Crr Week 6: Fungal Pneumonias (Hill)

Front 1

Which fungal infection may be either benign and self-limiting or granulomatous and supporative, in which the primary infection is initiated in the lungs with frequent subsequent dissemination to other body sites?

Back 1

Blastomycosis

Front 2

What is the etiological agent that results in blastomycosis?

Back 2

Blastomyces dermatitidis

Front 3

What are the major forms of blastomycosis?

Back 3

1. Primary pulmonary
2. Disseminated (cutaneous, other)

Front 4

How is the laboratory diagnosis of blastomycosis made?

Back 4

Direct mount
(fluids, prostate fluid, sputa, or tissue is examined in 10% KOH).

Front 5

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

Back 5

Blastomyces dermatitidis

Front 6

Blastomycosis is most common in which individuals?

Back 6

1. Males 40 - 60 years of age
2. Children

Front 7

How does the mold form of blastomycetes dermatitidis appear?

Back 7

Hyaline septate mycelia with microconidia
*Appears similar to Chrysosporium or Sepedonium

Front 8

How can Blastomycetes dermatitidis be confirmed, since it scan sometimes resemble other fungi?

Back 8

Should demonstrate that mycelial form can be converted to yeast form

Front 9

What treatments can be used for blastomycosis?

Back 9

1. Amphotericin B--> drug of choice
2. Hydroxystilbamidine (treats cutaneous form of disease)

Front 10

What is the natural habitat for Blastomycetes dermatitidis?

Back 10

Most likely soil

Front 11

Blastomycetes dermatitidis is endemic to which areas of the U.S?

Back 11

Mississippi and Ohio River Valleys and extends to the eastern seaboard

Front 12

Which fungal disease is a chronic granlumatous disease that originates as a pulmonary infection and disseminates, resulting in ulcerative granulomata in the nasal, buccal, and occasionally the GI mucosa?

Back 12

Paracoccidiodes brasiliensis

Front 13

Which fungal infection is frequently seen with other diseases such as Chagas' disease and helminth infections?

Back 13

Paracoccidiodes brasiliensis

Front 14

Paracoccidiodes brasiliensis is commonly seen as lesions on which regions of the body?

Back 14

Oropharynx and gingivae

Front 15

What are the different forms of paracoccidiodes brasiliensis disease?

Back 15

1. Pulmonary
2. Disseminated

Front 16

How is the lab diagnosis of paracoccidiodes brasiliensis made?

Back 16

Direct mount
*Sputum, biopsy the base and outher edge of ulcers, crusts, or pus typically contain the YEAST form

Front 17

On a direct mount, how is paracoccidioides brasiliensis characterized?

Back 17

Multiple budding yeasts
(consisting of globose, young cells)

Front 18

Which fungus sometimes appears as a "mariner's wheel" or "Mickey Mouse type" forms on direct mount?

Back 18

Paracoccidiodes brasiliensis

Front 19

What is the treatment for paracoccidioides brasiliensis?

Back 19

1. Amphotericin B (drug of choice)
2. Sulfonamides (mild forms)
3. Ketoconazole (clinical studies)

Front 20

What is the natural habitat of paracoccidioides brasiliensis?

Back 20

Soil and wood

Front 21

Which fungal infection is an opportunistic mycotic infection caused by molds in the class Zygomycetes and order Mucorales?

Back 21

Mucormycosis

Front 22

What is invasive mycormycosis defined by?

Back 22

The site of involvement

Front 23

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

Back 23

Mucormycosis

Front 24

List 2 etiologic agents of mucormycosis

Back 24

1. Rhizopus
2. Mucor

Front 25

Which fungal infection can invade the nasal region with rapid progression to sinuses, eye, brain, and meninges?

Back 25

Rhinocerebral mucormycosis

Front 26

Facial edema and bloody exudates maybe signs of which fungal infection?

Back 26

Rhinocerebral mucormycosis
*Can cause death within 1 week.

Front 27

Inhalation of the sporangiospores of which fungi results in colonization and invasion of the blood vessels, causing profound destruction of the lung parenchyma?

Back 27

Thoracic mucormycosis

*Onset to death may be no more than 1 - 4 weeks

Front 28

How is the lab diagnosis of mucormycosis made?

Back 28

Specimens of tissue, sputum, or nasal exudates should be taken
1. Direct microscope --> broad (10-15 um) irregular, branching, nonseptate hyphae

Front 29

What is the prognosis of mucormycosis?

Back 29

Mortality due to infections with organisms in the Mucorales is approximately 50%
*Diagnosis is often antemortem

Front 30

What is the recommended treatment for mucormycosis?

Back 30

1. Amphotericin B
2. Surgical debridement

*Control of the underlying disease is of great importance for positive prognosis

Front 31

List the kingdom, phylum, and class that the order Actinomycetales is under.

Back 31

Kingdom: Monera
Phylum: Schizomycota
Class: Eubacter

Front 32

Which infection is characterized by dark red area of persistent swelling and suppuration with the formation of abscesses with draining sinuses?

Back 32

Actinomycosis

Front 33

Describe the bacteria that causes actinomycosis

Back 33

Endogenous anearobic Gram(+) rods, which grow as filaments and branching rods

Front 34

List the 3 forms of actinomycosis.

Back 34

1. Cervicofacial
2. Thoracic
3. Abdominal

Front 35

Which bacteria infection results from organisms in the normal flora of the human mouth (saliva, tongue, gingival crevice debris, and tonsils)?

Back 35

Actinomycosis

Front 36

What are the predisposing factors for Actinomycosis?

Back 36

1. Malnutrition
2. Alcoholism
3. Systemic disease
4. Disruption of the mucosal surfaces
5. Depressed cell-mediated or humoral immune responses

Front 37

Which infection is diagnosed by looking for sulfur granules in material draining from the lesions?

Back 37

Actinomycosis

Front 38

What is the treatment for Actinomycosis/

Back 38

Long-term antibiotic therapy combined with surgical drainage of the lesions and excision of damaged tissue
*Penicillins

Front 39

What is the natural habitat of bacteria causing actinomycosis?

Back 39

Normal flora in mouth of man

Front 40

How is Nocardiosis generally acquired?

Back 40

Pulmonary route or trauma with contaminated object
*Infection progresses to form abscesses and sinus tracts

Front 41

What are the 2 etiologic agents resulting in Nocardiosis?

Back 41

1. Nocardia asteroides
2. Nocardia brasiliensis

Front 42

List the 3 forms of Nocardiosis

Back 42

1. Thoracic
2. Cutaneous
3. Meningitis

Front 43

How can Nocardiosis be acquired?

Back 43

1. The organism grows in soil, so it can become airbone and be inhaled
2. Can contaminate material and be introduced into subcutaneous tissues by trauma with contaminated object

Front 44

Which gram (+) bacteria reveals mutliple branching or fragmented (beading) filaments upon direct examination of sputum or tissue smears?

Back 44

Nocardia asteroides or brasiliensis
(Nocardiosis)

Front 45

What is the natural habitat of Nocardia asteroides or brasiliensis?

Back 45

Soil

Front 46

Which toxin is produced in grains and other food products and is a carcinogen?

Back 46

Aflatoxin

Front 47

Infection with Histoplasma, Blastomyces, Coccidioides, and Nocardia may present with symptoms indistinguishable from which disease?

Back 47

TB

Front 48

Which fungal infection is more likely if a person has high exposure to wooded areas close to water or around decaying vegetation?

Back 48

Blastomyces dermatitidis

Front 49

Verrucous skin lesions and pulmonary cavitary lesions are characteristic of which fungal infection?

Back 49

Blastomycosis

Front 50

In what form is blastomyces dermatitidis inhaled, and what phase does it convert to?

Back 50

Inhaled as spores (microconidia) and then convert to the yeast phase.

*The yeasts reproduce in the lung parenchyma and are phagocytized by macrophages and neutrophils with the subsequent development of granulomatous inflammation

Front 51

Where do the blastomyces dermatitidis yeast reproduce?

Back 51

In the lung parenchyma --> results in granulomatous inflammation

Front 52

Which fungus forms budding cells within multinucleated giant cells?

Back 52

Paracoccidiodes brasiliensis

Front 53

Which fungus is responsible for North American blastomycosis?

Back 53

Blastomyces dermatitidis

Front 54

Which fungus is responsible for South American blastomycosis?

Back 54

Paracoccidiodes brasiliensis

Front 55

Which fungal infection manifests as a chronic progressive systemic mycosis in men from the forested tropical and subtropical regions of Latin America?

