name for Coccidiodmycosis?

Answer 5

California fever, Desert rheumatism, San Joaquin valley disease, Valley fever

Question 6

6. What is used to treat fungal diseases?

Answer 6

Amphotericin B and Itraconazole

Question 7

7. Which form of histoplasmosis is characterized by healed lesions in the hilar lymph nodes as well as a positive histoplasmin skin test response?

Answer 7

Latent asymptomatic disease

Question 8

8. fungal diseases

Answer 8

~ the apical and posterior segments of the upper
lobes are most commonly involved
~ the anatomic changes of the lungs caused by
fungal diseases are similar to those seen in TB
~ cause a chronic restrictive pulmonary disorder

Question 9

9. anatomic alterations of the lungs

Answer 9

~ alveolar consolidation
~ alveolar-capillary destruction
~ caseous tubercles or granulomas
~ cavity formation

Question 10

10. fungal spores

Answer 10

various types are widely distributed throughout the air, soil, fomites, and animals, and even exist in the normal flora of humans

Question 11

11. human fungal disease

Answer 11

(mycotic disease or mycosis)
~ can be caused by primary or ‘true’ fungal
pathogens that exhibit some degree of virulence,
or secondary pathogens that take advantage of
a weakened immune system

Question 12

12. histoplasmosis

Answer 12

~ most common fungal infection in the US
~ caused by the dimorphic fungus Histoplasma
capsulatum
~ especially high along major river valleys of the
Midwest and south
~ 80-90% of the population throughout these areas
show signs of previous infection
~ AKA ‘Ohio Valley Fever’

Question 13

13. H. capsulatum

Answer 13

~ commonly found in soils enriched with bird
excreta, such as soil next to chicken coops, etc
~ may also be carried by bats

Question 14

14. route of acquisition

Answer 14

~ inhalation of the fungal spores that are released
when the soil from an infected area is disturbed
~ when it reaches the alveoli, at body temp, it
converts from its mycelial form (mold) to a
parasitic yeast form
~ clinical manifestations are very similar to those of
TB

Question 15

15. asymptomatic histoplasmosis

Answer 15

is the most common form of histoplasmosis and produces no signs/ symptoms in healthy people

Question 16

16. acute symptomatic pulmonary histoplasmosis

Answer 16

~ tends to occur in otherwise healthy individuals
who have had an intense exposure to H
capsulatum
~ also known as ‘spelunker’s lung’ as it tends to
affect cave explorer’s who come in contact with bat
excrement

Question 17

17. chronic pulmonary histoplasmosis

Answer 17

~ characterized by infiltration and cavity formation
in the upper lobes of one or both lungs
~ this type of histoplasmosis often affects people
with an underlying lung disease such as
emphysema
~ most common in middle-aged white men who
smoke
~ symptoms include- fatigue, fever, night sweats,
weight loss, productive cough, and hemoptysis -
similar to TB

Question 18

18. fungal culture

Answer 18

~ test is considered the gold standard for detecting
histoplasmosis
~ 4 weeks or longer for results
~ not the test of choice for dessimated
histoplasmosis, due to delayed results

Question 19

19. fungal stain

Answer 19

~ a tissue sample (sputum, bone marrow, lung, or
skin lesion) is stained with dye and examined
under a microscope for histoplasma capsulatum
~ positive result is 100% accurate
~ disadvantage lies with obtaining a sample

Question 20

20. serology

Answer 20

~ blood serology test checks blood serum for

antigens and antibodies

Question 21

21. coccidioidomycosis

Answer 21

~ caused by inhalation of the spores of
coccidiodes immitis
~ spherical fungi carried by wind-born dust particles
- AKA
California fever
Desert rheumatism
San Joaquin Valley disease
Valley fever
~ clinical manifestations are absent in about 60%
of the people who have a positive skin-test result

Question 22

22. chronic progressive pulmonary disease

Answer 22

characterized by nodular growths called fungomas and cavity formation in the lungs

