Fungal Infections

Question 1

most common candidiasis infection

Answer 1

candida albicans

Question 2

complications of a candida infection

Answer 2

arthritis
meningitis
blindness secondary to retinitis
endocarditis with massive emboli
Abscesses

Question 3

what happens to baby if Mom has candida ammionitis?

Answer 3

congenital candidiasis- red maculopapular or pustular rash

Question 4

clinical manifestations of disseminated candida infection

Answer 4

CV instability
respiratory failure
thrombocytopenia
hyperbilirubinemia
cotton wool spots

Question 5

diagnosis of candida

Answer 5

+pseudohyphae and budding yeast. can wet mount KOH-

Question 6

treatment of candida

Answer 6

• fluconazole
• oral Nystatin first line, clotrimazole for elderly
• renal- treat 7-14 days of fluconazole

Question 7

what predisposes adults to candida thrush?

Answer 7

• corticosteroid inhalation

- HIV!! always consider this if no other reason for it

Question 8

oral thrush infection

Answer 8

• infants: oral Nystatin
• older children: Nystatin mouthwash
• clotrimazole troches 4x a day are alternative in older children
• oral fluconazole if refractory
• eradicate candida from pacifiers, bottles, toys, mother’s breasts

Question 9

where is cryptococcus found in nature?

Answer 9

• SOIL WITH BIRD DROPPINGS!!
• fruit skins or juices
• unpasteurized milk

Question 10

Is cryptococcus curable in AIDS?

Answer 10

no it requires lifelong treatment with fluconazole 200 mg for life, can consider d/c treatment if CD4 count remains high for a prolonged duration

Question 11

where is cryptococcus confined to in immunoCOMPETENT people?

Answer 11

lungs, because cryptococcus spreads via inhalation

Question 12

Two rare complications if cryptococcus

Answer 12

1. cryptococcoma: mass lesson that causes obstructive hydrocephalus
2. meningitis

Question 13

diagnosis of cryptococcal meningitis

Answer 13

+crypt antigen in blood/csf with India ink
+ fungal cultures in blood/csf
csf analysis: pleocytosis, increased opening pressure, increased protein, decreased glucose

Question 14

treatment of cryptococcal meningitis

Answer 14

1. admit for 2 week induction of Amphotericin B (beware of rigors/fevers/chills
2. fluconazole 400 mg x 8 weeks
3. fluconazole 200mg for life

Question 15

exposure to what puts you at risk for histoplasmosis

Answer 15

bird droppings, bats, especially along the OHIO RIVER VALLEY

Question 16

how is histoplasmosis transmitred

Answer 16

inhalation

Question 17

describe the morphology of histoplasmosis

Answer 17

histoplasma capsulatum: dimorphic fungus with septate hyphae

Question 18

describe 3 manifestations of histoplasmosis

Answer 18

1. ACUTE PULMONARY: seen in epidemics
2. PROGRSSIVE DISSEMINSTED: pts with CD4 counts less than 100 or those taking TNF inhibitors. fever, hepatosplenomegaly, ulcers, adrenal gland involvement
   - CXR shows MILIARY PATTERN
3. CHRONIC PULMONARY: older pts with chronic lung dz

Question 19

What is a major complication of histoplasmosis?

Answer 19

Granulomatous mediastinitis- compromise of the great vessels

Question 20

Diagnosis of Histoplasmosis

Answer 20

1. Urine antigen assay!
2. Broncheoalveolar lavage
3. Supportive findings: X-ray may show pulmonary/splenic calcifications, anemia of chronic disease, alk phos and LD elevated, pancytopenia

Question 21

Treatment of histoplasmosis

Answer 21

Itraconazole solution 200-400 mg BID

• add amphotericin B if meningitis present or failure to respond to itraconazole
• lifelong suppression with itraconazole for AIDS patient