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Introduction to Clinical Mycology
Clinical Medicine Module 3
230
Medical
Graduate
06/15/2009

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Cards

Term
What is a unicellular organism that reproduces asexually by budding (blastoconidia formation) or fission?
Definition
yeast
Term
What are branching thread like tubular filaments which grow by apical extension, an area of intense metabolic activity
Definition
hyphae
Term
Which hyphae are hollow and multinucleate?
Definition
coenocytic
Term
Which hyphae are divided by partitions?
Definition
septate
Term
Which hyphae are on or under the surface of the medium, and provide nutrients?
Definition
vegetative
Term
Which hyphae often contain conidia which are easily airborne, involved in asexual reproduction and dissemination of spores?
Definition
aerial
Term
What is a mass of hyphae=mold?
Definition
mycelium
Term
Which form of fungi can exist either hyphal (usual form on culture media at room temperature) or yeast form (pathogenic form which grows at body temp)?
Definition
dimorphic
Term
What type of fungal form are the following? blastomyces. coccidiodes. histoplasma.
Definition
dimorphic
Term
Which fungal form involves elongated yeast forms linked like sausages which appear hyphal in character?
Definition
pseudohyphae
Term
What is caused by inhalation of material contaminated by a variety of molds?
Definition
hsn pneumonitis
Term
Which form of hsn pneumonitis involves intermittent high level exposure; fever, chills, cough, SOB; 4-8 hrs after exposure?
Definition
acute form
Term
Which form of hsn pneumonitis involves a low level chronic exposure; insidious onset of cough, SOB and weight loss?
Definition
chronic form
Term
What causes farmer's lung?
Definition
actinomycetes, molds
Term
What causes malt-workers lung?
Definition
aspergillus
Term
What causes maple bark-strippers lung?
Definition
aspergillus
Term
What causes sequoiosis?
Definition
aureobasidium
Term
What causes suberosis (cork workers)?
Definition
penicillium
Term
What causes cheese-washers lung?
Definition
penicillium
Term
What causes ventilator pneumonia (humidifiers, air conditioners)?
Definition
numerous fungi
Term
During what season does hsn pneumonitis occur in farmers?
Definition
occurs in *late winter or early spring* when farmers are using *moldy stored hay* to feed their livestock
Term
Does hsn pneumonitis predominate in smokers or non-smokers?
Definition
non-smokers (80-95%)
Term
Regarding mushroom poisoning- mycetismus- commercial market is predominately limited to what?
Definition
agaricus campestris
Term
What is a mycophagist?
Definition
collects and eats wild mushrooms
Term
What common saying refers to mycophagists?
Definition
"there are *old* mushroom hunters and there are *bold* ones, but ther are no *old, bold* mushroom hunters"
Term
What mushroom causes *95% of N American fatalities*?
Definition
*amanita phalloides*, the "death cap" mushroom
Term
What is the principle toxin of amanita phalloides? What are its physical properties?
Definition
*alpha-amantin*, an inhibitor of RNA polymerase II, which is *heat stable and water insoluble*
Term
Which phase of amanita mushroom poisoning occurs 6-24 hrs after ingestion, and involves profuse watery diarrhea with nausea and vomiting?
Definition
phase 1
Term
Which phase of amanita mushroom poisoning is quiescent?
Definition
phase 2
Term
Which phase of amanita mushroom poisoning occurs 3-6 days after ingestion and is the onset of hepatic and renal failure w/a 50-90% mortality?
Definition
phase 3
Term
What percentage of mushroom exposures from 1993-1997 were unintentional?
Definition
88%
Term
What percentage of mushroom exposures from 1993-1997 were in children under 6 y/o?
Definition
67%
Term
What percentage of mushroom exposures from 1993-1997 had symptoms?
Definition
6%
Term
Which primary site of infection is limited to the outermost layers of the skin or hair and only rarely elicit an inflammatory response b/c they colonize non-living structures?
