Fungal Disease

Question 1

Describe the etiology of a fungal infection of the lungs

Answer 1

Spore produce a frothy yeast like substance
PMN and macrophages engulf spores
Pulmonary capillaries dilate
Alveolar epithelium swells
Regional lymph nodes become involved

Question 2

Which lung surfaces are most commonly affected by fungal infections?

Answer 2

Apical and posterior segments of the upper lobes are most commonly affected

Question 2

What can be a long term result of fungal infection of the lungs?

Answer 2

Fibrosis and calcification of lung parenchyma replaces granulomas
Lung tissue retracts and grows firm

Question 3

What can severe cases of fungal infection result in?

Answer 3

Tissue necrosis
Granulomas
Cavity formation

Question 4

What kind of disorder are fungal infection survivors left with?

Answer 4

Restrictive pulmonary disorder

Question 5

What are the three most threatening fungal infections of the lungs?

Answer 5

Histoplasmosis
Coccodioidomycosis
Blastomycosis

Question 6

What is the most common fungal infection of the lungs in the united states?

Answer 6

Histoplasmosis

Question 7

What is another name for histoplasmosis?

Answer 7

Ohio valley fever

Question 7

Where is histoplasmosis particularly prevalent?

Answer 7

Ohio, michigan, illinois, mississippi, missouri, kentucky, tennessee, georgia, arkansas

Question 8

What fungus causes histoplasmosis?

Answer 8

Histoplasma capsulatum

Question 9

Where can the spores of histoplasmosis be found?

Answer 9

Soil with bird turds

Question 10

What disease presents similarly to histoplasmosis?

Answer 10

Tuberculosis

Question 11

Why do most people with histoplasmosis not seek medical help?

Answer 11

Only 40% demonstrate symptoms
Only 10% feel sufficiently sick enough to seek medical help

Question 12

What is the most common form of histoplasmosis?

Answer 12

Asymptomatic primary histoplasmosis

Question 12

Who is the most susceptible to a histoplasmosis infection?

Answer 12

HIV/AIDS patients

Question 13

What are the 4 forms that histoplasmosis can take?

Answer 13

Asymptomatic primary histoplasmosis
Acute symptomatic histoplasmosis
Chronic histoplasmosis
Disseminated histoplasmosis

Question 13

What evidence will be present in a patient who had contracted asymptomatic primary histoplasmosis?

Answer 13

Smalled healed lesion in lung parenchyma
Calcified hilar lymph nodes
Patients will test positive with distoplasmin skin test

Question 14

What determines the form that a histoplasmosis infection takes?

Answer 14

An individuals immune response dictates the form the histoplasmosis patient takes

Question 15

What severe symptoms would a patient with acute symptomatic histoplasmosis present with?

Answer 15

Acute pulmonary syndrome
Severe SOB

Question 16

What mild symptoms would a patient with acute symptomatic histoplasmosis present with?

Answer 16

Fever
Muscle pain
Headache
Dry hacking cough
Chills
Chest pain
Weight loss
Sweats

Question 17

What is acute symptomatic histoplasmosis also called?

Answer 17

Spelunkers lung
Frequently develops in cave explorers who recessive excessive exposure to bat shit as they raise dust in caves

Question 18

What does the chest xray of a patient with acute symptomatic histoplasmosis?

Answer 18

Kind of looks star speckled

Question 19

What occurs in chronic histoplasmosis?

Answer 19

Infiltration and cavity formation in the upper lobes of one or both lobes

Question 19

Who is chronic histoplasmosis most commonly seen in?

Answer 19

Middle aged men who smoke

Question 20

What patients are more likely to have disseminated histoplasmosis?

Answer 20

Vulnerable populations Very young/old Compromised immune system

Question 21

What tissues/samples can be used to culture histoplasmosis?

Answer 21

Blood Sputum Tissue from lymph node Lung tissue Bone marrow

Question 22

What is the gold standard for testing and diagnosis histoplasmosis?

Answer 22

Fungal culture

Question 23

What tissues are at risk if histoplasmosis disseminated?

Answer 23

Pretty much everything

Question 24

What do people infected with Coccidioidomycosis present with?

Answer 24

Fever, chest pain, cough, headaches, malaise

Question 25

How long does it take for a histoplasmosis to culture?

Answer 25

4 weeks

Question 25

What are the three tests for histoplasmosis?

Answer 25

Fungal culture - gold standard, but takes a long time fungal stain - very accurate but invasive Serological testing -fast, but not as accurate

Question 26

Where is Coccidioidomycosis endemic to?

Answer 26

Hot dry regions

Question 26

Coccidioidomycosis is also known as

Answer 26

California fever Desert rheumatism San joaquin valley disease Valley fever

Question 27

How does chronic Coccidioidomycosis present?

Answer 27

Nodular growths in lungs Cavity formation in the lungs

Question 28

How does disseminated Coccidioidomycosis present?

Answer 28

Swollen lymph nodes, meninges, spleen, liver, kidney and adrenal glands Skin lesions accompanied by joint pain in ankles and knees

Question 29

Where is blastomycosis endemic to?

Answer 29

South central and midwestern united states and canada

Question 29

How can Coccidioidomycosis be diagnosed?

Answer 29

Direct visualization of distinctive spherules in microscopy of patients sputum, tissue exudates, biopsies or spinal fluid Blood tests that can detect antibodies to the function Culture the organisms

Question 29

What is blastomycosis also known as?

Answer 29

Chicago disease Gilchists disease North american blastomycosis

Question 30

How does blastomycosis infection present?

Answer 30

Fever, cough, hoarseness, joint and muscle aches, possible pleuritic pain Productive cough, purulent sputum Skin lesions

Question 31

How is blastomycosis diagnosed?

Answer 31

Relies on direct visualization of yeast in sputum smears Culturing the fungus

Question 32

What are opportunistic fungal pathogens that infect the lungs?

Answer 32

Candida albicans Cryptococcus neoformans Asperigillus

Question 33

Where is aspergillus typically found?

Answer 33

Soil, vegetation, leaf detritus, food, and compost heap Air of granaries, barns and silos

Question 33

What can cause a candida albicans infection?

Answer 33

Inhaled steroid medications without washing mouth

Question 34

What can an aspergillus infection present as?

Answer 34

Allergic bronchopulmonary aspergillus, associated with asthma

Question 34

What distinctive formation can be found in the lungs as a result of aspergillus?

Answer 34

Aspergilloma = fungus ball that colonizes in a healed lung scar or abscess from a previous disease

Question 35

What findings would be present on a patient with a fungal infection in their lungs present with?

Answer 35

Decreased volumes, flows, capacities

Question 36

What would radiologic findings show in a patient with a pulmonary fungal infection?

Answer 36

Increased opacity Cavity formation Pleural effusion Calcification and fibrosis Right ventricular enlargement

Question 37

What is an RTs role in treating a patient with a pulmonary fungal infection?

Answer 37

Supportive treatment Oxygen therapy Bronchopulmonary hygiene Mechanical ventilation

Question 38

What is the treatment of choice for treating pulmonary fungal infections?

Answer 38

Amphotercicin B

Question 39

What is an alternative medication that can be used to treat fungal infections?

Answer 39

Azole antifungal agents Fluconazole and itraconazole