Fungal Infections

Front 1

5 dimorphic fungi

Back 1

Histoplasma, Sporothrix, Blastomyces, Coccioides, Candida,
(HSBC C)

Front 2

Do fungi produce endotoxins?

Back 2

No

Front 3

Where is Histoplasmosis endemic?

Back 3

Ohio and Mississippi River Valley, tree choppers

Front 4

Where is Coccidioidimycosis endemic?

Back 4

Southwest US, CA earthquakes

Front 5

Polysacc Capsule unique to which fungus?

Back 5

Cryptococcus

Front 6

Candida host damage vs response curve

Back 6

quarterpipe downward

Front 7

Candida high risk pop?

Back 7

1. Meds: Abx users, steroid users
2. Immunosuppressed: HIV, Neutropenics, surgery

Front 8

Large source of Cryptococcus?

Back 8

bird feces, pigeon poo

Front 9

Cryptococcus neoformans causes.....

Back 9

pneumonia, meningoencephalitis, skin lesions in cooler temps esp serotype D, osteolytic bone lesions
(PMSO)

Front 10

Why is Pneumocystic Carinii unique?

Back 10

not free living, no cell wall, treat with abx not antifungals, cannot be cultured, not a human commensal, not acquired from environment

Front 11

Normal opening pressure upon lumbar puncture

Back 11

~130

Front 12

Cryptococcus neoformans predisposing conditions are?

Back 12

Meds: glucocorticoids, TNF inhibitors, transplant pts,
Diseases: AIDS, lymphoma, sarcoid (A-L-S)

Front 13

Cryptococcus virulence factors are?

Back 13

Ability to grow at 37C and thrive in macros
Polysacc capsule
Melanin, Mannitol

Front 14

How do you diagnose Cryptococcus neo?

Back 14

Blood Culture
Cryptococcal Ag Serology
Lumbar punct: india ink positive
CSF culture

Front 15

What criteria do AIDS pts or immunocompromised have to achieve so as to not get recurrent cryptococcus?

Back 15

CD4 count >200

Front 16

Spelunkers and tree cutters get?

Back 16

Histoplasma capsulatum

Front 17

Histoplasma path?

Back 17

Inhale microconidia,
convert to yeast,
taken up by phagos and replicate

Front 18

Clinical manifestations of Histoplasma?

Back 18

TB like symptoms:
Cavitary histo from underlying COPD
Mediastinal fibrosis

Front 19

How do you diagnose Histoplasmosis?

Back 19

sputum and blood culture (slow),
bone marrow biopsy,
serology,
skin testing

Front 20

Med students that open petri dishes get?

Back 20

Coccidioides

Front 21

2 dimorphic forms of Coccidioides

Back 21

in culture or soil: arthroconidia
in host: spherules with endospores

Front 22

Endemic areas of Coccidioides are?

Back 22

hot arid areas of S. American and United States

Front 23

Coccidioides path

Back 23

inhaled arthroconidia swell to spherules--> endospores
TB like infection in lung that gets into blood
rare Meningitis

Front 24

Coccidioides most likely causes what and where?

Back 24

Community acquired Pneumonia in AZ or nearby states

Front 25

Endemic areas of Blastomyces dermatitidis?

Back 25

River Valleys

Front 26

3 characteristics of Blastomyces

Back 26

1.Thick walled yeast with broad based buds
2. Inhaled causes TB like symptoms, skin and bone symptoms, and meningitis,
3. WI-1 cell adhesin is main virulence factor

Front 27

Diagnosis of Blastomyces dermatitidis

Back 27

direct exam of tissue, culture, serology lacks spec/sens

Front 28

What do florists and twiggy wood workers get?

Back 28

Sporothrix schenckii

Front 29

Sporothrix schenckii causes what?

Back 29

Lymphangitic sporotrichosis: nodule at and along lymphatic sites

Front 30

Clinical symptoms of Sporothrix schenckii?

Back 30

plaque sporotrichosis: nontender red maculopapular granuloma limited to inoculation site

Front 31

How do you diagnose Sporothrix schenckii?

Back 31

Culture skin biopsy or pus
should see *asteroid bodies* = yeast cell w/ eosinophilic radiations

Front 32

Most common source of Candida?

Back 32

Host's own endogenous flora

Front 33

Candida virulence factors?