Definition
superficial
Term
Which primary site of infection is limited to keratinized tissue of the epidermis, hair and nails, and is more inflammatory?
Definition
cutaneous
Term
Which primary site of infection involves the mouth, esophagus, and vagina?
Definition
mucocutaneous
Term
Which primary site of infection is limited to deeper skin structures, is non-invasive, and is often related to traumatic inoculation?
Definition
subcutaneous
Term
Which primary site of infection is invasive?
Definition
systemic
Term
Where are superficial mycoses in the skin limited to?
Definition
*stratum corneum*
Term
Pityriasis versicolor and tinea nigra are both what type of mycoses?
Definition
superficial mycoses: skin
Term
Superficial mycoses in the hair is limited to where?
Definition
limited to cuticle
Term
Black and white piedra are both what kind of mycoses?
Definition
superficial mycoses: hair
Term
What causes pityriasis (tinea) versicolor? What kind of organism is this?
Definition
caused by *malassezia furfur*, a *lipophilic dimorphic yeast*
Term
Where is malassezia furfur found?
Definition
part of the normal skin flora, *found in areas rich in sebaceous glands*
Term
What is characterized by *hyper- or hypopigmented lesions* on upper torso, arms and abdomen- light if the skin is dark; drk if skin is light?
Definition
pityriasis versicolor: clinical
Term
What is the appearance of pityriasis versicolor lesions?
Definition
*dry scaly, chalky appearance*
Term
What is the function of KOH?
Definition
*cover slip, add KOH which destroys tissue elements (chitin in the fungal cell wall is resistant to destruction by alkali)*
Term
What has a classic *spaghetti and meatballs* appearance? Of what is this a result?
Definition
KOH: classic *spaghetti and meatballs* as a result of combined yeast and hyphal elements: pityriasis versicolor
Term
What shows lesions that fluoresce yellow under *Wood's light*?
Definition
pityriasis versicolor
Term
Is a culture routine in pityriasis versicolor? why or why not?
Definition
culture: not routine, b/c of special media requirements (requires a medium supplemented w/fatty acids, e.g. peanut oil)
Term
Selenium sulfide, 2.5% applied for 7 days is a tx for what disease? How is this tx continued?
Definition
pityriasis versicolor. b/c of 60% relapse rate in 1st yr, repeat application on the 1st and 3rd days of the month for 6 mos.
Term
What is an alternative to selenium sulfide in pityriasis tx?
Definition
itraconazole 200 mg/day for 5-7 days followed by 200 mg on the 1st day of the month for 6 mos.
Term
What is the cure rate of a single dose of fluconazole in tx of pityriasis versicolor?
Definition
single dose of fluconazole had a 65% cure rate and was better than itraconazole
Term
For how long may depigmented patches remain in pityriasis versicolor?
Definition
depigmented patches may remain for mos, esp in the winter
Term
What is one of the most common human diseases?
Definition
dermatophyte infections
Term
What is referred to as *keratinophilic* fungi?
Definition
dermatophytes possess *keratinases* and are referred to as *keratinophilic fungi*
Term
How do cutaneous mycoses differ from superficial mycoses?
Definition
differ from the superficial mycoses by evoking an inflammatory response
Term
What is also called ringworm?
Definition
cutaneous mycoses: dermatophytes
Term
What is most commonly called *tinea* plus the anatomic site?
Definition
dermatophyte infections
Term
What is a dermatophyte infection of the feet?
Definition
tinea pedis
Term
What is a dermatophyte infection of the scalp?
Definition
tinea captitis
Term
What is a dermatophyte infection of the hands?
Definition
tinea manis
Term
What is a dermatophyte infection of the body?
Definition
tinea corporis
Term
What is a dermatophyte infection of the nails?
Definition
tinea unguium
Term
What is a dermatophyte infection of the groin?
Definition
tinea cruris
Term
What is a dermatophyte infection of the beard?
Definition
tinea barbae
Term
What are the three genera to which dermatophytes belong?
