opportunistic fungal infections

Question 1

where is candida albicans found ?

Answer 1

found in the normal oral , gut, vaginal flora

Question 2

what is the most common contaminant of sputum culture ?

Answer 2

candida

Question 3

when candida dissementes what can it cause ?

Answer 3

endocardiditis
candidiemia

Question 4

what are the 2 unique shapes associated with candida ?

Answer 4

pseudo hyphae
and budding yeast at 20 C
germ tubes at 37 C

Question 5

what type of patients are more likely to suffer from disseminated candidiasis ?

Answer 5

neutropenic patients who are undergoing chemo
ICU patients
central line patients
TPN
IV drug users

Question 6

what is the germ tube test ?

Answer 6

to identify candida , the yeast that grows hyphae will grow out

Question 7

both hyphae and yeast on one slide ?

Answer 7

most likely looking at candida

Question 8

what are the causes of oral thrush ?

Answer 8

inhaled steroid in an asthma patient

Question 9

patient that is sexually active and now has thrush ?

Answer 9

should probably think of HIV

Question 10

what are the causes of candidal over growth in the eosphagus ?

Answer 10

eosphagitis usually happens in HIV patients
showing a white pseudomembrane on EGD

Question 11

what is the presentation of vulvovaginitis ?

Answer 11

itching
discharge
cottage cheese like discharge

Question 12

what is the classic patient associated with vulvovaginitis ?

Answer 12

a patient that has just taken an antibiotic

Question 13

what is the presentation of diaper rash caused by candidia ?

Answer 13

beefy red plaques with satellite papules

Question 14

when can candida cause endocarditis ?

Answer 14

an immunocompromised patient who is an IV drug user

Question 15

what is the treatment for each of the following :
vaginal disease / diaper rash
oral thrush
esophagitis
candidemia/endocaritis

Answer 15

vaginal disease / diaper rash : topical azole
oral thrush : nystatin swish and swallow, fluconazole
esophagitis : flucanozole
candidemia/endocaritis : capsofungin or amophecetrin B

Question 16

what is the treatment for resistant cases of esophagitis ?

Answer 16

voriconazole
capsofungin

Question 17

what is chronic mucocutaneous candidiasis and what is the probelm ?

Answer 17

mutation in the AIRE gene
T cells fail to react to the candida antigen
presents as a baby with recurrent candida infection - diaper rash , recurrent thrush

Question 18

what is the main immune defense for mucosal defense ?

Answer 18

T cells

Question 19

what are the most important cells for systemic defense ?

Answer 19

neutrophils , thats why cancer patients are at a higher risk for candidemia

Question 20

do CMC patients get candidemia ?

Answer 20

no

Question 21

what is the most common patient associated with aspergillus ?

Answer 21

must be immunocompromised
high dose chemo pts
stem cell trasnplant

Question 22

what type of infections are people with chronic granulomatous disease at a higher risk for ?

Answer 22

catalase positive organsisms

Question 23

what fungus is cigar shaped ?

Answer 23

the one that causes rose gardeners disease
sporothrix schenckii

Question 24

what are the catalase positive organisms ?

Answer 24

notoriously big bubbles HASSLE
nocardia
burkh
bordatella
h pylori
aspergillus
serratia
staph
listeria
e coli

Question 25

what are the lab and morphological features of aspergillus ?

Answer 25

catalase psoitive monomorphic fungi forms branching septate hyphae v shaped branches with visible septae the tips grow spores

Question 26

what are the diseases associated with aspergillus ?

Answer 26

aspergillosis allergic bronchopulmonary aspergillosis aspergilloma hepatocellular carcinoma

Question 27

what is the classic case associated with aspergillosis ?

Answer 27

severe lung disease neutropenic patient fever cough \pleuritic chest pain hemoptysis can dissement to any organ

Question 28

what are the treatments for aspergillosis ?

Answer 28

caspofungin amphotericin B voriconazole

Question 29

what ABPA, and who does it affect ?

Answer 29

hypersensitivty reaction to aspergillus happens in asthma or CF patients

Question 30

what are the findings associated with lymph tissue in patients who have ABPA ?

Answer 30

increase in Th2 CD4 cells which then stimulated the formation of IL 4 and IL 5 which allow for the recruitment of eosinophilia allows for IgE antibody production

Question 31

what is the classic case of ABPA ?

Answer 31

asthma of CF patients recurrent cough brownish mucus plugs hemoptysis peripheral blood eosinophilia high IgE levels

Question 32

hos is the diagnosis of ABPA made and what is the treatment ?

Answer 32

skin testing treatment is steroids

Question 33

what is an aspergilloma and where does it grow ?

Answer 33

fungus ball grows in pre formed cavities especially after TB infections

Question 34

what is the toxin cause by aspergillus and where is it found ?

Answer 34

aflatoxin caused by peanuts and soybeans locally grown food

Question 35

what is the main disease associated with cryptococcus neoformans ?

Answer 35

meningitis in immunocompromised patients

Question 36

where is cryptococcus neoformans usually found ?

Answer 36

found in the soil and in pigeon droppings

Question 37

what is the structure of cryptococcus neoformans ?

Answer 37

never see hyphae only a yeast very thick capsule

Question 38

how is cryptococcus neoformans cultured and what is the staining used for it?

Answer 38

cultured on sabourauds agar india ink is used and shows halos

Question 39

what test is used for the identification of cryptococus neoformans ?

Answer 39

latex agglutination test

Question 40

what is the appearance of cryptococcus neoformans once it reaches the brain ?

Answer 40

soap bubbles appearance

Question 41

what is the risk associated with LP in cryptococcal meningitis ?

Answer 41

higher risk f brain herniation due to high ICP

Question 42

what is the difference in presentation between bacterial meningitis and cryptococcal meningitis ?

Answer 42

bacterial meningitis shows symptoms almost immediatley whilst cryptococcal is indolent and happens over weeks

Question 43

what is the treatment for cryptococcal meningitis ?

Answer 43

intra thecal therapy is used and amphocetrin b along with flucytoseine

Question 44

what is the cause of mucormycosis ?

Answer 44

rhixopus sp mucor sp

Question 45

what type of patients are at a higher risk of mucormycosis and why ?

Answer 45

DKA patients , who have a medium that is high in glucose and ketoacidosis which is idel for the enzyme ketone reductase

Question 46

what is specific about the septae hyphae of aspergillus ?

Answer 46

acute angle branching of hyphae at 45 degrees

Question 47

DKA with severe sinusitis, fever headache and eye pain ?

Answer 47

think of mucromycosis

Question 48

how is a diagnosis of mucormycosis made ?

Answer 48

mucosal biopsy

Question 49

how do ypu differentiate between aspergillus and mucromycosis ?

Answer 49

mucromycosis - broad hyphae , with irregular branching , no septations aspergillus - narrow hyphae , v shaped branching , many septations

Question 50

what is the classic scenario associated with PCP ?

Answer 50

diffuse interstitial ppneumonia that happens with immunocompromised ptients especially HIV patients

Question 51

what does the chest x ray show in PCP ?

Answer 51

bilateral interstitial infiltrates

Question 52

how is PCP diagnosed ?

Answer 52

sputum sample , BAL biopsy cannot be cultured sent for staining silver stain used

Question 53

first line treatment for PCP ?

Answer 53

TMP SMX dapsone pentamidine

Question 54

what is the prophylaxis of PCP ?

Answer 54

TMP-SMX when CD4 cells are below 200 cells