Back 33

adherence
biofilms
proteinases
phospholipases
phase variation

Front 34

Candida risk factors?

Back 34

OR: Catheters, surgery, burns, abx, chemoTx, tube feeding
Transplants: Steroids, Bone Marrow Transplantation
Diseases: HIV, DM, Neutropenia

Front 35

Candida damage vs host response curve?

Back 35

Quarter pipe downward

Front 36

What does Candida look like? where?

Back 36

sharply demarcated at folds of skin

Front 37

Most common endocrinopathy in mucocutaneous Candidiasis?

Back 37

hyper PTH

Front 38

When do you clearly see hepatosplenic candidiasis?

Back 38

upon return of neutrophils

Front 39

How do you diagnose muco/cutaneous Candiasis?

Back 39

scrapings w/ 10% KOH

Front 40

Best stain for Candida?

Back 40

Silver stain

Front 41

How do you treat symptomatic candiduria?

Back 41

Remove the catheter

Front 42

How do you treat life threatening Candidiasis?

Back 42

With a Volleyball! (AVP)
Amphotercin, Voriconazole, Pneumocandin (echinocandin)
unless it's C. Parapsilosis

Front 43

How do you treat Candida in neonatal ICU?

Back 43

Azoles + Ampho because babies have less toxicity from Ampho

Front 44

How do you treat life threatening Candidiasis in certain pts?

Back 44

Fluconazole, except for C. krusei, glabrata, and tropicalis

Front 45

How do you treat Candidiasis thrush?

Back 45

Clotrimazole, nystatic topicals

Front 46

How do you treat Candida vaginitis?

Back 46

One dose Fluconazole
(Or Nystatin topicals, OR Azoles.)

Front 47

How do you treat Candida esophagitis?

Back 47

Fluconazole

Front 48

Is Aspergillus dimorphic?

Back 48

No. Only hyphal.

Front 49

Which Aspergillus spp produce aflatoxin?

Back 49

A. flavus and A. parasiticus. Can cause liver cancer.

Front 50

Damage vs host response curve of Aspergillus?

Back 50

U shaped. bottomed out. Class 4.

Front 51

3 types of pulmonary hyperresponsiveness to Aspergillus?

Back 51

Asthma,
Allergic Bronchopulmonary Aspergillosis (ABPA)
Extrinsic Allergic Alveolitis "Farmer's lung",

Front 52

Treatment of Allergic Bronchopulmonary Aspergillosis (ABPA)?

Back 52

Azoles + Steroids

Front 53

What kind of fungus formation is common w prior cavitary TB?

Back 53

Aspergilloma

Front 54

Symptoms of Aspergilloma?

Back 54

Cough
Clubbing,
Wheezing
Watch out for massive hemoptysis.

Front 55

3 molecular host responses to Aspergillus infection?

Back 55

1. Macro dectin1 and TLR2/4 bind beta-glucans on Asp--> inflamm cascade
2. Prod of O2 radical spp
3. Neutro prod of Lactoferrin: takes Fe awway from conidia

Front 56

Risk factors for invasive Aspergillosis?

Back 56

Transplants, neutropenia, steroids, AIDS, chronic lung disease, burns

Front 57

Symptoms of Invasive Pulmonary Aspergillosis?

Back 57

none early,
cough, low grade fever,
chest pain, hypoxia

Front 58

2 radiological signs of Invasive Pulmonary Aspergillosis?

Back 58

"Halo sign" and "Air Crescent sign" cavitation--> hemoptysis can be fatal

Front 59

which Aspergillus species causes Aspergillus sinusitis?

Back 59

A. Flavus

Front 60

What is the most common site of disseminated Aspergillosis?

Back 60

brain

Front 61

How do diagnose Aspergillosis?

Back 61

requires tissue and special silver stain

Front 62

How do you treat invasive Aspergillosis?

Back 62

Volleyballs again!
Amphotercin,
Voriconazole,
Pneumocandin,
or a combo of 2

Front 63

How do you treat semi-invasive Aspergillosis?

Back 63

Itraconazole or (better) Voriconazole

Front 64

How do you treat Aspergilloma?

Back 64

Surgery, Itraconazole/Voriconazole

Front 65

How do you treat ABPA?