Definition
epidermophyton, microsporum, trichophyton
Term
Serious tinea capitis epidemics in the 1950's was caused by which sp?
Definition
microsporum
Term
Now, tinea capitis is predominantly caused by what organism?
Definition
trichophyton tonsurans
Term
Where are spores found in ectothrix?
Definition
spores surround the shaft due to destruction of the cuticle
Term
How does ectothrix fluoresce?
Definition
may be fluorescent or non-fluorescent
Term
How does ectothrix usually present?
Definition
as areas of *alopecia*
Term
How does ectothrix clear patches of hair?
Definition
hairs break off just above the scalp leaving "gray patches"
Term
Where do spores appear in endothrix?
Definition
inside the hair shaft
Term
What organisms cause endothrix?
Definition
produced by trichophyton spp, in the us most commonly t. tonsurans
Term
How does endothrix fluoresce?
Definition
non-fluorescent
Term
How do patches of hair clear in endothrix?
Definition
hair breaks off at the follicle leaving a "black dot"?
Term
What is a *kerion*?
Definition
boggy, purulent patches of alopecia, inflammatory- endothrix
Term
What organism causes favus?
Definition
trichophyton schoenleinii
Term
Where are hyphae found in favus?
Definition
hyphae course through the hair shaft w/air spaces
Term
What is the most serious form of dermatophytes?
Definition
favus most serious form, may lead to alopecia w/scarring
Term
Describe the border of tinea cruris.
Definition
typical scalloped, erythematous, scaling border
Term
Which is more common: tinea cruris or intertrigo of the groin?
Definition
much more common is intertrigo of the groin, cuased by candid albicans
Term
How is the incidence of onychomycosis changing?
Definition
incidence *increasing* (rare in US before WWII)
Term
Is onychomycosis more common in men or women?
Definition
more common in *men* than women
Term
Is onycomycosis more common in toenails or fingernails?
Definition
*toenails* 4x more commonly infected than fingernails
Term
What is the prevalence of onychomycosis among pts aged 40-60?
Definition
15-20%
Term
What is the prevalence of onychomycosis among pts aged 60-70?
Definition
32%
Term
What is the prevalence of onychomycosis among pts over age 70?
Definition
>48%
Term
What percent of pts with onychomycosis reported significant embarrassment which limited social interactions?
Definition
75%
Term
What percent of pts w/onychomycosis reported the nail involvement made it difficult to work w/their hands or painful to wear shoes?
Definition
44%
Term
What percentage of pts with onychomycosis found the disease limited their ability to walk?
Definition
15%
Term
What percentage of onychomycosis is caused by dermatophytes? what are 3 causative organisms?
Definition
90%: trichophyton rubrum. epidermophytom floccosum. trichophyton mentagrophytes.
Term
What percentage of onychomycosis is caused by yeasts? What is the causative agent?
Definition
8%, candida sp
Term
What percentage of onychomycosis is caused by nondermatophyte molds? What are the causative agents?
Definition
2%: aspergillus, scopulariopsis, and others
Term
How is onychomycosis tx?
Definition
Itraconazole *pulse* therapy: 200 mg, bid for 1 week ea month x 3

Terbinafine (lamasil) 250 mg, QD for 6 weeks (fingernails) or 12 weeks (toenails) or 7 days every 3 mos x 12 mos
Term
What are 2 topical nail lacquers used for onychomycosis?
Definition
*ciclopirox*, qd, and *amorolofine*, once weekly, are available as polymer film nail lacquers. also used as *combination therapy* w/itraconazole or terbinafine
Term
What presents as nodular and ulcerative lesions that develop along the lymphatics that drain the site of inoculation? What are these lesions called?
Definition
*sporotrichoid*, sporotrichosis
Term
What causes sporotrichosis? Who first described it?
Definition
caused by *sporothrix schenkii*, a dimorphic fungus first described by *bernard schenck, a second year medical student*
Term
Where can sporotrichosis be found?
Definition
sphagnum moss, splinters from rotting timbers and rose thorns (has been called the "alcoholic rose gardeners disease") are well described sources
Term
How are sporotrichosis organisms visualized?
