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33 Cards in this Set
- Front
- Back
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endemic mycoses of north america
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histoplasmosis
blastomycosis |
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Other endemic mycoses
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penicilliosis
paracoccidioidomycosis |
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characteristic of histoplasmosis
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histoplasma capsulatum
dimorphic fungi <35 C mold >37 C yeast |
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epidemiology of histoplasmosis
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mostly in mississippi and ohio river valleys
exists worldwide associated w/ bird and bat guano local outbreaks associated w/ caves, bird roosts, construction |
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pathogenesis of histoplasmosis
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similar to TB
microconidia inhaled phagocytized by alveolar macrophages divide within macrophages and disseminate |
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presentation of acute histoplasmosis
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may be aSx
may be mild flu like self limited (no Tx) most common cause in US of calcified granulomas in lung liver and spleen |
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who gets acute progressive disseminated histoplasmosis?
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HIV and profoundly immunocompromised
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who gets chronic progressive disseminated histoplasmosis?
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non immunosuppressed pts
present w/ malaise, weight loss, fever oral ulcers hepatosplenomegaly may have bone marrow involvement w/ low hite blood cells or anemia |
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Dx of histoplasmosis
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direct - silver stain
culture histoplasmin skin test - not used for Dx serology - complement fixation, immunodiffusion antigen testing - urine and serum |
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Tx of histoplasmosis
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ampho B for severe illness
itraconazole for less severe and follow up therapy prolonged Tx voriconazole and posaconazole have activity but little clinical experience |
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other histoplasmosis?
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cavitary pulmonary disease
aseptic meningitis |
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cavitary pulmonary disease, Dx, Tx
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look like TB
usually in pts w/ emphysema Dx - culture or serolog Tx - itraconazole |
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aseptic meningitis
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chronic lymphocytic meningitis
Dx - CSF culture or serology Tx - amp B followed by prolonged fluconazole |
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what is mediastinal fibrosis?
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exuberant immune response to H. capsulatum. depostition of fibrotic tissue in mediastinum
no Tx. |
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characteristics of blastomycosis
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blastomyces dermatitidis
dimorphic fungi tissue - broad based budding |
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epidemiology of blastomycosis
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endemic in central and eastern US
associated w/ outdoor activity esp in wooded areas along waterways |
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pathophysiology of blastomycosis
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entry via lungs
initial infection aSx - incubation 30-45 days |
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presentation of blastomycosis
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pulmonary - usually focal
cutaneous - chronic non healing lesions that ulcerate bone and joint - invasive/destructive focal lesions central nervous system - aseptic meningitis |
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Dx of blastomycosis
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biopsy
culture serology - EIA (enzyme immunoassay), titer >1:16, CF not reliable urine antigen (has cross reactivity between blasto and histo) |
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Tx of blastomycosis
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itroconazole
ampho B for CNS or severe disease (fluconazole for CNS if ampho not tolerated) vori and posa have activity but little clinical experience |
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characteristics of coccidiodomycosis
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coccidiodoides immitis (in southern cali)
coccidiodes posadasii (isolates outside of cali) dimorphic fungi arthroconidia are infectious particles tissue - spherules w/ endospores |
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epidemiology of coccidiodomycosis
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endemic in soil in SW US
significant differences in risk of dissemination - filipino >>> african > european |
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Sx of acute coccidiodomycosis?
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50% aSx
non specific respiratory illness infiltrates or hilar adenopathy on CXR |
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Dx of acute coccidiodomycosis
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changes in serology
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Tx of acute coccidiodomycosis
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controversial - some Tx everyone
recommended for pts at high risk for dissemination - HIV organ transplant, pregnancy.. etc severe or prolonged Sx Itraconazole |
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presentation of chronic coccidiodomycosis
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chronic fibrotic pneumonia
extrapulmonary disease - bone and joint, cutaneous, meningitis |
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Dx of coccidiodomycosis
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biopsy
culture serology - CF titer >1:32 indicated secondary disease - titer indicates severity (except meningitis) - also ID and tube precipitin tests available |
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Tx of coccidiodomycosis
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ampho B for Tx for severe disease
itraconazole. (not for CNS) fluconazole vori and posa have activity but little clinical experience prolonged therapy |
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characteristics of penicilliosis
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penicilium marneffe
dimorphic fungi endemic in norther tailand, indochina, souther china common AIDS related opportunistic infection |
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presentation of penicilliosis
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fever, malaise, weight loss >. 4weeks
1 or more skin lesions lymphadenopathy, hepatosplenomegaly, cough |
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Dx of penicilliosis
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pathology or culture
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Tx of penicilliosis
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ampho B followed by itraconazole
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characteristics of paracoccidioidomycosis
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caused by paracoccidioides brasiliensis
"south american blastomycosis" (presents like blasto) |