Back 65

Itraconazole + steroids

Front 66

Where do Zygomycetes live?

Back 66

Soil

Front 67

3 modes of transmission for Zygomycetes?

Back 67

1. Breathe spores
2. Touch it
3. fermented milk/corn products or herbal remedies

Front 68

Risk factors for Zygomycosis?

Back 68

DESFEROXAMINE Tx where Zygomycetes can scavenge Fe
Neutropenia, DM/DKA, steroids, transplants, broad spec abx, Burns

Front 69

Common facial form of Zygomycosis?

Back 69

Rhinocerebral Zygomycosis: facial pain, fever, rapid progression

Front 70

Areas that Zygomycosis can go to?

Back 70

Pulm, GI, Face, skin

Front 71

What do Zygomycetes look like?

Back 71

Right Angle Ribbons
nonseptate irregular hyphae

Front 72

How do you treat Zygomycosis?

Back 72

Debridement + high dose Ampho
OR Posaconazlole with Echinocandin

Front 73

What does Tinea corporis (ringworm) look like?

Back 73

circumscribed, serpiginous inflammatory border

Front 74

How do you diagnose Dermatophytes?

Back 74

scrape, 10% KOH, some spp fluoresce under UV light

Front 75

Young people get this. rash. spring break. Puerto Rico.

Back 75

Malassezia furfur

Front 76

Why do young people get Malassesia furfur?

Back 76

Cause it's lipophilic. Hormonal changes cause changes in sebaceous glands.

Front 77

Clinical manifestation of Malassesia furfur? (Pityriasis versicolor)

Back 77

rash on back, chest, abdomen, neck, upper limbs

Front 78

Mechanism of AmphotercinB?

Back 78

macrolide ring interacts with cell mem ergosterol to form holes through membrane

Front 79

Although resistance to Ampho is rare, which species have it?

Back 79

Malassezia furfur, Aspergillus terreus, Candida lusitania, others

Front 80

How do you treat oral candidiasis?

Back 80

Oral slurry of AmphoB

Front 81

Toxic side effects of AmphotericinB?

Back 81

fever, chills, arrhythmia, hypotension, type1 renal tubular acidosis, K and Mg wasting, renal failure, anemia. watch those on other nephrotoxins and those on heart meds

Front 82

How has Ampho been improved?

Back 82

combine with liposome: less nephrotoxic, higher levels, but expensive

Front 83

Mech of Flucytosine?

Back 83

Inhibits DNA and RNA synthesis

Front 84

How do you treat cryptococcal meningitis?

Back 84

AmphoB+Flucytosine b/c excellent penetration to CSF

Front 85

Toxic side effects of Flucytosine?

Back 85

bone marrow suppression

Front 86

What's the only available formation of Flucytosine?

Back 86

PO

Front 87

Mech of Azoles?

Back 87

Inhibits ergosterol synth by inhibiting C14 demethylation of lanosterol

Front 88

Differences b/w Fluconazole and Itraconazole

Back 88

Fluconazole has better CSF levels, renal excretion. Itraconazole absorption enhanced by acid/food, poor CSF penetration, hapatic excretion

Front 89

Toxic side effects of Azoles?

Back 89

interaction with drugs that affect cytochrome P450s. Liver failure.

Front 90

Which drug is interchangable with Fluconazole?

Back 90

Voriconazole

Front 91

Interesting side effect of Voriconazole?

Back 91

see yellow flashing lights: photopsia

Front 92

Drug given in many places for prophylaxis before bone marrow transplants? What about the drug makes it good?

Back 92

Posaconazole, long half life and no P450 induction

Front 93

Echinocandin (Pneumocandins) mech?

Back 93

Inhibit 1,3 beta glucan synthase (component of many fungal cell walls)

Front 94

What two types of fungi are susceptible to Pneumocandins?

Back 94

Aspergillus, Candida

Front 95

What important type of fungus is resistant to Pneumocandins?

Back 95

Cryptococcus neoformans cause it has 1,6 beta glucans in cell wall

Front 96

Tox side effects of Pneumocandins?

Back 96

phlebitis, fever, cyclosporin increases levels, tacrolimus decreases levels

Front 97

How do you treat Dermatophytes?

Back 97

Griseofulvin, terbinafine (Lamisil), topical azoles, heat treatment