Definition
organisms usually not seen even w/special stains, but may have *asteroid bodies*, also called the *SplendoreHoppli phenomenon*. Budding cigar shpaed yeast in culture at 37 degrees C, but at 25 degrees C grows as delicate branching hyphae w/conidia at the ends of conidiophores in a rosette pattern.
Term
What disease is seen w/*asteroid bodies*? what is this called?
Definition
sporotrichosis, *Splendore-Hoeppli phenomenon*
Term
What disease is seen w/budding cigar shaped yeast with conidia at ends of conidophores in a rosette pattern?
Definition
sporotrichosis
Term
How is sporotrichosis tx?
Definition
saturated soln of KI (SSKI), *itraconazole*, amphotericin B
Term
What causes histoplasmosis?
Definition
caused by inhalation of conidia of *histoplasmosa capsulatum*
Term
Where does histoplasmosis occur?
Definition
Occurs worldwide; in the US most common in the midwest in the *Ohio and Mississippi River Valleys (up to 80% skin test reactivity), also endemic in VA and MD along eastern seaboard*
Term
Where does histoplasma capsulatum grow?
Definition
grows in soil enriched by fecal material of chickens, bats and birds, esp starlings
Term
With what have histoplasmosis outbreaks been associated?
Definition
spelunking, cleaning chicken coops, and demolishing buildings during urban renewal
Term
How is infection by histoplasmosis caused?
Definition
infection is by inhalation followed by transient fungemia which results in calcified ranulomas in the liver and spleen (commonly seen in xrays of persons from the midwest)
Term
How many persons are infected each year with histoplasmosis? What percentage of these are asymptomatic?
Definition
500,000; 95%
Term
What percentage of histoplasmosis pts develop a self limited illness w/ fever, cough, HA, myalgias, and anorexia?
Definition
5%
Term
What percentage of histoplasmosis pts develop progressive disease, usually immunocompromised or lg inoculum?
Definition
1%
Term
What is associated w/spelunking?
Definition
histoplasmosis: 20 additional cases were ID'd and traced to *cave exploration* at the convention
Term
What disease occured during students on *spring break* who had resided at the Calinda Beach Hotel in *acuapulco* that was undergoing construction?
Definition
histoplasmosis
Term
With what illness were 32 inmates and workers hospitalized for at the *Powhatan Correctional Center in VA*?
Definition
histoplasmosis outbreak- june 1993
Term
What stage of histoplasmosis resembles TB w/cough weight loss, fever, dyspnea, and hemoptysis?
Definition
*chronic pulmonary*
Term
What stage of histoplasmosis is due to efects in *cell mediated immunity* and varies from acute fulminant to subacute to insidious and chronic?
Definition
*disseminated*
Term
In what population is accut disseminated histoplasmosis most frequent?
Definition
most frequent in pts w/defective T-cell immunity- hematologic malignancies, corticosteroids, AIDS, transplant recipients and infants
Term
What are the s/s of acute disseminated histoplasmosis?
Definition
fever, weight loss, hepatosplenomegaly, and pancytopenia
Term
How might AIDS pts present w/acute disseminated histoplasmosis?
Definition
AIDS pts may present w/a fulminating syndrome similar to bacterial sepsis- shock, ARDS and DIC
Term
Which stage of histoplasmosis has a more gradual onset of fatigue, weight loss, with less organomegaly?
Definition
chronic disseminated
Term
Over what time period do symptoms progress in *chronic disseminated* histoplasmosis?
Definition
mos (subacute) to yrs (chronic)
Term
What are some specific s/s of chronic disseminated histoplasmosis?
Definition
*oral ulcerations, adrenalitis*, and rarely endocarditis and meningitis
Term
What are tests for histoplasmosis?
Definition
*complement fixation*- std test to detect Abs. *immunodiffusion*- detects Abs to H and M agents. *Urine and blood polysaccharide *Ag* detection by radioimmunoassay and direct stains of *buffy coat* and tissue*
Term
What is cultured for histoplasmosis dx?
