FUNGUS

Question 1

what are fungi

Answer 1

eukaryotic, non motile, rigid cell wall (chitin/polysacch), ergosterol cell membrane

Question 2

fungi- yeasts describe and name (review)

Answer 2

• round/oval/budding repro
• candida
• cryptococcus neoformas

Question 3

fungi- molds describe and list (review)

Answer 3

tubular hyphae, aspergillus

Question 4

dimorphic fungi- name

Answer 4

histoplasmosis (endemic fungi)

year OR mold form

Question 5

chest CT scan used for what?

Answer 5

pneumocystis jirovecii pneumonia

(PCP)

Question 6

PCP Pneumonia- what is it, common in who, high risk lab result??

Answer 6

fungi w protozoa characteristics

• common in AIDS pts (before prophylaxis)
• CD4>200 high risk
• 10-20% population carries, eventually clears

Question 7

PCP S+S

Answer 7

• progressive dyspnea (short of breath)
• non productive cough
• fever
• hypoxemia

Question 8

PCP lab/image findings

Answer 8

• hypoxemia (extertional/when walking with pulse ox)
• elevated LDH
• CXR (bilat symmetrical pattern)/CT chest (ground glass)
• ground glass opacity on x-ray (inc opacity)

Question 9

PCP diagnose/test

Answer 9

• PCR sputum
• bronchoscopy into lungs, squirts water and soaks up water to send for analysis (PCR)
• serum B-D-glucan positive

Question 10

PCP treatment

Answer 10

BACTRIM.—-TMP/SMX for 21 days

• possibly steroids for hypoxemia

Question 11

PCP prophylaxis

Answer 11

start when CD4<200 w HIV/immunocomp pt

BACTRIM IS FIRST LINE.

(less than 200=aids, need to be on antibio)

Question 12

Candida- what are they, grow how

Answer 12

yeast, unicellular, grow well in CULTURE media

albicans and glabrata!

Question 13

Candida found where

Answer 13

part of normal flora

can invade GI, female genital tract, skin

Question 14

candida barriers

Answer 14

• INTACT skin and mucosa
• WBC

Question 15

candida host risk factors

Answer 15

• immunosuppression
• DM
• disruption of skin

Question 16

candida exogenous risk factors

Answer 16

• catheters (urinary, venous)
• ABX use (kills normal flora)

Question 17

candida auris- describe

Answer 17

HIGHLY RESISTANT to fluconazole (common treatment)

def consider when screening for candida infection

Question 18

candida infections- THRUSH

• describe
• location

Answer 18

creamy, curd like patch on tongue/oral mucosa

Question 19

thrush treatment

Answer 19

nystatin rinse

Question 20

candida esophagitis S+S

Answer 20

• painful swallowing
• heartburn
• nausea

Question 21

candida esoph diagnose/test and treatment

Answer 21

endoscopy/visualization

fluconazole (oral)

Question 22

candida vaginitis

Answer 22

most common candida infection, candida overgrowth

Question 23

candida vag- treatment

Answer 23

topical fluconazole, or PO

Question 24

how do we diagnose all these candida?

Answer 24

physical exam

Question 25

urinary tract candidiasis - associated with what

Answer 25

in urine, hard to treat - can be asymp or symp (cystitis) - assoc with ABX and CATHETER use

Question 26

candida bloodstream common in pt with?

Answer 26

LIFE THREATENING, high mortality - common in pt with LINES (pic line, cbc line) - seen in ICU, GI surgery

Question 27

Candida treatment overview

Answer 27

depends on location: bloodstream- IV AZOLE thrush- nystatin rinse, clotrimazole lozenge mucosas- topical nystatin, PO fluconazole esophagus- fluconazole

Question 28

when do you suspect fungi?

Answer 28

during NON RESOLVING pneumonia (symptoms: nodules, fungal ball, effusion)

Question 29

endemic fungi 4 type

Answer 29

Histomycoces, blastomycoses, coccygiomycoses, cryptococcyges

Question 30

coccidioidomycosis

Answer 30

- common in arizona and cali - self limited usually not, but can be severe, meningitis syndrome

Question 31

coccidioidomycosis S+S

Answer 31

localized pulmonary infection - cough, chest pain, fever - pleural effusion - pulmonary disease - nodules (rare) - rash

Question 32

rare complication of coccidioidomycosis

Answer 32

extrapulmonary disease

Question 33

coccidioidomycosis diagnose/test

Answer 33

depends where it is/what tissue lung- sputum culture

Question 34

treat coccidioidomycosis

Answer 34

fluconazole, itraconazole severe disease- amphotericin, admitted for IV therapy

Question 35

histoplasmosis found where

Answer 35

soil contaminated, americas, islands caribbean

Question 36

histo S+S

Answer 36

- pneumonia syndromes (early) can cause meningitis

Question 37

histoplasmosis meds

Answer 37

fluconazole, itraconazole or IV for severe

Question 38

blastomycosis is acute or chronic

Answer 38

acute, usually not recognized

Question 39

blastomycosis S+S

Answer 39

- flu like illness - non healing lesion, can biopsy - if manifesting as extrapulmonary--> verrous or ulcerative lesions

Question 40

blastomyc usually manifested how

Answer 40

pulmonary - flu like symptoms with abrupt onset

Question 41

blastomyc treatment

Answer 41

fluconazole

Question 42

cryptococcosis enters body how

Answer 42

inhale, pulmonary meningitis- extrapulmonary skin,blood- less common

Question 43

cryptococcosis treatment

Answer 43

prolonged course of IV therapy, amphoterecin With or without fluconazole - if pulmonary use flutconazole

Question 44

crypt treatment meningitis

Answer 44

IV therapy, amphotericin and flucytosine

Question 45

cryptococc treatment pulmonary disease

Answer 45

fluconazole