Fungal Pneumonia and Antifungals

Question 1

what type of patients usually suffer from fungal infections?

Answer 1

immunocompromised

Question 2

name three types of acquired immunodeficiencies that predispose to fungals

Answer 2

HIV
Cancer
Transplant

Question 3

what are the three respiratory pathogenic yeasts?

Answer 3

candida
cryptococcus
pneumocystis

Question 4

what are the three respiratory pathogenic molds?

Answer 4

aspergillus
Mucor
rhizopus

Question 5

what are the three respiratory dimorphics that are pathogenic?

Answer 5

histoplasma
blastomyces
coccidioides

Question 6

what is the key pearl on candida albicans?

Answer 6

germ tube formation

Question 7

what type of disorder leads to risk for candida albican pneumonia?

Answer 7

neutropenic patients

Question 8

which two antifungals are used for treating candida respiratory infections?

Answer 8

echinocandins and amphotericin B

Question 9

what type of cell is cryptococcus?

Answer 9

encapsulated yeast

Question 10

where are the two common sites for cryptococcus infection?

Answer 10

meningitis and respiratory (pneumonia)

Question 11

what two drugs to treat cryptococcal infection?

Answer 11

amphotericin B and flucytosine

Question 12

with PCP or PJP what is the characteristic shape that forms as yeast?

Answer 12

cyst like yeast forms…looks like hamburger

Question 13

what type of pneumonia do you see with PJP on Xray?

Answer 13

interstitial pneumo with ground glass infiltrates

Question 14

where does PJP usually occur as infection?

Answer 14

mainly in lungs…outside if super immunocomp like AIDS

Question 15

what are the two drugs used to treat PJP usually? why these?

Answer 15

sulfamethoxazole and trimethoprim

antibiotics because resistant to antifungals

Question 16

is aspergillus septate or aseptate hyphae?

Answer 16

septate hyphae!

Question 17

what is a disease that aspergillus is commonly seen with?

Answer 17

hematologic malignancies

Question 18

what is the best drug to treat aspergillus?

Answer 18

voricanizole

Question 19

are mucor/rhizopus septate or aseptate?

Answer 19

aseptate

Question 20

what is the best drug to treat mucor/rhizopus?

Answer 20

amphotericin B

Question 21

what is the stain used to see cryptococcus?

Answer 21

india pink stain

Question 22

what is the buzz word that describes how candida grows?

Answer 22

budding yeast or pseudohyphae

Question 23

what must you get to treat a candida pneumonia?

Answer 23

a tissue biopsy

Question 24

what stain is commonly used to see PJP?

Answer 24

silver stain

Question 25

what three laboratory techniques are used to see PJP?

Answer 25

direct visualization in lung tissue BAL induced sputum

Question 26

describe how aspergillus grows in the lungs

Answer 26

it makes fungal balls that are called aspergillomas...they reside in the cavities of the lungs

Question 27

how do you visualize aspergillus for diagnosis?

Answer 27

direct observation in tissue

Question 28

how do you visualize mucor and rhizopus for diagnosis?

Answer 28

direct observation in tissue

Question 29

describe how histoplasma capsulatum looks by shape in a patient and where they reside?

Answer 29

oval cells inside tissue macrophages

Question 30

when do you treat histoplasma and with what?

Answer 30

itraconazole and amphotericin B only when symptoms are really bad

Question 31

describe what happens when histoplasma is grown in lab and what is the shape of it?

Answer 31

taken from patient as yeast and allowed to grow in lab it will become a mold...the mold looks like a ships wheel

Question 32

describe the shape of blastomyces

Answer 32

thick walled yeast with broad based budding

Question 33

what is tricky about pneumonia with blastomyces?

Answer 33

it originally appears to be bacterial but does not respond to any antibiotics

Question 34

what is treatment for blastomyces?

Answer 34

amphotericin B and itraconazole

Question 35

where is coccidioides immitis most common?

Answer 35

in the SW USA

Question 36

describe the shape of coccidioides

Answer 36

circular with endospored when in tissue, but in environment it is barrel shaped

Question 37

what does coccidioides form in the lung (2)

Answer 37

cavity or nodules

Question 38

which of the dimorphic organisms is associated with desert bumps or erythema nodosum?

Answer 38

coccidioides

Question 39

what is the treatment for coccidioides?

Answer 39

amphotericin B or fluconzole

Question 40

what is nocardia asteroides?

Answer 40

this is a branching bacteria that can cause pneumonia

Question 41

how do you describe Nocardia asteroides?

Answer 41

beaded filaments that are weakly acid fast

Question 42

how to treat nocardia asteroides?

Answer 42

SMX/TMP

Question 43

what is actinomyces israelii?

Answer 43

a branching bacteria that can cause pneumonia

Question 44

what symptom do people with actinomyces israelii normally have?

Answer 44

oral/facial abscesses

Question 45

how to treat actinomyces israelli?

Answer 45

penicillin

Question 46

what is the shape of actinomyces israelii and is it acid fast?

Answer 46

filamentous...not acid fast, unlike nocardia

Question 47

what two aspects of fungi are usually targeted with antigen detection tests?

Answer 47

mannoproteins and beta glucans

Question 48

what three bugs have good fungal antigen detection tests?

Answer 48

cryptococcus aspergillus histoplasma