Definition
culture of blood (lysis centrifugation), bone marrow, and urine for disseminated disease
Term
How is Histoplasmosis tx?
Definition
no tx for acute self lmtd. *amphotericin B* for severely or acutely ill. *itraconazole* for moderately ill and for chronic suppression as is needed for AIDS pts to prevent relapse
Term
What causes blastomycosis?
Definition
caused by inhalation of conidia of *blastomyces dermatitidis*
Term
To what is blastomycosis closely related?
Definition
closely related to *H. capsulatum*, is an ascomycete
Term
What is the sexual phase of blastomycosis?
Definition
sexual phase is *Ajellomyces dermatidis*
Term
Where is blastomycosis endemic?
Definition
endemic in Ohio and Mississippi River Valley regions, as well as the Missouri and Arkansas River basins
Term
In descending order of incidence, where is blastomycosis most frequently reported?
Definition
Kentucky, Arkansas, Mississippi, NC, Tennessee, Louisiana. Also found in Wisconsin, Minnesota, Illinois, VA (microfocus in *franklin, VA*)
Term
Outbreaks of what illness have *involved dogs and humans together, among raccoon hunters and their dogs in Southampton Co., VA)?
Definition
blastomycosis
Term
25-50% of blastomycosis cases involve what, clinically?
Definition
*osteomyelitis*, any bone may be involved
Term
After osteomyelitis, what are the next 2 most common sequellae of blastomycosis?
Definition
prostatitis and epididymo-orchitis
Term
In what disease might a pt have pulmonary infection that may be acute w/ARDS w/heavy inovulation, self lmt pneumonitis, or chronic disease?
Definition
blastomycosis
Term
How are most blastomycosis dx made?
Definition
most dx made by ID of broad based budding yeast in tissue bx or purulent material or by culture
Term
Serologic tests and skin tests of blastomycosis are poor. Why?
Definition
high cross reactivity w/ *Histoplasma* and *Coccidioides*
Term
How is blastomycosis tx?
Definition
*itraconazole* is the drug of choice for non-life threatening disease. *amphotericin B* is the tx of choice for life threatening acute infections
Term
What causes coccidioidomycosis?
Definition
dimorphic fungus *Coccidioides immitus*
Term
How many new cases/yr are caused by coccidioidomycosis?
Definition
35,000-100,000
Term
Where does the mycelial phase of Coccidioides immitis grow?
Definition
in soil and on lab media
Term
Is the mycelial phase of Coccidioides immitis infectious?
Definition
highly infectious
Term
About what should the lab be warned when dealing with Coccidioides immitis in the mycelial phase?
Definition
warn lab about potential isolate
Term
Where does the spherule phase of Coccidioides immitis occur?
Definition
parasitic, phase in humans
Term
Is the spherule phase of Coccidioides immitis infectious?
Definition
non-infectious
Term
What are 2 examples of teh spherule phase of Coccidioides immitis?
Definition
endospores, spherules
Term
What is the portal of entry for Coccidioides immitis?
Definition
lung: *inhalation of arthrospores in dust*
Term
What is the infective dose of Coccidioides immitis?
Definition
10 arthrospores
Term
Where is Coccidioides immitis endemic?
Definition
S CA, esp San Joaquin Valley. New Mexico. W TX. AZ.
Term
What disease was contracted by 35 church members from PA who traveled to Hermosillo, *Mexico* for 1 week to help *construct* a church?
Definition
Coccidioidomycosis
Term
What disease was correlated with a *model airplane* event?
Definition
Coccidioidomycosis
Term
What percent of Coccidioidomycosis pts present as a subclinical, asymptomatic primary infection, detected by a positive skin test?
Definition
60%- most common
Term
What percent of Coccidioidomycosis pts present with clinical pulmonary disease in the primary infection?
Definition
40%
Term
Coccidioidomycosis causes what percent of all CAP in AZ, esp those who have lived in the area <10 yrs?
