Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nagasaki Flashcard Extravaganza > Mycosis > Flashcards

Mycosis Flashcards

1
Q

What is the micro of cryptococcosis?

A

Eukaryotic organism - fungi
C.neoformans / C.gatti

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the source of cryptococcosis?

A

Ubiquitous
Found in soil, decayed wood, pigeon droppings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the epidemiology of cryptococcosis?

A

About 500-700K/year
Largely 2nd to advanced HIV in SS Africa - CD4 <100. Occurs worldwide
Also in immunosuppressed pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the clinical syndrome of cryptococcosis?

A

Subacute meningitis - fever, headache, 6th nerve palsy due to very raised ICP
Lesion on skin - small nodules
Lung lesions - multifocal/cavitatory
GI sx
Visual sx

May occur in late HIV or as IRIS phenom when starting ART

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is cryptococcosis diagnosed?

A

Positive antigen -> cryptococcemia
Then look for end organ dx - skin, lungs, brain
Then LP -> if positive then cryptococcal meningitis
CSF tested with antigen/culture/india ink test

Rarely: picked up on blood cultures when very disseminated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the CSF pattern of cryptococcosis?

A

High WBC (not always, if low-> poor prognosis)
High protein
Low or normal glucose

Very raised ICP
Usually clear or straw coloured

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management of cryptococcosis

A

Ambisome/flucytosine
Induction then maintenance
Ppx usually fluconazole or ambisome

Delay ART start if off / continue if already on (IRIS risk)

Therapeutic LPs to reduce pressure, consider shunt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is this?

A

Crypto on India Ink
Small spore with halo
You don’t see hyphae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most virulent fungi on earth?

A

Coccidioides immitis (C. posadasii)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the epi of coccidioidomycosis?

A

Endemic area: Southwest US (Arizona, California, New Mexico, Texas, etc), and some Central and South American countries (esp. Mexico)
150,000 are infected/year in USA

Affect those with cellular immunodeficiency (AIDS, steroid, etc.), diabetes, COPD, pregnancy, race (African American > Hispanic, Asian> Caucasian)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the clinical syndrome of coccidioidomycosis?

A

1) Acute pulmonary form:
* Symptoms: flu-like (fever, cough, sputum, chest pain, arthritis), erythema nodosum, etc.
* eosinophilia may be present (→ eosinophilic pneumonia) * Chest image: pulmonary infiltrate, hilar LN swelling,
pleural effusion, etc.

2) Chronic pulmonary form:

  • Symptoms: cough, hemoptysis, BW loss, low grade fever, night sweat…
  • Chest images: nodule, thin-walled cavity (near pleura →
    pneumothrax)…
    chronic fibrocavitary pneumonia:

3) Disseminated (extrapumonary) coccidioidomycosis:
* target organs are: meninges (mild symptoms), skin,
bone (joints), etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the diagnosis of coccidioidomycosis?

A

1) Pathology: skin, lung…, Smear: sputum…
2) Culture & identification*: sputum, TBLB, skin biopsy 3) Serology: antibody(ID; CF ≧x16→dissemination
suspected), antigen(urine/serum/CSF…), PCR(not commercially available) of BALF, etc.
△beta-glucan

BIOHAZARD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment of coccidioidomycosis?

A

1) :fluconazole, itraconazole,posaconazole 3-6 Mo or longer;
3) in serious condition or during pregnancy: amphotericin B or liposomal
・chronic pulmonary coccy(nodules, cavities) if symptomatic and/or change of chest images: resection(or antifungal agents)

・chronic fibrocavitary pneumonia
Should be treated w/ azoles or amphotericin B →
resection may be considered

・disseminated:poor prognosis
1) azoles MT 400mg, or amphotericin B (or liposomal AMPH-B)
2) in meningitis, fluconazole MT400mg, lifelong

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the pathophysiology of coccidioidomycosis?

A

Natural habitat: soil
* Route of infection: inhalation of conidia (arthroconidia)
* Pathophysiology: pneumonia → disseminate systemically * Incubation period: 1−4w (recurrence may take place, even
tens of years after the exposure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the micro of Talaromyces/Penicilliosis?

A

fungal infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the epidemiology of Talaromyces/Penicilliosis?

A

Occurs in advanced HIV in SE Asia

17
Q

What is the clinical syndrome of Talaromyces/Penicilliosis?

A

Small painless skin lesions on head and neck
Systemic features include: fever, general discomfort, weight loss, cough, difficulty breathing, diarrhoea, abdominal pain, LN, HSM
Lesions look like MC

18
Q

What is the pathophysiology of Talaromyces/Penicilliosis?

A

From bamboo rat faeces, esp rainy season

19
Q

What is the diagnosis of Talaromyces/Penicilliosis?

A

Biopsy/BM

Intracellular and extracellular forms are oval and have a characteristic transverse septum. In culture, colonies are powdery green and produce red pigment; however, cultures are negative in a significant number of cases

20
Q

What is the treatment of Talaromyces/Penicilliosis?

