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Fungal Pneumonia Flashcards

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1
Q

Dimorphic fungi

A
  1. Blastomyces dermatitidis
  2. Histoplasma capsulatum
  3. Coccidioides immitis
  4. Paracoccidioides brasiliensis
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2
Q

Characteristics of Histoplasma capsulatum

A
  1. Endemic in mississippi and ohio river valleys

2. grows in soil and bird droppings

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3
Q

Dx of Histoplasma capsulatum

A
  1. Tissue biopsy: Oval yeast cells within macrophages
  2. serology
  3. Urinary antigen
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4
Q

Tx of Histoplasma capsulatum

A
  1. Itraconazole (mild/moderate)

2. Amphotericin (IV) followed by Itraconazole (PO) (for severe)

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5
Q

Characteristics of Blastomyces dermatitidis

A
  1. Endemic in Ohio/Mississippi river valleys; Missouri and Arkansas river basins
  2. grows in moist soil
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6
Q

Dx of Blastomyces dermatitidis

A
  1. Tissue biopsy: Thick-walled yeast cells with SINGLE BROAD-BASED BUD
  2. serology
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7
Q

Tx of Blastomyces dermatitidis

A
  1. First Line: Itraconazole (IV) or [Amphotericin (IV) - if severe]
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8
Q

Characteristics of Coccidioides immitis

A
  1. Endemic in Southwestern U.S. and latin America
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9
Q

What organisms cause erythema nodosum?

A
  1. Blastomyces dermatitidis
  2. Coccidioides immitis
  3. MTB
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10
Q

Pathogenesis of Coccidioides immitis

A

In the lungs, large spherules form and are filled with endospores

-spherule walls rupture, endospores are released and differentiate into new spherules

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11
Q

Who are at increased risk for Coccidioides immitis dissemination?

A
  1. African-Americans
  2. Filipinos
  3. Women in 3rd Trimester
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12
Q

Dx of Coccidioides immitis

A
  1. serology
  2. spherules seen microscopically
  3. Eosinophilia is common
  4. Skin test (not common)
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13
Q

Tx for Coccidioides immitis infection

A
  1. Amphotericin (for persistant lung lesion or disseminated disease) (also immunocompromised)
    - followed by itraconazole or flucanazole PO
  2. Fluconazole for meningitis
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14
Q

Characteristics of Paracoccidioides brasiliensis

A
  1. Found in rural Latin America, especially Brazil
  2. More severe desseminated clinical manifestation: oral, nasal and facial nodular ulcerated lesions and submandibular LAD
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15
Q

Dx of Paracoccidioides brasiliensis

A
  1. Tissue biopsy: Yeast cells with multiple buds

2. Serology

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16
Q

Tx of Paracoccidioides brasiliensis

A
  1. Itraconazole - for several months

2. Amphotericin for severe disease

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17
Q

Characteristics of Aspergillus fumigatus

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A
  1. found worldwide
  2. Mold with septate hyphae
  3. Grow on decaying vegetation producing chains of conidia
18
Q

Features of Aspergillus fumigatus infections

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A
  1. Fungus ball within cavities of lung
    - produce hemoptysis
  2. Allergic rxn of the bronchi
    - produces asthmatic symptoms and high IgE titer
  3. Invasive pneumonia
    - producing hemorhage, infarction, and necrosis
    * esp in those w/ heme malignancies and neutropenia
19
Q

Largest risk factor for Aspergillus fumigatus pneumonia?

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A

Having a hematologic malignancy and neutropenia

20
Q

Dx of Aspergillus fumigatus

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A

Biopsy:

  1. Septate, acute-angle branching hyphae
  2. radiating chains of conidia
21
Q

Characteristic finding in Aspergillus CT scan?

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A

Halo sign (cloudiness) around lesions

  • caused by focal hemorrhage around the lesion
22
Q

Tx of Aspergillus fumigatus

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A
  1. First line: Voriconazole (IV/PO)
    2nd: Amphotericin or posaconazole (PO)
  2. Remove fungus balls
  3. for allergic bronchopulmonary aspergillus fumigatus (ABPA): steriods and antifungal agents
23
Q

Characteristics of Mucormycosis

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A
  1. Oppertunistic infection caused by bread mold fungi
  2. nonseptate broad hyphae with frequent right angle branching*
  3. Tranmission: airborne spores
  4. invade tissues and vessels (angioinvasive)
24
Q

Risk factors for mucormycosis

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A
  1. DM
  2. Neutropenia
  3. Iron overload
  4. Burns/surgical wounds
  5. Corticosteroid use
25
Clinical manifestations of mucormycosis
1. invasive rhinocerebral sinusitis, brain abscesses - originates in paranasal sinuses and spreads to orbit, hard palat - high mortality rate 2. Pneumonia 3. Cutaneous infection
26
Dx of mucormycosis
Biopsy - nonseptate broad hyphae with frequent right angle branching. - spores in a sporangium
27
Tx of mucormycosis
- tx underlying disorder - amphotericin - surgical removal of necrotic infected tissue - posaconazole can also be used
28
Characteristics of Pneumocysitis jiroveci (carinii)
1. Yeast 2. leading cause of death in AIDs patients 3. causes pneumonia in immunocompromised (PCP)
29
Pathogenesis of Pneumocysitis jiroveci (carinii)
Cysts in alveoli produce inflammatory response resulting in frothy exudate that blocks 02 exchange - CD4+ T cells clear out the organism
30
Main risk factor for Pneumocysitis jiroveci (carinii)
CD4 count
31
Dx of PCP
1. Lung biopsy: cysts - Methenamine silver or Giemsa stains 2. Flourescent antibody staining 3. PCR on respiratory tract specimens
32
Tx of PCP
1st line: Trimethoprim-Sulfamethoxazole - Clindamycin/Primaquine - Atovaqone - Pentamidine *prophylaxis for AIDs patients with CD4 ct
33
Characteristics for Cryptococcus neoformans
1. Oval budding yeast with polysaccharide capsule | 2. Found in soil and bird (pigeon) droppings
34
Clinical manifestations of Cryptococcus neoformans
1. Causes meningitis in immunocomp. (AIDS) - most common life-threatening disease in AIDS pts 2. Pneumonia in immunosuppressed/compromised
35
Characteristics of cytomegalovirus (CMV)
1. DNA enveloped Virus - similar in morphology and structure to other herpes virus 2. Enters latent state primarily in monocytes and reactivates when immunity decreased
36
Clinical manifestations of CMV
Asymptomatic except in immunosuppresed (esp renal and stem cell transplant recipients) => Pneumonitis - Colitis and retinitis in AIDS pts. (no pneumonitis)
37
Characteristics of Nocardia asteroides
1. Aerobic GP bacterium 2. may be weakly acid-fast 3. thin branching filaments 4. Found in soil - causes Nocardiosis
38
Clinical manifestation of Nocardiosis in immunocompromised
1. causes pneumonia, lung abscess with cavity formation, lung nodules or emphysema 2. Predilection for brain tissue causing abscesses
39
Dx for Nocardiosis
1. Gram stain/acid-fast stain | 2. culture
40
Tx for Nocardiosis
Trimethoprim-sulfamethoxazole - may need combination therapy. Resistance can occur
41
Tx for Cryptococcus neoformans infection
1. CNS: Amphotericin B (IV) + flucytosine (PO) | 2. Non-CNS: Fluconazole (PO)

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