Definition
30%
Term
what percent of Coccidioidomycosis primary infections are disseminated?
Definition
1%
Term
What may be associated w/ a *hsn rxn*, such as *erythema nodosum* and arthralgias? How is this commonly known?
Definition
Coccidioidomycosis; *Valley fever* or "*miners bumps*"
Term
In which populations is there a marked increase in the rate of disseminated Coccidioidomycosis?
Definition
African Americans (10-15x) and Filipinos (50x), pregnancy, immunosupressions and AIDS.
Term
What might persistent symptoms, negative skin tests, and rising *eosinophilia* indicate in Coccidioidomycosis?
Definition
disseminated Coccidioidomycosis
Term
What *ms delayed hsn; excellent prognosticator* of Coccidioidomycosis?
Definition
Coccidioidin Skin Test
Term
What do rising and falling titers indicate with complement fixation used to dx Coccidioidomycosis?
Definition
rising titer of concern, falling titers w/tx or time is good prognostically.
Term
What is the tx of choice for disseminated Coccidioidomycosis?
Definition
*AMB* for fulminant or life threatening infection. *Fluconazole* for moderate disease and meningitis. Itraconazole may prove to be an alternative
Term
What type of organisms take advantage of an impaired host immune system?
Definition
opportunists
Term
What underlying host defects are risk factors for fungal infections?
Definition
neutropenial. t-cell dysfuntion. diabetes.
Term
What immunosuppression problems are risk factors for fungal infections?
Definition
cytotoxic chemo. high dose corticosteroids. bone marrow/organ transplantation.
Term
What is the trend in fungal infectious agents?
Definition
trend is to increasing non-*C. albicans* and mold infections, esp. more resistant spp like *Scedosporium, Fusarium, and Zygomycetes* (increasing prophylaxis)
Term
Are outcomes of fungal infections more closely related to the fungal sp or the degree of immunosuppresion?
Definition
outcomes are more closely realted to the *degree of immunosuppression* rather than the particular fungus
Term
What skin areas does candidiasis involve?
Definition
warm moist skin- *intertriginous areas* esp. common in diabetics, skin folds of the obese
Term
Describe the skin lesions found in candidiasis.
Definition
erythematous, macerated skin w/vesiculopustular satellite lesions.
Term
What is the tx for candidiasis?
Definition
dry skin, azole creams (lotrimin, 1%, miconazole)
Term
What percent of women have suffered at least one episode of vulvovaginitis?
Definition
75%
Term
What factors predispose to vulvovaginitis?
Definition
Abx, steroids, BCP, pregnancy, diabetes
Term
In what population is oral thrush prevalent?
Definition
neonates. recent Abx. denture wearers. inhaled corticosteroids. HIV/AIDS.
Term
What causes severe chronic cutaneous (skin and nails) and mucosal infections that is most commonly a narrow and specific problem with cell mediated immunity against the causative agent?
Definition
chronic mucocutanous candidiasis
Term
How frequently do pts w/chronic mucocutaneous candidiasis develop systemic or disseminated disease?
Definition
almost never.
Term
What is the ease of disseminated candidiasis dx?
Definition
difficult to dx, 50% of proven autopsy cases have negative blood cultures
Term
How is candidiasis dx?
Definition
KOH or gram stain of mucosal scrapings. C. albicans is ID'd by the *germ tube test*- production of hyphal outgrowths (germ tubes) when grown in serum at 37 degrees C, examine at 2-3 hrs.
Term
On what lab media does candidiasis grow?
Definition
will grow rapidly as a yeast on most lab media. does not require a special fungal media or fungal blood cultures, although may improve yield.
Term
What is a *germ tube test*?
Definition
C. albicans is ID'd by the *germ tube test*- production of hyphal outgrowths (germ tubes) when grown in serum at 37 degrees C, examine at 2-3 hrs.
Term
How is Candidemia tx?
