Fungal Pulmonary Disease Flashcards Preview

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Flashcards in Fungal Pulmonary Disease Deck (18):
1

Dimorphic
Yeast only
Hyphae only
Neither

Dimorphic - histo, blasto, coccidio...yeast in host and mycelia in nature

YEast only - cryptococucs, candida

Hyphae only - aspergillus or mucormycosis

Neither - pneumocystis

2

Patho of dimorphic fungi

CMI is important and will show granulomas

Non-infectious granuloma does NOT rule out dimorphic fungi

Neither does absence of yeast forms through silver stain

3

Hyphae pathology

Phagocytic function is much more important

Tissue sections show necrotic tissue bc organisms are angioinvasive

Aseprgillus - 45 deg

Mucor - 90 dfegree

4

Histoplasmosis

Endemic to our region

Dimorphic

Soil organism

Outbreaks follow excavation or bird roost exposure

Initial infection subclinical like TB and Blastomycosis with early dissemination and control

Splenic calcifications show resolved

If acute sx, 7-21 days after incubation and mimic influenza

5

Acute inhalational
Chronic cavitary histo

Mimics influenza...may produce buckshot CXR

Mimics calssic TB and favors men with COPD...smoking cessation and itraconazole

6

Disseminated
Mediastinal
Histoplasmoma

Miliary pattern on radiograph

Unique among fungi...adenopathy...differentiate from actue adenitis

Commonest cause of benign lung nodule in KY

7

Blastomycosis

Dimorphic

Symptomatic in only 50% (30-45 day incubation)

Maybe near rivers?

Skin lesions with heaped-up or ulcerated appearance

Fungus mimics cancer (borad based budding yeast)

8

Pneumocystis pneumonia

Profound CMI

Dry cough, fever, dyspnea

Radiograph should airspace infiltrates and pneumatoceles...GGO that can cause pneumothorax

Different than most fungal dzs in tx

9

Infectious comps in HIV

Pneumocystis rare if CD4 above 200

Bactrim is good prophylaxis

10

Coccidiomycosis

Dimoprihc in SW US

Primary infection 7-21 days after exposure...triead of fever, erythema nodosum, and arthralgia

Looks like communicty acquired pnuemonia

May get overwhelimg infection with resp failure and sepctic shock

Dx by serology or spherules

Beware lab cultures but can't transmit person to perosn

11

Invasive aspergillosis
Chronic necrotizing aspergillosis

Hematogenous spread in pro,onged neutropenia (lung transplant, leukemia)...patients with prolonged fever

Structural lung dz and locally impaired immunity (emphy, silicosis)...looks and acts like TB

12

Aspergilloma
Allergic broncho-pulmonary aspergillosis

Usually asymptomatic colonization of pre-existent cavity with slow progression...main sx is hemoptysis

Local hyper-immune rxn leading to bronchiectasis...presents as asthma

13

Mucormycosis

Spore inhalation

Prolonged neutropenia and diabetes with ketoacidosis are risk factros along with heavy metal chelaiton therapy

Pulmonary and rhinocerebral sxs

AMphotericin B and aggrsessive surgery...only active imidazole is posaconozaole

14

Actinomyces

Nocardia

Filamentous, gran-pos bacteria part of mouth flora...crosses tissue plans, invades chest wall and creates fistulas...sulfur granules

Also filamentous but weakly acid fast...immunocompromised and nodular without cavitation

15

Serology

Measures immune response

Best for coccidiomycosis

Histoplasma has 50% false neg and blasto even less sensitive

16

Urine antigen

For histo and blasto

Negative in lung limited, must be disseminated...works with better in immunocompromised

Cross reacts with both fungi

17

Beta-Glucan

Most fungal species (except crypto ans mucor)...best for invasive fungal infections

Neg doesnt rule out

18

Galactomannan

Aspergillus

False positive with Beta-lactams, plasmalyte and other fungal infections