Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pulmonary Week 2 > Fungal and Immunocompromised Pneumonia > Flashcards

Fungal and Immunocompromised Pneumonia Flashcards

1
Q

What are the types of fungal infections?

A
  • superficial and cutaneous mycoses
  • subcutaneous (skin, lymphatics, subQ tissue)
  • Endemic mycoses
  • Oppoertunistic mycosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What causes endemic mycoses?

A

dimorphic fungi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Notes about dimorphic fungi

A
  • most common etiologic agents of pulmonary infection by fungi
  • infection results from inhalation of spores that mold forms in soil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does ‘dimorphic’ mean?

A

-grow as yeast in human tissue and as mold at room temp

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens with spores of dimorphic fungi are inhaled?

A

they differentiate into yeasts or spherules. Most are self-limited but all can cause pneumonia and disseminate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some dimorphic fungi?

A
  • Blastomyces dermatitidis
  • Histoplasma capsulatum
  • Coccidioides immitis
  • Paracoccidioides brasiliensis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where is Histoplasma capsulatum endemic?

A

Mississippi and Ohio River

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Where does Histoplasma capsulatum grow?

A

soil and bird droppings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does Histoplasma capsulatum infection present?

A
  • mostly asymptomatic pulmonary infection

- but can have fever, chills, cough, chest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

In AIDS, Histoplasma capsulatum can disseminate. What organs are typically affected?

A
  • BM (pancytopenia)
  • Mouth/Gi (ulcers)
  • Skin (rash, nodules)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Tissue biopsy of positive Histoplasma capsulatum will show what?

A

oval yeast cells within macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How else can Histoplasma capsulatum be diagnosed?

A
  • serology

- Urinary antigen (good for AIDS patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does Histoplasma capsulatum show on CXR?

A
  • infiltrates
  • mediastinal LAD
  • cavitary lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are two possible skin manifestations of Histoplasma capsulatum infection?

A
  • skin rashes

- erythema nodosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Note about skin rashes in Histoplasma capsulatum

A

seen in disseminated Histo (rash is rare, but common in AIDS/immunocompromised)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is erythema nodosum?

A

tender nodules that present on extensor surfaces (tibia and ulna skin). Result from delayed hypersensitivity response to fungal antigen and is an indicatory of poor prognosis (not specific to histo but also seen in coccidioides and TB)

Aka desert bumps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Where is Blastomyces dermatitidis endemic?

A

Ohio/Mississippi River Valley, Missouri, and Arkansas River basins (grows in moist soil)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How does Blastomyces dermatitidis present?

A

asymptomatic respiratory illness, 50% will have cough, chest pain, sputum, fever/night sweats

most resolve spontaneously

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Disseminated Blastomyces dermatitidis results in what?

A

ulcerated granulomatous lesions of the skin (70%), bone (33%), GI tract (25%), and CNS (10%). Seen in both immunocompetent and compromised patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What does tissue biopsy of Blastomyces dermatitidis show?

A

thick-walled yeast cells with single broad-based bud

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is Blastomyces dermatitidis diagnosed?

A
  • CXR (lobar consolidation)
  • tissue biopsy
  • serology
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is Histoplasma capsulate treated?

A

Ampho B for severe and Itra otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How is Blastomyces dermatitidis treated?

A

Ampho B for severe and Itra otherwise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Where is Coccidioides immitis endemic?

A

Southwest and Latin America

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Describe the pathogenesis of Coccidioides immitis

A

In the lungs, large spherules form and filled with endospores. Upon rupture, endospores are released and differentiate into new spherules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How does Coccidioides immitis present?

A
  • mild flu-like illness with fever and cough (‘valley fever’) in 10%
  • erythema nodosum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How common is dissemination in Coccidioides immitis?

A

1% (to bone, meninges, and skin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What ethnicities are at increased risk for dissemination of Coccidioides immitis?

A

-AA, Filipinos, and women in 3rd trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

____ is common with Coccidioides immitis

A

Eosinophilia

30
Q

How is Coccidioides immitis treated?

A
  • Ampho for persistent lung lesions or disseminated

- Fluconazole for meningitis

31
Q

Where is Paracoccidioides brasiliensis endemic?

A

rural latin america, especially brazil

32
Q

How does Paracoccidioides brasiliensis present?

A

mild respiratory infection which can disseminate and develop oral, nasal, and facial nodular ulcerated lesions and submandibular LAD

33
Q

How is Paracoccidioides brasiliensis diagnosed?

A
  • tissue biopsy shows yeast cells with multiple buds (aka pilot well configuration)
  • Serology
34
Q

Treatment of Paracoccidioides brasiliensis?

A
  • several months of Itra

- Ampho for severe

35
Q

Where is Aspergillus fumigatus found and how does it exist?

A

worldwide in a mold with ACUTE branching septate hyphae that grows on decaying vegetation producing chains of conidia

36
Q

Features of Aspergillus fumigatus infection.

