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Definition
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Definition
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Definition
| nuclear division and spore formation |
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Definition
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Term
| hilar adenopathy is a common feature of what |
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Definition
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Term
| of all the systemic fungal inf being studied, which 2 are opportunistic (vs pathogenic)? |
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Definition
| sporotrichosis and cryptococcosis |
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Term
| where is histoplasmosis found? |
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Definition
| mississippi and ohio river valleys. caribbean islands (haiti), south and central america |
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Term
| how do we get infected with histoplasmosis? |
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Definition
| contact with soil rich in nitrogen/contminated with high [] of bird or bat guano |
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Term
| what are the 5 clinical manifestations of histoplasmosis? |
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Definition
| acute pulmonary histoplasmosis; acute pulmonary histoplasmosis with heavy exposure or impaired cell mediated immunity; chronic cavitary histoplasmosis; complications related to mediastainal involvement; disseminated disease |
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Term
| what are the clinical sx of acute pulmonary histoplasmosis? |
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Definition
| asymptomatic or self limited, inucbation period 10-16 days, lasts several days to weeks; fever, weakness, malaise, headache, cough (nonproductive), sub-sternal chest pain, CXR patchy pneumonia and hilar adenopathy (only with large # of inhaled spores), erythema nodosum, rheumatologic manifestations (5%) |
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Term
| "summer flu" = infection with what? |
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Definition
| histoplasmosis (acute pulmonary) |
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Term
| describe clinical sx for acute pulm histoplasmosis with heavy exposure or impaired cell mediated immunity |
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Definition
| CXR bilateral diffuse reticulonodular infiltrates; ARDS, "buckshot" calcifications (nodules calcify) |
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Term
| "buckshot" calcifications pathognomonic of? |
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Definition
| acute pulm histoplasmosis with heavy exposure or impaired cell mediated immunity |
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Term
| who's affected by chronic cavitary histoplasmosis (m vs f? race?) |
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Definition
| after puberty m:f = 3:1; no observed racial differences |
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Term
| what is the clinical sx most associated with chronic cavitary histoplasmosis? |
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Definition
| "marching cavity" - continuing necrosis increases size of cavity, can take over entire lung. cough, sputum, hemoptysis, dyspnea, assoc with COPD |
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Term
| what are the 3 mediastinal complications associated with histoplasmosis (1% of pts)? |
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Definition
| 1. granulomatous mediastinitis (massive enlargement of mult mediastinal LN --> matted together, caseation necrosis --> impinge on mediastinal struc) 2. mediastinal fibrosis (lethal, uncommon, excessive fibrosis progressively envelopes the struc of the mediastinum --> encroaches on superior vena cava and pulm art/veins or bronchi) 3. pericarditis (6%) younger pts |
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Term
| clinical manifestations of disseminated histoplasmosis? |
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Definition
| fever, malaise, anorexia, cytopenias, hepatosplenomegaly, lymphadenopathy, gi tract ulceration, weight loss, cns and skin involvment, miliary pattern on CXR |
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Term
| how do we definitively diagnose disseminated histoplasmosis? |
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Definition
| best test: cell wall polysaccharide antigen detection (urine>serum); next best is isolation by culture (takes a long time, bone marrow bx best) |
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Term
| where would we come into contact with coccidiodomycosis? |
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Definition
| lower sonoran life zone (desert southwest), california, northern mexico, argentina, paraguay, arizona, "sun belt" states |
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Term
| how do we become infected with coccidiodomycosis? |
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Definition
| inhalation of arthroconidia in dry/dusty months or after ground disruption (ie earthquake, construction sites) |
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Term
| what are the 3 clinical presentations of coccidiodomycosis? |
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Definition
| self-limited primary pulmonary disease (valley fever); diffuse pneumonia, disseminated |
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Term
| what are the clinical sx of valley fever? |
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Definition
| (coccidiodomycosis, primary lung inf) incubation period 1-3 weeks, fever cough myalgias arthrlagias pleuritic chest pain night sweats HA profound fatigue, erythema nodosum (+prognosis), erythema multiforme, "toxic" erythema; hilar or paratracheal adenopathy (25%); pulm nodules or cavities (5%) |
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Term
| what groups of people are at an increased risk for disseminated coccidiodomycosis? (m vs f? race?) |
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Definition
| m>f (d/t diff in sex hormones?); AA, filipino at higher risk (d/t HLA and blood group diffs?); pregnancy (40-100x, risk increases by trimester); immunocompromised (CD4<250) |
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Term
| what are the clinical sx of disseminated coccidiodomycosis? |
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Definition
| occurs weeks to months after primary infection. CNS most common site of extra-pulm involvement (meningitis, 30% mortality and hydrocephalus in 30-50%), can also involve skin, LN, bones, joints |
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Term
| how do we dx coccidiodomycosis? |
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Definition
| IgM precipitins (1-3 wk after inf), IgG complement fixing abs (titers >1:32), demonstration of organism in tissue (spherules - giant cells and pmn infiltrate when they break open, little caseation necrosis) |
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Term
| do we culture coccidiodomycosis? |
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Definition
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Term
| how do we dx coccidiodomycosis meningitis? |
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Definition
| coccidiodal abs in csf (IgG). try to isolate organism from other tissues though |
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Term
| where would we find blastomycosis? |
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Definition
| south central and north central north america (carolinas and mississippi river) |
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Term
| what are the clnical sx of blastomycosis? |
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Definition