Question 23

23. dessimated coccidioidomycosis

Answer 23

~ the lymph nodes, meninges, spleen, liver, kidney,
skin, and adrenals may be involved
~ skin lesions (bumps on the face and chest) are
commonly accompanied by arthralgia or arthritis
especially in ankles and knees
~ this is commonly called:
- desert bumps
- desert arthritis
- desert rheumatism

Question 24

24. screening & diagnosis

Answer 24

of coccidioidomycosis can be made by direct visualization of distinctive spherules in microscopy of the patient sputum, tissue exudates, biopsies, or spinal fluid

Question 25

25. blastomycosis

Answer 25

AKA - Chicago disease Gilchrist's disease North American Blastomycosis ~ caused by Blastomyces dermatitidis ~ found in forest soil, decaying wood, animal manure, abandoned buildings, and chicken poop ~ primary portal is the lungs ~ unlike histoplasmosis, the cough is usually productive, the sputum purulent ~ extrapulmonary lesions involve skin, bones, spleen, reproductive tract, liver, kidney, or prostate gland ~ skin lesions may be 1st sign of disease often on face, hands, wrists, or legs as nodules that erode to skin surface ~ diagnosis can be made from visualization of yeast in sputum smears or fungus can be cultured

Question 26

26. opportunistic pathogens

Answer 26

~ candida albicans ~ Cryptococcus neoformans ~ aspergillus

Question 27

27. thrush

Answer 27

~ candida albicans infection of the mouth ~ characterized by a white, adherent, patchy infection of the mouth, gums, cheeks, and throat

Question 28

28. aspergillus

Answer 28

~ may be the most pervasive of all fungi ~ found in soil, vegetation, leaf detritus, food and compost heaps

Question 29

29. allergic bronchopulmonary aspergillosis

Answer 29

~ a form of asthma | ~ aspergillus infection

Question 30

30. chest assessment

Answer 30

``` ~ ↑ tactile & vocal fremitus ~ dull percussion note ~ bronchial breath sounds ~ crackles, wheezing ~ pleural friction rub ~ whispered pectoriloquy ```

Question 31

31. hemodynamic indices

Answer 31

``` ~ CVP ↑ ~ RAP ↑ ~ PA ↑ ~ PCWP normal ~ PVR ↑ ```

Question 32

32. chest xray

Answer 32

``` ~ ↑ opacity ~ cavity formation ~ pleural effusion ~ calcification & fibrosis ~ right ventricular enlargement ```

Question 33

33. antifungal agents

Answer 33

``` ~ Amphotericin B 1st choice ~ Ketoconazole ~ Itraconazole ~ Fluconazole Diflucan ~ Terbinafine Lamisil ```

Question 34

34. respiratory care treatment protocols

Answer 34

~ O₂ therapy ~ bronchopulmonary hygiene ~ mechanical ventilation

Question 35

35. Which of the following is or are used to treat fungal diseases? 1. Streptomycin 2. Amphotericin B 3. Penicillin G 4. Itraconazole a. 1 only b. 2 only c. 4 only d. 2 and 4 only

Answer 35

d

Question 36

36. Which of the following forms of histoplasmosis is characterized by healed lesions in the hilar lymph nodes as well as a positive histoplasmin skin test response? a. Disseminated infection b. Latent asymptomatic disease c. Chronic histoplasmosis d. Self-limiting primary disease

Answer 36

b

Question 37

37. The condition called "desert bumps," "desert arthritis," or "desert rheumatism" is associated with which fungal disorder? a. Histoplasmosis b. Blastomycosis c. Coccidioidomycosis d. Aspergillosis

Answer 37

c

Question 38

38. Incidence of histoplasmosis is especially high in which of the following area(s)? 1. Arizona 2. Mississippi 3. Nevada 4. Texas a. 2 only b. 4 only c. 2 and 4 only d. 2 and 3 only

Answer 38

a. 2 only

Question 39

39. Which of the following is the most common fungal infection infection in the United States? a. Coccidioidomycosis b. Histoplasmosis c. San Joaquin Valley disease d. Blastomycosis

Answer 39

b