A

amphotericin B followed by itraconazole or voriconazole

21
Q

What is the micro of histoplasmosis?

A

Causative agent: dimorphic fungus Histoplasma capsulatum (→hitoplasmosis
capsulati)
(Histoplasma duboisii: African histoplasmosis)

22
Q

What is the epidemiology of histoplasmosis?

A

Endemic area:
USA (Ohio-Misissippi Valley, eg. Indiannapolis), Southeast Asia (particularly Thailand), etc.
( cf. Africa (duboisii-type)

23
Q

What is the pathophysiology of histoplasmosis

A

In soil/bat and bird droppings

Pathophysiology:
pneumonia → dissemination (primarily in RES)
* Risk factors:
cellular immunity deficiency (e.g. AIDS) able to infect healthy adults
* Dangerous activities: exploration of bat-inhabited caves, cleaning of roof, construction works, etc..
* Prognosis: high mortality in disseminated cases or in immunocompromised patients

24
Q

What is the clinical syndrome of histoplasmosis?

A

Acute pulmonary histoploasmosis
Symptoms: flu-like, erythema nodosum
Chest images: normal, granular, hilar node swelling,
pleural effusion, nodules, etc.

Chronic pulmonary histoplasmosis
* Risk factor: COPD
* Acute inflammation → fibrosing pneumonitis
* Chest Images: fibrosis (mostly upper lobes), cavities,
infiltrates (similar to TB, sarcoidodis)

Disseminated histoplasmosis
* risk factor: cellular immunodeficiency (AIDS, etc)
* disseminate to meninges, liver, spleen, mucous membrane,
adrenal glands, bone marrow, etc.
acute: high fever, fatigue, mucous ulcer,
hepatosplenomegaly, anemina, meningitis.

chronic: ulcer in oral mucosa, hepatosplenomegaly,
adrenal dysfunction, endocarditis, meningitis.

Others: mediastinal lymphadenitis, mediastinal granuloma, fibrosing mediastinitis (often fatal!!), broncholithiasis, etc.

25
Q

How do you diagnose histoplasmosis?

A

In disseminated HIV-related disease, urinary antigen has high negative and positive predictive value and is very useful

In immunocompetent patients it is rarely positive, and diagnosis is difficult. Biopsy often needed but this often just shows necrosis without many fungi.

26
Q

How do you treat histoplasmosis?

A

1a. acute pulmonary histo (moderately severe to severe): liposomal ampho, then itraconazole for 12 weeks; add methylprednisolone when necessary.
1b. acute pulmonary histo (mild to moderate):
no treatment; itraconazole for 6-12 weeks for symptoms MT 1 month.
2. chronic pulmonary histo: Always requires antifungal agents . itraconazole for 12-24 months
3a. progressive disseminated histo (moderately severe to severe): liposomal amphotericin B →itraconazole MT 12 months
3b. progressive disseminated histo (mild to moderate ): itraconazole MT 12 months.
* lifelong itraconazole may be required if immunosuppression continues.
* No isolation of patients is required.

27
Q

What is the difference between the American and African histoplasmosis?

A

African histoplasmosis (histoplasmosis duboisii)

  • different from capusulati in many aspects
  • slowly progressive
  • target: skin (papule in face, trunk), bone(osteomyelitis, arthritis, subcutaneous abscess → drainage to skin). Liver and spleen
28
Q

What is the epidemiology of paracoccidiomycosis

A

Endemic areas:
Limited to South America (Brazil, Columbia, Benezuella,etc)

29
Q

What is the pathophysiology of paracoccidiomycosis?

A

Natural habitat: unknown. Isolated from some wild animals such as armadilloes and South American Coati

  • Route of infection: inhalation of spores
    ・ Pathophysiology:
    interstitial pneumonia
    → disseminate primarily to mucous membrane, superficial LN.
    ・ Risk factors:unknown (male:female = 20:1)
    ・ Incubation period: Very long. average10 years
    (MT40 years in some cases)
30
Q

What is the clinical syndrome of paracoccidiomycosis?

A

interstitial pneumonia
→ disseminate primarily to mucous membrane, superficial LN.

31
Q

What is the diagnosis of paracoccidiomycosis?

A

Diagnosis
* very characteristic background: year-long history of living in the endemic area
* pathology (characteristic “pilot’s wheel” appearance) * mycology: slow growth rate, sporulation is weak
→ not very useful
* serology: antibody(not quite specific, but helpful)

32
Q

What is the treatment for paracoccidiomycosis?

A

MUST TREAT all cases! No spontaneous resolution.
* antifungal agents: AMPH-B, azoles, (sulfa)

33
Q

What is this?

A

paracoccidiomycosis
Mickey Mouse/Ship’s Wheel appearance

Nagasaki Flashcard Extravaganza (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions