Infectious Disease: Fungal Infections Flashcards by Tyler Rzucidlo

What is Yeast

Microscopic single-celled fungus

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What is a Filamentous Mold

Multicellular fungus that may form hyphae

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What is Dimorphic

Yeast or Filamentous

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What do molds produce

Spores (conidia)

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What do spores develop into

Fungi

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What is another name for Fungal infections

Mycoses

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What are systemic Mycosis

only in specific endemic areas

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What are the major fungi that cause Systemic Mycosis

Histoplasmosis

Blastomycosis

Coccidioidmycosis

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What are opportunistic Mycoses

Occur in immunocompromised states

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What are the major Opportunistic Fungi

Candida

Aspergillus

Cryptococcus

Mucor

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What are the major Cutaneous Fungi

Tinea Versicolor

Tinea Pedis

Sporothrix

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What are the typical causes of Systemic Mycoses

Histoplasmosis

Blastomycosis

Coccidiomycosis

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What type of fungi are seen in systemic Mycoses

Dimorphic fungi
-mold in soil

Cold = mold with spores

warm = yeast

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What type of infections are associated with Systemic Mycoses

Lung infections

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What do all the systemic mycoses cause

Granulomatous inflammation

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What can all the Systemic Mycoses mimic

TB or Sarcoidosis
-lung granulomas
-hilar lymphadenopathy

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How are mild Systemic mycoses treated

Itraconazole

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How are severe/systemic systemic mycoses treated

Amphotericin B

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What happens if you try to treat systemic mycoses with Steroids

Symptoms worsen

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What is the Endemic Area for Histoplasmosis

Ohio and Mississippi river valley

“midwest”

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What is the endemic area for Blastomycosis

Ohio and Mississippi River Valley

“midwest”

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What is the endemic area for Coccidioidomycosis

Southwest US
-Arizona
-New Mexico
-California

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What is the Key site for Histoplasmosis

Caves
-soil with bird or bat droppings

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What happens when Histoplasmosis spores are inhaled

They turn to yeast at body temperature

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What are the most common symptoms of Histoplasmosis

Pulmonary with slow onset over weeks of mild pneumonia Hilar Lymphadenopathy

What may occur after healing in Histoplasmosis

Pulmonary Nodule -Seen as granuloma on biopsy

What population is Disseminated Histoplasmosis seen in

Immunocompromised -HIV/AIDS -TNFa inhibitors -Solid organ transplant

What are clinical features of Disseminated Histoplasmosis

Lymphadenopathy Hepatosplenomegaly Tongue/mouth ulcers Pancytopenia Skin lesions Pulmonary Infiltrates

How do you treat Disseminated Histoplasmosis

Amphotericin B

What are the diagnostic testing options for Histoplasmosis

Ag testing -urine, blood, BAL Ab testing Fungal Cultures Tissue Biopsy

What is seen on tissue biopsy for Histoplasmosis

Yeast within macrophages

What is the most common symptom of Blastomycosis

Chronic Pneumonia -slow, insidious onset

How do you make the presumptive diagnosis of Blastomycosis

Visualization of yeast -sputum, BAL Broad based budding yeast

How do you make the definitive diagnosis of Blastomycosis

Sputum Culture

How can extrapulmonary disease present in Blastomycosis

Skin is most common Wart lesions with irregular borders Osteomyelitis is 2nd most common

How Does Coccidioidomycosis grow

Mold beneath the desert surface -dry conditions causes mold to fracture into spores inhalation causes infection

What are the clinical features of Coccidioidomycosis

Valley fever -Similar to CAP -Fever, malaise, cough -Arthralgias -Erythema Nodosum