Back 55

South American blastomycosis
(Paracoccidiodes brasiliensis)

Front 56

Describe the chronic granulomatous disease process of paracoccidiodes brasiliensis.

Back 56

1. Primary pulmonary
2. Reactivates years later
3. Disseminates to buccal, nasal, GI mucosa

Front 57

How is South American Blastomycosis diagnosed?

Back 57

KOH prep/ sputum stain
(Paracoccidiodes brasiliensis)

Front 58

How is the diagnosis of Rhinocerebral zygomycosis made?

Back 58

1. CT of paranasal sinuses
2. Direct microscopy
3. Biopsy

Front 59

Which fungi have a predilection for arterial blood vessels and often cause emboli and necrosis of surrounding tissue?

Back 59

Rhizopus spp and Mucor spp.
(Zygomycosis)

Front 60

Necrotizing aspergillosis usually occurs in which individuals?

Back 60

1. Neutropenic patients
2. Bone marrow transplant recipients
3. Pts on steroid or cytotoxic chemotherapy

Front 61

What are the 2 clinical manifestations of aspergillus fumigatus?

Back 61

1. Necrotizing pneumonia
2. Aspergilloma (fungus ball)

Front 62

How is the diagnosis of aspergillus fumigatus made?

Back 62

1. Direct microscopy
2. Biopsy and stain with GMS/PAS

Front 63

Allergic bronchopulmonary aspergillosis (ABPA) is typically associated with what type of patients?

Back 63

1. Asthma
2. Cystic fibrosis

Front 64

Allergic bronchopulmonary aspergillosis results from what type of hypersensitivity reactions?

Back 64

Type I and III

Front 65

What are amanitin and phalloidin?

What is the MOA?

Back 65

Potent heptotoxins

*Inhibit RNA polymerase II and interruption of mRNA synthesis, resulting in cellular necrosis

Front 66

Describe the 3 clinical phases that follow ingestion of amanitin or phalloidin.

Back 66

1. Abdominal pain, vomiting, and diarrhea within 24 hour
2. Some remission, but elevated liver enzymes (24 - 36 hours)
3. Toxic liver injury, encephalopathy, hypoglycemia, coagulopathy, and coma

Front 67

What is the treatment for aminitin and phalloidin poisoning?

Back 67

1. Activated charcoal (oral)
2. IV penicillin G
3. Silibin
4. Liver transplant is often indicated

Front 68

What kind of dermatologic allergic response can result from a fungal infection somewhere else in the body?

Back 68

Id reaction
(autoexzematization)

Front 69

Which mushrooms cause hallucinations?

Back 69

Psilocybin/ psilocin

Front 70

Which toxic fungus can be found in cereals/grains?

Back 70

Aspergillus flavus
(Aflatoxin)

Front 71

Are Actinomyces and Nocardia aerobic or anaerobic microbes?

Back 71

Actinomyces --> anaerobic
Nocardia --> aerobic

Front 72

What is the hallmark characteristic of Actinomyces and Nocardia infections?

Back 72

They produce granules

Front 73

Are Actinomyces and Nocardia gram(+) or (-)?

Back 73

Gram (+)

Front 74

Cervicofacial actinomycosis involves which bacterium?

Back 74

Actinomyces israelli

Front 75

Cervicofacial actinomycosis is usually caused by..?

Back 75

Dental work or oromaxillofacial traumas

Front 76

Where do cervicofacial actinomycosis typically occur?

Back 76

Submandibular region
"lumpy jaw"

Front 77

Which form of actinomycosis typically follows bowel surgery?

Back 77

Abdomina actinomycosis

Front 78

What is the treatment for actinomycosis?

Back 78

1. IV penicillin for 2-6 wks
2. Oral penicillin or amoxacillin for 6 - 12 months

Front 79

What are the clinical manifestations of Nocardia asteroides?

Which form is the most common?

Back 79

1. Cutaneous (cellulitis/mycetoma)
2. Pulmonary (local or diffuse pneumonia)
3. Disseminated (deep abscesses and necrosis CNS)

*Pulmonary is the most common

Front 80

Which infection usually results in pulmonary cavitation, abscess formation, pleural effusion, or empyema?

Back 80

Pulmonary nocardiosis

Front 81

Which respiratory pathogen is urease positive

Back 81

Nocardia steroides
(pulmonary nocardiosis)

Front 82

How is nocardia asteroides aquired?

Back 82

Local traumatic inoculation or inhalation