Fungal Infections of the Respiratory Tract

Question 1

What is the most common endemic fungal infection in the US?

Answer 1

Histoplasmosis

Question 2

Where is histoplasma usually found?

Answer 2

Midwest and central states along the ohio and Mississippi river valleys

Question 3

What type of soil is histoplasmosis usually found in?

Answer 3

Those with bird or bat droppings

Question 4

Spelunkers disease = ?

Answer 4

Histoplasmosis

Question 5

What is the morphological change that histoplasma undergoes from the soil to in the body?

Answer 5

Yeast in the heat, mold in the cold

Question 6

What are the typical locations that contain histoplasmosis? (3)

Answer 6

Caves
Farm buildings
Wood lots

Question 7

What are the two major routes through which histoplasmosis gains access to the body?

Answer 7

Inhalation

Transplantation

Question 8

Who is at risk for the development of histoplasmosis?

Answer 8

Impaired cell mediated immunity

Question 9

What are the findings with resolved histoplasmosis infections?

Answer 9

Calcified lung nodules

Question 10

What is the mortality rate with histoplasmosis?

Answer 10

7.5%

Question 11

What is the most common manifestation of histoplasmosis?

Answer 11

Asymptomatic infection

Question 12

How long do subacute cases of histoplasmosis last for?

Answer 12

Weeks to months post exposure

Question 13

What are the ssx of histoplasmosis?

Answer 13

Fevers
Chills
Cough
Chest pain
Myalgias

(non-specific)

Question 14

What are the usual exam findings with histoplasmosis?

Answer 14

Rales and possibly consolidation

Question 15

What are the CXR finding with histoplasmosis?

Answer 15

Hilar and mediastinal lymphadenopathy with focal infiltrates which are patchy or nodular in appearance

Question 16

Cavitations with histoplasmosis, but are sometimes seen with what disease?

Answer 16

COPD

Question 17

How long does the LAD with histoplasmosis last for?

Answer 17

Years

Question 18

What is the main other noninfectious disease that looks very similar to histoplasmosis?

Answer 18

Sarcoidosis

Question 19

What is sarcoidosis?

Answer 19

Decreased cell mediated immunity, but increase humoral immunity. This causes

Question 20

Who is sarcoidosis usually seen in (Ethnicity)?

Answer 20

Blacks

Question 21

What are the two forms of acute histoplasmosis?

Answer 21

Reticulonodular

Milliary

Question 22

What are the pulmonary clinical manifestations of histoplasmosis? (3)

Answer 22

Broncholithiasis
Mediastinal granuloma
Fibrosing mediastinitis

Question 23

What are the cardiac/vascular clinical manifestations of histoplasmosis? (2)

Answer 23

Pericarditis

Superior vena cava syndrome

Question 24

What are the systemic clinical manifestations of histoplasmosis? (1)

Answer 24

Rheumatological

Question 25

What are the dermatological clinical manifestations of histoplasmosis? (2)

Answer 25

Erythema nodosum | Erythema multiforme

Question 26

What is erythema nodosum?

Answer 26

an inflammatory condition characterised by inflammation of the fat cells under the skin, resulting in tender red nodules or lumps that are usually seen on both shins. It can be caused by a variety of conditions

Question 27

What pulmonary findings what suggest histoplasmosis? (4)

Answer 27

- Pneumonia with mediastinal adenopathy - Mediastinal or hilar masses - Pulmonary nodule - Cavitary lung disease

Question 28

What other finding with pericarditis should histoplasmosis be suspected?

Answer 28

-Pericarditis with LAD

Question 29

What is the most useful test to diagnose Histoplasmosis? How long does this take?

Answer 29

Cultures | Weeks

Question 30

What is the fastest way to diagnose histoplasmosis?

Answer 30

Antigen detection in the blood or urine

Question 31

What does the urine/blood test for histoplasmosis look for?

Answer 31

H. Capsulatum galactomannan

Question 32

Complement tities of what value are highly suggestive of histoplasmosis?

Answer 32

1:32

Question 33

Which has a higher sensitivity, and which has a higher specificity: complement fixation, immunodiffusion