| pulmonary infection from asymp to severe pneumonia to ARDS. extra pulm = skin, GU, septic arthritis, osteomyelitis |
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Term
| how do we dx blastomycosis? |
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Definition
| isolate org from culture of tissue (dna probe), tissue bx (distinct morphology: thick walled, broad based budding yeasts) |
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Term
| how does someone become infected with sporotrichosis? what are the clinical sx? |
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Definition
| exposure to contaminated soil, moss, decaying leaves (no particular geographic dist), acquired by direct inoculation of organism into skin, papule develops --> mild tender LN along path of cutaneous lymphatics) |
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Term
| how do we dx sporotrichosis? |
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Definition
| growth of organism from aspirate of lesion, bx specimen |
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Term
| what is the only pathogenic, encapsulated fungal infection of man? |
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Definition
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Term
| where will one come into contact with cryptococcus? |
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Definition
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Term
| how do we become infected with cryptococcus? |
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Definition
| 2 distinct variants of cryptococcus neoformans; both associated with bird guano (pigeon poop) |
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Term
| in immunologically normal people, what are the clinical sx of cryptococcus? |
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Definition
| asymptomatic, self limited primary pulm inf, disseminated disease likes CNS (meningitis) |
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Term
| in immunologically normal people, what are the clinical sx of cryptococcus? |
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Definition
| asymptomatic, self limited primary pulm inf, disseminated disease likes CNS (meningitis) |
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Term
| why has inf with cryptococcus been declining? |
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Definition
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Term
| how does cryptococcus present in HIV+ patients? |
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Definition
| 2/3 of the time presents as cryptococcal meningitis (HA, altered mental status, fever) ; 1/3 have primary pulmonary disease without evidence of meningitis |
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Term
| how do we dx cryptococcus? |
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Definition
| culture (blood, csf, tissue); antigen detection via latex particle agglutination; india ink prep from CSF (encapsulated, narrow based budding yeasts) |
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Term
| what are 2 most common opportunistic yeasts? |
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Definition
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Term
| what are the 2 most common opportunistic molds? |
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Definition
| aspergillus, mucormycosis |
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Term
| what are 2 previously rare fungal infections now seen with increasing frequency? |
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Definition
| septate filamentous fungi (fusarium, scedosporium, trichoderma) and non-candida yeasts (trichosporon) |
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Term
| what is the most frequent nosocomial infection caused by candida? |
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Definition
| candidemia (bloodstream inf) mortality 38% |
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Term
| what are the clinical manifestations of disseminated candidiasis? |
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Definition
| new or worsening fever, organ specific: hepatitis, meningitis, endophthalmitis, skin, urinary tract |
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Term
| how do we diagnose candidemia an disseminated candidiasis? |
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Definition
| high index of suspicion, blood culture using lysis centrifugation system (lyse wbc), evidence of candida in target organs (urine, eye, skin, liver ) |
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Term
| what are the 3 clinical presentations of aspergillus infection? |
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Definition
| saprophytic, allergic, and invasive |
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Term
| describe saprophytic aspergillus infection |
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Definition
| pulmonary aspergilloma (forms in pre-existing lung cavity); paranasal sinus aspergilloma |
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Term
| describe allergic aspergillus infection? |
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Definition
| sinusitis, bronchopulmonary, can convert to chronic or acute invasive aspergillosis when immunosuppressed |
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Term
| describe invasive aspergillosis |
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Definition
| acute or chronic. infections of lower resp tract, sinuses, and skin. presents as headache, nasal stuffiness, proptosis and cranial nerve palsies as aspergillus invades the walls of sinuses and invades the skull and neural tissue; can infect cv system and other tissues as a result of hematogenous spread |
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Term
| how do we dx aspergillosis |
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Definition
| radiograph: peripheral infiltrates, wedge shaped reflecting vascular invasion; CT: halo sign or air crescent sign; direct examination of bronchoalveolar lavage fluid; antigen assay; demonstration of organisms in tissue for DEFINITIVE dx (acute angle branching and true septation) |
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Term
| what are the conditions most commonly assoc with mucormycosis? |
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Definition
| diabetes, metabolic acidosis, organ transplant, chronic steroid use, leukemia/lyphoma, dx with desferoxamine, AIDS |
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Term
| what is the prognosis for mucormycosis infection? |
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Definition
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Term
| what is the classical clinical syndrome of mucormycosis infection? and who's at risk for this? |
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Definition
| rhinocerebral mucormycosis; diabetics, frequently with acidosis |
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Term
| how does rhinocerebral mucormycosis present? |
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Definition
| unilateral eye pain, lacrimation, and nasal stuffiness (direct invasion of tissue from paranasal sinuses. invasion of blood vessels causes infarc of adjacent tissue, necrosis of hard palate, invasion into orbit and brain) mortality 60% |
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Term
| how do we dx rhinocerebral mucormycosis? |
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Definition
| isolation of organism from tissue bx at margin of necrotic tissue. organism seen invading blood vessels. NO true septation, broad angle branching |
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Term
| aspergillus and mucormycosis have a propensity for what area of body? |
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Definition
| invasion of blood vessels (and invade head and neck) |
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