Bhl Week 5: Opportunistic Infections

Front 1

What is the primary infection site of Cryptococcosis?

Back 1

Lungs

*Following inhalation of the fungus, the primary infection may remain localized or disseminate.

Front 2

What form of Cryptococcosis infection is most frequently diagnosed?

Back 2

CNS disease
(Primary pulmonary infections have no diagnostic symptoms are and usually asymptomatic).

Front 3

European blastomycosis refers to which fungi?

Back 3

Cryptococcosis

Front 4

Which fungi ranks first among fungal diseases that kill patients with AIDS?

Back 4

Cryptococcosis

Front 5

Which etiologic agent results in Cryptococcosis?

Back 5

Cryptococcus neoformans

Front 6

How is the laboratory diagnosis of Cryptococcosis made?

Back 6

1. Direct mount (yeast cells identified from CSF and pulmonary tissue using KOH or india ink).
2. Culture
3. Serology agglutination assay (look for cyrptococcal antigen)
4. Assays for CMI responsiveness (lymphocyte proliferation, skin test)

Front 7

What physical characteristic of cryptococcal yeast cells is seen on a direct mount?

Back 7

Capsule surrounding the cells

Front 8

What is the difference in prognosis of pulmonary infections versus CNS infections of cryptococcosis?

Back 8

Pulmonary lesions in non- compromised patients have a good prognosis; they usually heal without treatment
CNS hematogenous spread have a grave prognosis unless treated immediately

Front 9

What is the drug of choice for cryptococcosis?

Back 9

Amphotericin B

Front 10

What 2 drugs are used concurrently in the treatment of cryptococcal meningitis?

Back 10

1. 5-FC
2. Amphotericin B

Front 11

Which opportunistic pathogen is found in pigeon manure and debris around pigeon roosts?

Back 11

Cryptococcus neoformans

Front 12

Which fungal infection is also known as thrush?

Back 12

Candidiasis

Front 13

Which fungal infection is also known as moniliasis?

Back 13

Candidiases

Front 14

What is the major pathogen associated with candidiasis?

Back 14

Candida albicans

Front 15

List 4 forms of Candidiasis.

Back 15

1. Cutaneous and mucosal
2. Chronic mucocutaneous
3. Systemic
4. Allergic

Front 16

How is the laboratory diagnosis of candidiasis made?

Back 16

1. Direct examination (ovoid budding yeast cells; psuedohyphae and/or true hyphae)
2. Isolation-- plate on dextrose agar

Front 17

How is C. albicans distinguished from the other species?

Back 17

C. albinans is the only species that makes chlamydoconidia

(hyphae, chlamydoconidia, and blastoconidia will be seen)

Front 18

Which drugs are effective in controlling mild to moderate infections with Candida?

Back 18

1. *Nystatin
2. Clotrimazole and miconazole (alternatives)

Front 19

What is the drug of choice for treating disseminated Candidiasis?

Back 19

Amphotericin B

Front 20

What is the natural habitat of Candida?

Back 20

Humans (ubiquitous)

Front 21

Which fungal infection results in a respiratory infection that typically resolves rapidly?

Back 21

Coccidioidomycosis

Front 22

What type of individuals are more susceptible to disseminated Coccidioidomycosis?

Back 22

Males > females
Filipinos > African Americans > Mexicans (all more susceptible than Caucasians)

Front 23

How is Coccidioidomycosis acquired?

Back 23

Inhalation of airborne arthroconidia

Front 24

Which etiologic agent is responsible for Coccidioidomycosis?

Back 24

Coccidioides immitis

Front 25

Which opportunistic fungi have athroconidia that are barrel-shaped, and easily airborne?

Back 25

Coccidioides immitis

Front 26

What are the two forms of Coccidioidomycosis?

Back 26

1. Primary pulmonary
2. Disseminated

Front 27

Which opportunistic fungi form spherules and endospores at 37*C?

Back 27

Coccidioides immitis

Front 28

How is the lab diagnosis of Coccidioidomycosis made?

Back 28

1. Direct mount (spherules + endospores)
2. Culture (barrel-shaped arthroconidia w/ disjunctor cells in between)
3. Serological tests
4. Assays for CMI responsiveness

Front 29

What does a positive tube precipitin (TP) test indicate when testing for coccidioidomycosis?

Back 29

Primary or reactivation of coccidioidomycosis

Front 30

What does an increasing CF titer indicate in a patient with coccidioidomycosis?

Back 30

Increased severity of disease

Front 31

How is primary coccidioidomycosis treated?

Back 31

Bed rest and restricted activity

Front 32

How is secondary coccidioidomycosis treated?

Back 32

Amphotericin B
(grave prognosis)

Front 33

Which fungi has a natural habitat in the alkaline soil of the lower Sonoran life zone in North, Central, and South America?

Back 33

Coccidioides immitis

Front 34

Which etiologic agents results in pneumocystosis?

Back 34

Pneumocystis jiroveci

Front 35

Which fungi has a life cycle that consists of diploid trophozoites going through meiosis, then forming a developing cyst?

Back 35

Pneumocystic jiroveci

Front 36

How does the pulmonary form of pneumocystosis present?

Back 36

1. Fatigue
2. Cough (mild, dry)
3. Fever
4. Progressive SOB
5. Rapid breathing

Front 37

The extrapulmonary form of pneumocystosis is usually reported in what type of patients?

Back 37

Late stage HIV infections

Front 38

How is the diagnosis of pneumocystosis made?

Back 38

1. History
2. Chest x-ray
3. Physical exam
4. Identifying the cysts in induced sputum, bronchial lavage, or lung biopsy

Front 39

What is the treatment for pneumocystosis?

Back 39

Trimethoprim/sulfamethoxazole

Front 40

Which fungal infection may mimic tuberculosis?

Back 40

Histoplasmosis

Front 41

T or F.
Most cases of histoplasmosis progress to chronic lung disease.

Back 41

FALSE
95% cases are inapparent or benign.
Only 5% cases have chronic progressive lung disease

Front 42

Which opportunistic pathogen results in Histoplasmosis?

Back 42

Histoplasma capsulatum

Front 43

What are the infectious particles of histoplasma capsulatum?

Back 43

1. Microconidia
2. Fragments of hyphae

Front 44

Which opportunistic fungi is an intracellular pathogen and appears in macrophages?

Back 44

Histoplasma capsulatum

Front 45

How is the identification of H. capsulatum confirmed?

Back 45

The mold form is converted to the yeast form by transfering the fungus to a tube of brain heart infusion agar with glutamine or blood, and incubated

Front 46

What is the drug of choice for histoplasmosis?

Back 46

Amphotericin B

Front 47

Which opportunistic fungi is found in guano of birds and bats and is endemic in Oklahoma?

Back 47

Histoplasma capsulatum

Front 48

What is the most common pathogen to cause Aspergillosis?

Back 48

Aspergillus fumigatus

Front 49

Inhalation of which opportunistic fungi may result in an immediate hypersensitivity reaction?

Back 49

Aspergillosis

Front 50

How is allergic bronchopulmonary aspergillosis diagnosed?

Back 50

1. Asthma
2. Recurrent pulmonary densities in chest x-rays
3. Eosinophilia
4. Immediate hypersensitivity reaction

*Fungal growth in bronchi

Front 51

Aspergillus conidia can develop into a colony on the surface of the respiratory tract called....?

Back 51

Aspergilloma or fungus ball

Front 52

The allergic forms of Aspergillosis are treated with which drugs?

Back 52

1. Corticosteroids
2. Anti-fungals

Front 53

How is Aspergilloma treated?

Back 53

Treatment depends on severity:
May not require treatment or may require surgical resection and treatment with aphotericin B and flucytosine

Front 54

How is invasive aspergillosis treated?

Back 54

Aggressive treatment with amphotericin B initiated as soon as possible

Front 55

Individuals with ketoacidosis resulting from diabetes mellitus, drugs, or uremia are very susceptible to which fungal infection?

Back 55

Mucormycosis

Front 56

Which mycotic infection is caused by molds in the class Zygomycetes?

Back 56

Mucormycosis

Front 57

List 2 forms of Mucormycosis.

Back 57

1. Rhinocerebral mucormycosis
2. Thoracic mucormycosis

Front 58

Which fungal infection may result in invasion of the nasal region with rapid progression to sinuses, eye, brain, and meninges?

Back 58

Rhinocerebral Mucormycosis

Front 59

What are the clinical signs of Rhinocerebral mucormycosis?

Back 59

Facial edema and bloody exudates

Front 60

Which two fungi are often contaminants of laboratory media, therefore special care must be taken to confirm that the organism is actually the cause of disease?

Back 60

1. Aspergillus
2. Mucormycosis (zygomycetes)

Front 61

What is the mortality rate of Mucormycosis due to Mucorales organisms?

Back 61

50%

Front 62

What is the treatment for mucormycosis?

Back 62

1. Amphotericin B
2. Surgical debridement

Front 63

What is the etiologic agent of Blastomycosis?

Back 63

Blastomyces dermatitidis

Front 64

Which fungi usually occurs as a thick-walled globus yeast, with the blastoconidium attached to the parent cell by a broad base?

Back 64

Bastomyces dermatitidis

Front 65

When cultured, how is B. dermititidis confirmed?

Back 65

Mycelial form must be converted to yeast form for confirmation

Front 66

What is the treatment for Blastomycosis?

Back 66

Amphotericin B

Front 67

What is the natural habitat of blastomycetes dermititidis?

Back 67

Soil

Front 68

What type of factors may predispose an individual to systemic cadidiasis infections?

Back 68

1. Neutropenia
2. Severe burns
3. Drug abuse
4. Intravenous catheters

Front 69

Metabolites of which opportunistic fungi are toxic and carcinogenic?

Back 69

Aspergillus

Front 70

Which fungus has stalks topped with flask-shaped vesicles (phialides)?

Back 70

Aspergillus

Front 71

Which agent is responsible for toxoplasmosis?

Back 71

Toxoplasma gondii

(*parasite)

Front 72

What is the therapy for toxoplasmosis?

Back 72

Sulfadiazine + pyrimethamine

Front 73

What are the treatments for Herpes zoster?

Back 73

1. Acyclovir
2. Famciclovir

Front 74

Which fungi involves septate hyphae in Y-shaped branching, frequently invading blood vessels?

Back 74

Aspergillus