Answer 33

``` CF = sensitive ID = specific ```

Question 34

How do you treat mild-moderate Histoplasmosis?

Answer 34

Itraconazole for 6-12 weeks

Question 35

How do you treat moderate-severe Histoplasmosis?

Answer 35

Amp B 1-2 weeks, then itraconazole for 12 weeks

Question 36

How do you treat the cavitary form of histoplasmosis?

Answer 36

Itraconazole for at least 12 months

Question 37

What is the most common region of the US for coccidioidomycosis?

Answer 37

Desert southwest

Question 38

What are the 2 specific of coccidioidomycosis? Where are each of these found?

Answer 38

Immitis = california | Posadasii =elsewhere

Question 39

What form is coccidioidomycosis found in?

Answer 39

Yeast in the heat, mold in the cold

Question 40

What is the seasonal variation with coccidioidomycosis?

Answer 40

dry seasons following rainy ones

Question 41

Valley fever = ?

Answer 41

coccidioidomycosis

Question 42

What is the histological finding with coccidioidomycosis?

Answer 42

Spherules

Question 43

Spherules on histology = ?

Answer 43

coccidioidomycosis

Question 44

What is the most common clinical presentation of coccidioidomycosis?

Answer 44

Asymptomatic to benign fever

Question 45

What is the most common symptom of coccidioidomycosis?

Answer 45

Pneumonia with hemoptysis Fatigue and arthralgias

Question 46

What are the skin lesions that can be found with coccidioidomycosis? HOw common is this compared to Histoplasmosis?

Answer 46

Erythema multiforme Erythema nodosum Much less common than histo

Question 47

What is the treatment for the pulmonary nodules that can occur with coccidioidomycosis?

Answer 47

None needed

Question 48

Which 2 forms of pneumonia d/t coccidioidomycosis infection requires treatment?

Answer 48

Reticulonodular | Chronic fibrocavitary pneumonia

Question 49

What is the best way to diagnose coccidioidomycosis? Why?

Answer 49

Serological testing Culture takes too long to grow, and exposes lab workers

Question 50

True or false: any positive test for coccidioidomycosis is significant

Answer 50

True

Question 51

Does a negative test for coccidioidomycosis r/o it definitively?

Answer 51

No

Question 52

What are the specific serological tests for coccidioidomycosis?

Answer 52

ELISA | Complement fixation

Question 53

How do you determine if the cavitary lesions seen with coccidioidomycosis need treatment?

Answer 53

If cavities are thin walled and asymptomatic

Question 54

What is the use of the skin test for coccidioidomycosis?

Answer 54

helps to r/o, but any exposure will result in a positive test

Question 55

What is the treatment for chronic fibrocavitary disease caused by coccidioidomycosis?

Answer 55

12 months of an azole

Question 56

What is the treatment for reticulonodular pneumonia caused by coccidioidomycosis?

Answer 56

Amp B

Question 57

Where, geographically, is Blastomycosis usually found?

Answer 57

Southeastern and south-central states

Question 58

Where in the environment is Blastomycosis usually found

Answer 58

WOoded areas with decaying vegetation

Question 59

What is the form of blastomycosis in the environment and in the body

Answer 59

Yeast in the heat, mold in the cold

Question 60

What are the histological findings of Blastomycosis?

Answer 60

Broad based budding yeast with a thick wall

Question 61

What are the two most common infections with Blastomycosis?

Answer 61

Lung (91%) | Skin (18%)

Question 62

What are the characteristics of the skin lesion produced by Blastomycosis?

Answer 62

Verrucous with irregular borders and gray to violet color

Question 63

What is the usual presentation of Blastomycosis (when symptomatic)?

Answer 63

Pneumonia (just like TB/others)

Question 64

What are the characteristics of the cough with Blastomycosis ?

Answer 64

non-productive, progressing to productive

Question 65

How do you diagnose Blastomycosis?

Answer 65

Culture is definitive, but presumptive diagnosis can be made with sputum sample with yeast

Question 66

True or false: symptomatic Blastomycosis usually requires treatment

Answer 66

True

Question 67

What is the treatment for Blastomycosis?

Answer 67

Amp B until 1-2 weeks If mild, then itraconazole

Question 68

Who gets infected with pneumocystis?

Answer 68

Only Immunocompromised

Question 69

True or false: most of us never encounter pneumocystis

Answer 69

False--very common. Is a opportunistic infection

Question 70

What type of tumors predisposed to pneumocystis infection?

Answer 70

Solid tumors or hematological malignancies

Question 71

What is the usual presentation of pneumocystis infection in the HIV patient? Non HIv?

Answer 71

- HIV = gradual | - Non-HIV = fulminant respiratory failure

Question 72

What are the typical ssx of pneumocystis infection?

Answer 72

Cough and fever

Question 73

What are the CXR findings with pneumocystis?

Answer 73

Bilateral interstitial infiltrates, maybe pneumothorax

Question 74

What are the CT findings with pneumocystis?

Answer 74

Ground glass changes

Question 75

HIV patient who develops pneumonia leading to a pneumothorax should be suspected of having what infection?

Answer 75

pneumocystis

Question 76

Can you culture pneumocystis? How do you diagnose it?

Answer 76

- No | - Need to stain with special stains

Question 77

What is the typical way to diagnose pneumocystis?

Answer 77

Hypertonic saline and BAL sample

Question 78

What is the treatment for pneumocystis?

Answer 78

TMP-SMX

Question 79

What level of prednisone use should prophylaxis begin for pneumocystis?

Answer 79

Greater than than 20 mg daily

Question 80

Use of what drug indicates that need to use prophylactic therapy for pneumocystis?

Answer 80

Alemtuzumab

Question 81

What leukemia should have prophylaxis for pneumocystis?

Answer 81

ALL

Question 82

What is the prophylactic treatment for pneumocystis?

Answer 82

TMP-SMX once daily

Question 83

Below what CD count are HIV patients susceptible to pneumocystis?

Answer 83

200