Definition
fluconazole for *C. albicans, C. tropicalis, C. parapsilosis*. B/c of increasing rates of *C. glabrata, caspofungin or mycafungin has become the empiric drug of choice*
Term
What is commonly isolated from pigeon excreta?
Definition
Cryptococcosis- does not infect pigeons.
Term
What is closely associated w/Eucalyptus trees w/most cases in Australia, recent outbreak in Vancouver Island, Canada?
Definition
C. gattii
Term
What can cause acute and chronic pneumonia, and often appears as a mass lesion w/a pleural base?
Definition
Cryptococcosis
Term
What has a predilection for CNS infection; most common cause of fungal meningitis; may also cause mass lesions?
Definition
Cryptococcosis
Term
What is the most common cause of meningitis in AIDS pts?
Definition
Cryptococcosis
Term
On what are serologic tests for Cryptococcosis based?
Definition
based on detection of the polysaccharide *Ag* by latex agglutination
Term
Rare false positives for serologic tests for Cryptococcosis are noted in what infections?
Definition
Trichosporon beigelli
Term
Rapid dx of Cryptococcoal meningitis can be made how?
Definition
India ink preparation
Term
What is the sensitivity of India ink preparation?
Definition
50% sensitive; may be confused w/lymphocytes and other artifacts
Term
Cryptococcosis: in tissue, what will stain the capsule?
Definition
*mucicarmine* will stain the capsule, PAS and Hematoxylin and Eosin (H&E) do not stain the capsule
Term
In what type of tissue inflammation does cryptococcosis result?
Definition
results in minimal tissue inflammation, may be a mass of yeasts or meningitis w/o pleocytosis, esp in immunocompromised
Term
What type of agar may be used for Cryptococcosis?
Definition
*bird seed agar*, develops typical brown colonies
Term
What is very common in the environment which can result in contamination of specimens?
Definition
Aspergillus
Term
What causes Aspergillosis? How is it manifested?
Definition
A broad spectrum of disease caused by spp of *Aspergillus*, may be *allergic* or *invasive* manifestations depending on the status of the immune system
Term
What presents as episodic asthma, expectoration of brown mucous plugs, pulmonary infiltrates?
Definition
allergic bronchopulmonary aspergillosis
Term
What presents with eosinophilia, immediate skin test reactivity to causative Ag's, elevated IgE Abs to causative agent, elevated total IgE
Definition
allergic bronchopulmonary aspergillosisi: immediate skin test reactivity to Aspergillus Ags, elevated IgE Abs to A. fumigatus
Term
How is allergic bronchopulmonary aspergillosis tx?
Definition
corticosteroids are the tx of choice
Term
What involves saprophytic colonization of old cavities; a mass of intertwined hyphae?
Definition
aspergillus- fungus balls
Term
What precipitins are present in serum in more than 90% and about 50% have positive sputum cultures?
Definition
Aspergillus
Term
What is a *crescent sign*?
Definition
solitary, oval mass w/in a cavity which produces a *crescent sign*- aspergillus- fungus balls
Term
What is the most common symptom of aspergillus- fungus balls?
Definition
hemoptysis
Term
What is associated w/profound immunosuppression w/prolonged neutropenia or crticosteroids, esp transplants AML, and multiple myeloma?
Definition
aspergillosis- invasive
Term
What is an *angioinvasive* fungus leading to tissue infarction?
Definition
aspergillosis- invasive
Term
What is the *halo sign*?
Definition
nodular or patchy lung infiltration, single or multiple w/a surrounding ground-glass infiltrate ("*halo sign*"), which reflects hemorrhage secondary to blood vessel invasion *or* an area of tissue necrosis and cavitation "*crescent sign*" occurs later
Term
Which antibody and skin tests are useful to dx aspergillosis?
Definition
no Ab or skin tests
Term
When are blood cultures positive with aspergillosis?
Definition
blood cultures almost never positive even with widely disseminated disease or endocarditis
Term
What is a common problem with expectorated sputum samples when dx aspergillosis
Definition
often contaminated
Term
How can aspergillosis be dx?
