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Flashcards in Fungal Infections of the Respiratory Tract Deck (83):
1

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

Histoplasmosis

2

Where is histoplasma usually found?

Midwest and central states along the ohio and Mississippi river valleys

3

What type of soil is histoplasmosis usually found in?

Those with bird or bat droppings

4

Spelunkers disease = ?

Histoplasmosis

5

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

Yeast in the heat, mold in the cold

6

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

Caves
Farm buildings
Wood lots

7

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

Inhalation
Transplantation

8

Who is at risk for the development of histoplasmosis?

Impaired cell mediated immunity

9

What are the findings with resolved histoplasmosis infections?

Calcified lung nodules

10

What is the mortality rate with histoplasmosis?

7.5%

11

What is the most common manifestation of histoplasmosis?

Asymptomatic infection

12

How long do subacute cases of histoplasmosis last for?

Weeks to months post exposure

13

What are the ssx of histoplasmosis?

Fevers
Chills
Cough
Chest pain
Myalgias

(non-specific)

14

What are the usual exam findings with histoplasmosis?

Rales and possibly consolidation

15

What are the CXR finding with histoplasmosis?

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

16

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

COPD

17

How long does the LAD with histoplasmosis last for?

Years

18

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

Sarcoidosis

19

What is sarcoidosis?

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

20

Who is sarcoidosis usually seen in (Ethnicity)?

Blacks

21

What are the two forms of acute histoplasmosis?

Reticulonodular
Milliary

22

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

Broncholithiasis
Mediastinal granuloma
Fibrosing mediastinitis

23

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

Pericarditis
Superior vena cava syndrome

24

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

Rheumatological

25

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

Erythema nodosum
Erythema multiforme

26

What is erythema nodosum?

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

27

What pulmonary findings what suggest histoplasmosis? (4)

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

28

What other finding with pericarditis should histoplasmosis be suspected?

-Pericarditis with LAD

29

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

Cultures
Weeks

30

What is the fastest way to diagnose histoplasmosis?

Antigen detection in the blood or urine

31

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

H. Capsulatum galactomannan

32

Complement tities of what value are highly suggestive of histoplasmosis?

1:32

33

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

CF = sensitive
ID = specific

34

How do you treat mild-moderate Histoplasmosis?

Itraconazole for 6-12 weeks

35

How do you treat moderate-severe Histoplasmosis?

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

36

How do you treat the cavitary form of histoplasmosis?

Itraconazole for at least 12 months

37

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

Desert southwest

38

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

Immitis = california
Posadasii =elsewhere

39

What form is coccidioidomycosis found in?

Yeast in the heat, mold in the cold

40

What is the seasonal variation with coccidioidomycosis?

dry seasons following rainy ones

41

Valley fever = ?

coccidioidomycosis

42

What is the histological finding with coccidioidomycosis?

Spherules

43

Spherules on histology = ?

coccidioidomycosis

44

What is the most common clinical presentation of coccidioidomycosis?

Asymptomatic to benign fever

45

What is the most common symptom of coccidioidomycosis?

Pneumonia with hemoptysis

Fatigue and arthralgias

46

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

Erythema multiforme
Erythema nodosum

Much less common than histo

47

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

None needed

48

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

Reticulonodular
Chronic fibrocavitary pneumonia

49

What is the best way to diagnose coccidioidomycosis? Why?

Serological testing

Culture takes too long to grow, and exposes lab workers

50

True or false: any positive test for coccidioidomycosis is significant

True

51

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

No

52

What are the specific serological tests for coccidioidomycosis?

ELISA
Complement fixation

53

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

If cavities are thin walled and asymptomatic

54

What is the use of the skin test for coccidioidomycosis?

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

55

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

12 months of an azole

56

What is the treatment for reticulonodular pneumonia caused by coccidioidomycosis?

Amp B

57

Where, geographically, is Blastomycosis usually found?

Southeastern and south-central states

58

Where in the environment is Blastomycosis usually found

WOoded areas with decaying vegetation

59

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

Yeast in the heat, mold in the cold

60

What are the histological findings of Blastomycosis?

Broad based budding yeast with a thick wall

61

What are the two most common infections with Blastomycosis?

Lung (91%)
Skin (18%)

62

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

Verrucous with irregular borders and gray to violet color

63

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

Pneumonia (just like TB/others)

64

What are the characteristics of the cough with Blastomycosis ?

non-productive, progressing to productive

65

How do you diagnose Blastomycosis?

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

66

True or false: symptomatic Blastomycosis usually requires treatment

True

67

What is the treatment for Blastomycosis?

Amp B until 1-2 weeks

If mild, then itraconazole

68

Who gets infected with pneumocystis?

Only Immunocompromised

69

True or false: most of us never encounter pneumocystis

False--very common. Is a opportunistic infection

70

What type of tumors predisposed to pneumocystis infection?

Solid tumors or hematological malignancies

71

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

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

72

What are the typical ssx of pneumocystis infection?

Cough and fever

73

What are the CXR findings with pneumocystis?

Bilateral interstitial infiltrates, maybe pneumothorax

74

What are the CT findings with pneumocystis?

Ground glass changes

75

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

pneumocystis

76

Can you culture pneumocystis? How do you diagnose it?

-No
-Need to stain with special stains

77

What is the typical way to diagnose pneumocystis?

Hypertonic saline and BAL sample

78

What is the treatment for pneumocystis?

TMP-SMX

79

What level of prednisone use should prophylaxis begin for pneumocystis?

Greater than than 20 mg daily

80

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

Alemtuzumab

81

What leukemia should have prophylaxis for pneumocystis?

ALL

82

What is the prophylactic treatment for pneumocystis?

TMP-SMX once daily

83

Below what CD count are HIV patients susceptible to pneumocystis?

200