How to Diagnose Coccidioidomycosis

Serologic: IgG and IgM -may be negative early after exposure

Where is Candida normally found

Normal Flora of Mouth, intestine, skin and vagina

What can lead to overgrowth disease with Candida

Impaired immune defenses

How does Candida overgrowth present

Oral Thrush Esophagitis Vulvovaginitis Diaper Rash

How does disseminated Candida present

Endocarditis Disseminated Candidiasis

When is Aspergillus disease seen

Abnormal lung function Immunocompromise

What diseases are caused by Aspergillus

Allergic Bronchopulmonary Aspergillosis (APBA) Chronic Pulmonary Aspergillosis Invasive Aspergillosis

When does APBA occur

Chronic lung disease leads to bronchiectasis

What patient population usually suffers from Chronic Pulmonary Aspergillosis

Pt with underlying TB

What is the pathogenesis of Chronic Pulmonary Aspergillosis

Pre-existing cavity colonized

How does Chronic Pulmonary Aspergillosis present

Slow onset -weight loss -chronic cough -hemoptysis

How is Chronic Pulmonary Aspergillosis diagnosed

(-) TB testing (+) Aspergillus IgG Aspergilloma

What is an Aspergilloma

"Fungus Ball" Upper lobe cavitary lesion on imaging

How do you treat an aspergilloma

Surgical Resection

What does Invasive Aspergillosis require

Immunocompromise -neutropenia -high dose glucocorticoids

How does Invasive Aspergillosis present

Fever Chest pain cough Hemoptysis

What is seen on CXR in Invasive Aspergillosis

Nodules and infiltrates

What is seen on CT scan in Invasive Aspergillosis

Halo sign -nodules surrounded by ground-glass infiltrates

How is invasive Aspergillosis treated

Serum biomarkers Sputum for fungal stain and culture

What serum biomarkers are used to diagnose Invasive Aspergillosis

Galactomannan Beta-d-Glucan

What is the treatment for Invasive Aspergillosis

Voriconazole

What is the form of Cryptococcus Neoformans

Yeast with a thick capsule -not dimorphic

What is the main disease caused by Cryptococcus Neoformans

Meningitis -especially in HIV/AIDS

Where is Cryptococcus Neoformans found

Soil and Pigeon dropping

How does Cryptococcus neoformans cause infection

Inhaled lungs Blood stream Meninges

How does Cryptococcal Meningitis Present

Indolent symptoms over weeks -Headache -fever

How do you diangose Cryptococcal Meningitis

Lumbar puncture -india ink stain -cryptococcal Ag -culture

What is seen on india ink stain in Cryptococcal Meningitis

Yeast with halos

What is often done before LP in Cryptococcal Meningitis

Neuroimaging: CT/MRI r/o CNS mass or inc ICP

What does treatment of Cryptococcal Meningitis require

prolonged treatment -induction -consolidation -maintenance

Induction treatment for Cryptococcal Meningitis

Amphotericin B + Flucytosine 2 weeks or more

Consolidation therapy for Cryptococcal Meningitis

Oral Fluconazole 8 weeks

Maintenance therapy for Cryptococcal Meningitis

Oral Fluconazole lower dose up to 1 year

What are Mucormycosis

Rare fungal infections of the nose, eyes, brain

What causes Mucormycosis

Rhizopus Mucor

What key enzyme to fungi in Mucormycosis have

Ketone Reductase

What environment does Mucormycosis thrive in

High glucose

Risk factors for Mucormycosis

DM, DKA Treatment with steroids Leukemia Stem Cell Transplant

How does Mucormuycosis cause disease

Inhale spores -enter nose or alveoli -invades vessel walls

Clinical features of Mucormycosis

Severe sinusitis Fever, discharge congestion sinus pain Erythema/cyanosis of skin over sinuses Palate Necrosis Black Eschars orbital pain orbital swelling facial numbness -CN damage

Classic Case Presentation of Mucormycosis

Patient with DKA Fever Headache Eye pain

How to diagnose Mucormycosis

Mucosal Biopsy

What is seen on Mucosal Biopsy for Mucormycosis

Broad Hyphae with irregular branching

How do treat Mucormycosis

Surgical Debridement Amphotericin B

Infectious Disease: Fungal Infections Flashcards

(82 cards)