Definition
bx of affected tissue w/culture or histologic examination for septate hyphae w/acute angel branching w/a 3 um diameter
Term
What has become the drug of choice for aspergillus?
Definition
voriconazole
Term
How does aspergillus respond to amphotericin? especially which sp?
Definition
poor response with amphotericin, esp. *A. terreus*
Term
What are risk factors for zygomycosis?
Definition
**metabolic acidosis. hyperglycemia*. corticosteroids. profound leukopenia. *deferoxamine therapy. long term prophylaxis w/voriconazole**
Term
In what pt population is rhinocerebral zygomycosis most common?
Definition
most common in *diabetics w/ketoacidosis*, also pts w/metabolic acidosis from other causes.
Term
Where does rhinocerebral zygomycosis originate?
Definition
originates in *paranasal sinus, spreads to orbit, hard palate and brain*
Term
What causes *periorbital edema, proptosis, epistaxis, necrotic black eschars in the nares or on the hard palate*, cranial nn palsies, obtundation, and death?
Definition
zygomycosis: rhinocerebral
Term
What is an **angioinvasive** fungus which results in *tissue infarction, necrosis and hemorrhage*?
Definition
zygomycosis
Term
Zygomycosis may cause invasive pulmonary and disseminated syndromes identical to what organism?
Definition
Aspergillus
Term
What serologic or skin test is useful in dx zygomycosis?
Definition
no serologic or skin test
Term
What would a histologic examination of zygomycosis reveal?
Definition
histologic examination of bx of involved tissue w/broad irregular, non-septate hyphae w/wide angle branching, "ribbon-like"
Term
How is zygomycosis tx?
Definition
*correction of underlying metabolic abnormality*, *amphotericin B, high dose but responses are low w/mortality of 75%*, *Posaconazole* is a new azole, available for compassionate use. *surgical debridement, often extensive and mutilating*
Term
What is the cost/day of AMB?
Definition
$8.84
Term
What is the cost/day of Abelcet?
Definition
$439.00
Term
What is the cost/day of Ambisome?
Definition
$1065.00
Term
What is indicated for pts w/pre-existing renal insufficiency, who develop nephrotoxicity on AMB or who are receiving other nephrotoxic drugs?
Definition
use **Abelcet (ABLC)** b/c it is intermediate in cost ($400/day) and usually well tolerated
Term
What is indicated for pts who have baseline near normal renal function and who are not receiving other nephrotoxic medications?
Definition
**AMBb** b/c it is very inexpensive ($10/day) and many pts will tolerate it well
Term
When is Ambisome indicated?
Definition
Limit the very expensive **Ambisome** ($1000/day) to those that have **both** severe infusion related toxicity and nephrotoxicity
Term
Most Commons: What is the most common cause of invasive fungal infection in stem cell or organ transplant patients.
Definition
Aspergillosis
Term
Most Commons: What is the most common cause of fungal meningitis?
Definition
Cryptococcosis is the most common cause of fungal meningitis.
Term
Most Commons: What infection is one of the most important causes of seizures in the developing world and in
immigrants to the United States from endemic countries?
Definition
Cysticercosis infection is one of the most important causes of seizures in the developing world and in
immigrants to the United States from endemic countries
Term
Most commons: What is the most common site of Actinomyces infection?Cervicofacial or
thoracic disease may occasionally involve the central nervous system, most commonly as what?
Definition
The most common site of Actinomyces infection is the cervicofacial area (about 60% of cases). Cervicofacial or
thoracic disease may occasionally involve the central nervous system, most commonly as a brain abscess or
meningitis.
Term
Book ?: Does blastomycosis occur more commonly in immunocompetent or immunocompromised individuals?
Definition
immunocompetent. however, if infection occurs in an HIV involves rapid progression and frequent dissemination
Term
Book ?: What is the most common cause What is the most common cause of invasive fungal infection in stem cell or organ transplant pts?
Definition
aspergillosis
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