A
  • fungus ball formed within cavities of lungs (can produce hemptysis)
  • allergic infection of bronchi that produces asthmatic symptoms and high IgE titer
  • invasive PNA with hemorrhage, infarction, and necrosis
37
Q

What patient population is especially at risk for invasive PNA form of Aspergillus fumigatus?

A

those with hematologic malignancies and neutropenia

38
Q

How does Aspergillus fumigatus present upon CT?

A

Can have single or multiple nodules with cavitation and a a ’halo’ sign which are areas of focal hemorrhage around a lesion

39
Q

How is Aspergillus fumigatus treated?

A
  • Voriconazole for invasive disease (ampho B and echinocandins alternatives if not well-tolerated)
  • remove fungus balls
40
Q

What is the treatment for ABPA?

A

steroids and antifungals

41
Q

Describe Mucormycosis

A

Opportunistic infections caused by bread mold fungi (Mucor, Rhizomes, Cunninghamella, Lichtheimia)

42
Q

What are some risk factors for Mucormycosis?

A
  • diabetes
  • neutropenia
  • Iron excess
  • burns/surgical wounds
  • corticosteroid use
43
Q

How is Mucormycosis transmitted?

A

airbourne spores that invade tissue and blood in those with reduced host defenses

44
Q

How does Mucormycosis present?

A
  • invasive rhinocerebral sinusitis
  • frontal lobe abscesses
  • pneumonia
  • cutaneous infection
45
Q

How does invasive rhinocerebral sinusitis occur?

A

originates in the paranasal sinuses and spreads to the orbit, hard palate, and brain and carries a high mortality rate

46
Q

How is Mucormycosis diagnosed?

A

tissue biopsy with nonseptate broad hyphae with frequent RIGHT ANGLE branching; spores in a sporangium

47
Q

How is Mucormycosis treated?

A

treat underlying disorder + Ampho and surgical removal of necrotic tissue

Alternative: Poscaonazole

48
Q

How does Pneumocystis jiroveci exist?

A

yeast

49
Q

Pneumocystis jiroveci is the most common cause of ___ in immunocompromised patients

A

pneumonia

50
Q

Pathogenesis of Pneumocystis jiroveci (PCP)

A

cysts in alveoli produce inflammation, resulting in frothy exudate that block oxygen exchange (organism does not invade lung tissue)

51
Q

How is Pneumocystis jiroveci cleared?

A

CD4 T cells recruit monocytes and macrophages which clear the organism (thus, AIDS is a major risk factor)

52
Q

How does Pneumocystis jiroveci present?

A
  • Dry cough, progressive dyspnea
  • fever
  • tachypnea, hypoxemia
53
Q

CXR of PCP

A
  • pneumothorax

- bilateral infiltrates

54
Q

How is PCP diagnosed?

A
  • Cysts in lung biopsy or from bronchoscopy fluids
  • fluorescent AB staining
  • PCR on RT specimens
55
Q

How are cysts identified from PCP?

A

methenamine silver, Giemsa stain

56
Q

How is PCP treated?

A

-Cotrimoxazole (Bactrim) (1st line)

57
Q

2nd line options for PCP

A
  • Clindamycin/Primaquine
  • Atovaquone
  • Pentamidine
58
Q

Prophylaxis for AIDS patients with CD4 count below 200?

A

Bactrim, Dapsone, or Atovaquone

59
Q

How does Cryptoococcus neoformans exist?

A

yeast in soil and PIGEON droppings that has the appearance of oval budding yeast with a wide polysaccharide capsule

60
Q

What disease does Cryptoococcus neoformans cause?

A

meningitis in immunocompromised (especially in AIDS)

AND

PNA in immunocompromised AND competent persons

61
Q

How does Cryptoococcus neoformans induced PNA present in immunocompetent persons?

A

asymptomatic or mild respiratory symptoms

62
Q

How does Cryptoococcus neoformans induced PNA present in immunocompromised persons?

A

fever, chest pain, dyspnea, cough, and hemoptysis

63
Q

T or F. CMV is a herpes virus

A

T.

64
Q

How does CMV exist in the body?

A

enters latent state primarily in monocytes and can be reactivated when cell-meidtaed immunity is decreased

65
Q

What patients is CMV commonly reactivated?

A

-renal and stem cell transplant recipients

pneumonitis results

66
Q

What does activation of CMV in AIDS patients cause?

A

colitis and retinitis (typically NOT pneumonitis)

67
Q

Two buzz words with CMV

A

ground glass appearance and inclusion bodies on H&E

68
Q

What causes Nocardiosis?

A

Nocardia asteroides

69
Q

Describe Nocardia asteroides

A

gram+ aerobe found in soil with thin branching filaments

70
Q

In immunocompromised patients, Nocardia asteroides can disseminate and has a predilection for ____

A

brain tissue (can cause brain abscesses)

71
Q

How is Nocardiosis diagnosed?

A

gram stain/acid-fast stain; culture

72
Q

Treatment of Nocardiosis

A

Cotrimoxazole (resistance common- check susceptibilities)

Pulmonary Week 2 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions