Sketchy: Aspergillis

Question 1

Where will aspergillomas be seen on an upright CXR?

Answer 1

at the bottom (they’re gravity dependent)

Question 2

Aspergillus form ______ with fruiting bodies.

Answer 2

conidiophores

Question 3

What kind of reaction is Allergic bronchopulmonary asperigillosis (ABPA)?

Answer 3

type I hypersensitivity

Question 4

What does Aspergillus look like on microscopy?

Answer 4

its hyphae branch at acute angles and have septations

Question 5

Name the fungi:

• its hyphae branch at acute angles and have septations

Answer 5

Aspergillus

Question 6

Ddx?

• necrosis of paranasal sinuses and nose

Answer 6

• Mucor
• Aspergillosis

Question 7

Angioinvasive aspergillosis invades _____ and disseminiates very quickly throughout the body.

Answer 7

blood vessels

Question 8

Who is susceptible to developing aspergillomas?

Answer 8

those who already have lung cavities (TB, Klebsiella)

Question 9

Cue:

• scarecrow with black dots where his kidneys, heart, and nose should be, and the top of his head has a black spot with a ring around it

Answer 9

• Disseminated Angioinvasive aspergillosis. Affects:
• kidney = kidney failure
• heart = endocarditis
• nose = necrosis when spread to paranasal sinuses
• head ring spot = ring-enhancing brain lesions

Question 10

Cue:

• frogs

Answer 10

frogs = amphibians = Amphotericin B for tx of angioinvasive dz

Question 11

Dx?

• a cat

Answer 11

catalase positive

Question 12

What does angioinvasive aspergillosis look like on light microscopy?

Answer 12

acute angle septate hyphae invading blood vessels and the surrounding tissues

Question 13

Cue:

• cow with a liver-shaped spot grazing next to a tractor with a crab on it

Answer 13

• liver spot = hepatocellular carcinoma
• crab = CA

Question 14

How can Angioinvasive aspergillosis be distinguished from TB?

Answer 14

Aspergillosis will have ring-enhancing lesions on CT

Question 15

What is Aspergillus fumigatus?

Answer 15

a fungi

Question 16

What s/s does Allergic bronchopulmonary asperigillosis (ABPA) cause?

Answer 16

• wheezing
• fever
• migrating pulmonary infiltrates

Question 17

Who gets angioinvasive aspergillosis?

Answer 17

immunocompromised pts (esp neutropenia from leukemia/lymphoma)

Question 18

What is the tx for Aspergillis infections?

Answer 18

• -conazoles (esp VORIconazole) for less serious
• surgical debridement
• Amphotericin B for angioinvasive dz

Question 19

Cue:

• Farm worker with a cane, sweaty and coughing up blood, is standing next to a sprinkler system with red hoses

Answer 19

• angioinvasive aspergillosis:
• cane = immunocompromised
• sweaty = fever
• coughing up blood = hemoptysis
• red hoses = blood vessels invaded by aspergillis

Question 20

Cue:

• pinecones within a vortex

Answer 20

-conazoles (esp VORIconazole) = tx for less serious Aspergillis infections

Question 21

How could the cause of necrosis of paranasal sinuses and nose be differentiated?

Answer 21

• Mucor = right angle branching
• Aspergillosis = acute angle branching

Question 22

______ are extremely carcinogenic, esp. for the development of hepatocellular carcinoma.

Answer 22

Aflatoxins

Question 23

ASpergillus

Answer 23

Acute Septate

Question 24

Cue:

• sweaty farm worker carrying an inhaler labeled “IgE”, running underneath the airplane

Answer 24

• Allergic bronchopulmonary asperigillosis (ABPA):
• sweaty = fever
• inhaler = asthma, wheezing, CF pts
• IgE = increased IgE in Type I hypersensitivity rxn
• running = migratory (pulm infiltrate)
• airplane = labeled ABPA

Question 25

Ddx? * fever * neuro deficits * cough/PNA symptoms * hx of TB

Answer 25

* TB * Aspergillosis (will have ring-enhancing lesions on CT)

Question 26

What are the 3 infections that Aspergillus causes?

Answer 26

1. Allergic bronchopulmonary asperigillosis (ABPA) 2. Aspergillomas 3. Angioinvasive aspergillosis

Question 27

Cue: * peanut plant and a wheat field

Answer 27

peanuts and wheat --\> aflatoxins --\> also produced by Aspergillus FLAVIS --\> hepatocellular carcinoma

Question 28

Name 2 fungi that are catalase positive.

Answer 28

1. Candida albicans 2. Aspergillus fumigatus

Question 29

Aflatoxins are extremely carcinogenic, esp. for the development of \_\_\_\_\_\_\_.

Answer 29

hepatocellular carcinoma

Question 30

Dx? * acute angle septate hyphae invading blood vessels and the surrounding tissues

Answer 30

Angioinvasive aspergillosis of Aspergillis

Question 31

Cue: * crop duster flying over an asparagus farm

Answer 31

Aspergillus fumigatus

Question 32

Cue: * farmworker coughing into a napkin next to a cactus with peanuts at the bottom of it

Answer 32

* coughing = aspergillomas (fungus balls w/i the lungs) * cactus = TB cavities (pts with these are susceptible to aspergillomas) * peanuts at bottom = aspergillomas are gravity dependent (will be on bottom of upright CXR)

Question 33

How is Aspergillus transmitted?

Answer 33

conidiophores with fruiting bodies are inhaled

Question 34

Cue: * peanut plant with acute-angle branching and septae and yellow flowers

Answer 34

* Aspergillus hyphae branch at acute angles and have septations * flowers look like conidiophores with fruiting bodies (their inhalation = transmission)

Question 35

What immunoglobulin will be increased in Type I hypersensitivity reactions?

Answer 35

IgE