Blastomycosis Etiology
South central and midwestern US and Can; Blastomyces sp
Blastomycosis S/S
Chronic pulm infection common but can be asymptomatic; cough, fever, dyspnea, chest pn, often w/purulent sputum, pleurisy
Blastomycosis Lab
Leukocytosis and anemia; CXR/CT: airspace consolidation or masses
Blastomycosis Management
No CNS involvement: itraconazole (PO); CNS involvement: IV amphotericin B
Blastomycosis Prevention
Monitor pt for relapse
Mucormycosis Etiology
Opportunistic infections of Rhizopus, Mucor, Absidia, Cunninghamella; lots of predisposing conditions
Mucormycosis S/S
Invasive dz of sinuses, orbits, lungs; widely disseminated more common post-chemo and broad spectrum antifungal prophylaxis
Mucormycosis Lab
Biopsy required for dx; cultures us. negative
Mucormycosis Management
Prolonged amphotericin B; posaconazole following control of acute infection
Mucormycosis Prevention
Control of dm and other underlying conditions; extensive repeated surgical debridement of necrotic tissue
Candidiasis Etiology
Common normal flora an opportunistic pathogen; oral (thrush), vaginal (vaginitis), GI mucosal (esophagitis) cardiac (endocarditis) dzs
Candidiasis S/S
Esophageal: osynophagia, GERD, nausea
Vulvovaginal: vulvar pruritis, burning discharge, dyspareunia
UTI: same sx as bacterial
Candidiasis Lab
Disseminated: blood cx (50%), positive mucosal cx (urine sputum)
Hepatosplenic: alkaline phosphatase elevated, tissue biopsy/cx, blood cx not definitive
Endocarditis: dx requires either pos cx from blood, emboli, or from vegetations on valves
Esophageal: endoscopy w/biopsy and cx
Candidiasis Management
Esophegeal: Fluconazole (PO) or Itraconazole (PO)
Vulvovaginal: Clotrimazole (topical) or Fluconazole (PO)
Candidemia: Fluconazole (IV)
Hepatosplenic: Fluconazole (PO) and amphotericin B (IV)
Endocarditis: Amphotericin (IV), Fluconazole (PO) can be added
Candidiasis Prevention
Prevent unnecessary usage of broad spectrum abx and IV catheters; relapse common in HIV pts; fluconazole prophylaxis recommended for high-risk pts (induction chemo)
Cryptococcoses Etiology
Most common cause of fungal meningitis; many species; usually found in immunocompromised pts (esp. chemo, Hodgkin, corticosteroid use, HIV, transplant)
Cryptococcoses S/S
HA, confusion, CN abnormalities, N/V, nuchal rigidity; respiratory sx (C gatti); cellulitis-like sx (C neoformans)
Cryptococcoses Lab
HIV pts: serum cryptococcal antigen
Cryptococcal meningitis: CSF shows (a lot of stuff)
MRI more sensitive than CT in finding CNS abnormalities
Cryptococcoses Management
Acute: Amphotericin B (IV) eventually switching to Fluconazole (PO)
Maintenance: Fluconazole (AIDS pt should receive continuous prophylaxis)
Cryptococcoses Prevention
Repeated lumbar punctures or ventricular shunting to relieve high CSF pressure or hydrocephalus
Histoplasmosis Etiology
H capsulatum; found in soil contaminated w/bird or bat droppings in endemic areas (OH/MS River valleys, etc); common in immunocompromised; inhaled
Histoplasmosis S/S
Most cases asymptomatic; flu-like illness sx; more severe atypical pneumonia sx
Progressive/disseminated: Fever, weight loss, dyspnea, cough, ulcers of MM, HSM, IBD-like sx, septic shock (immunocompromised pts)
Histoplasmosis Lab
Elevated: alkaline phosphatase, lactase dehydrogenase, ferritin; anemia; sputum culture only pos in chronic resp histo; antigen testing of bronchoalveolar lavage fluid may be beneficial; bone marrow cx and urine antigen very sensitive; lung/splenic calcifications may be seen with radiographs
Histoplasmosis Management
Acute: Itraconazole (POP)
Severe: Amphotericin B (IV)
HIV prophylaxis: Itraconazole (PO)
Histoplasmosis Prevention
Acute histoplasmosis usually resolves within 6 months w/tx; Progressive/disseminated histoplasmosis will result in death if untreated
