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23 Cards in this Set

  • Front
  • Back
Compare and contrast the diagnosis of fungal infections at cutaneous and mucosal sit risky vs.systemic
cutaneous/ mucosal- accesible tissues, easy but under-utilized
systemic- early Dx is difficult
Why is early Dx of fungal infections more difficult with systemic infections vs. cutaneous
systemic infections:
-lack of inflammatory response in host
-invasive Dx procedures
-lack of sensitive, minimally invasive assays
Describe the Dx procedure for vulvovaginal candidiasis and why it is important
-important to carry out Dx because less than 50% of sxs were actually VVC
-Take swab, ph 4-4.5 wet mount 10% KOH and culture
T/F blood cultures are a reliable means for Dx of ICI
false, Dx for invasive candidiasis is only 50-70% acccurate
List 5 non culture Dx methods for candidiasis
1. serum ab (cell wall mannan)
2. serum ag (cell wall mannan)
3. metabolites (mannose, enolase, arabinitol, secreted aspartyl proteinase)
4. B 1,3 glucan assay
5. PCR (18s ribosomal)
Culture of Candida from the urine w/ or w/o pyuria does not imply clinical significance. What situations suggest a significant infection
-persistence after catheter removal
-confirmation with 2nd urine sample
When should urinary candidasis be treated
-symptomatic
-asymptomatic if obstructive uropathy, impending urological procedure, syndrome of disseminated candidiasis
In addition to the blood, where might candida be found in infections
peritoneum, drains, urine, sputum, skin/ wounds
List 4 ways to differentiate Candida species in the lab
1. azole antibiotic species activity
2. germ tube test
3. sugar assimilation
4. 26s rRNA (PNA FISH)
T/F an "ugly" nail is diagnostic of a fungal infeciton of the nail (onychomcosis)
false, only 50% of ugly nails are caused by fungal infection
Describe the procedure used to Dx a fungal nail infection
clip or scrape the skin, soak in KOH and wet mount
-culture
-PAS histopathology
List 4 ways that aspergillus can present as disase
1. colonization of lungs, sinuses
2. allergic ABPA, AFS
3. saprophytic/ asgergilloma in pre-existing lung cavity
4. invasive pulmonary, disseminated
Describe how aspergillus can be Dx'ed with histology and microscopy
-Gomori methenamine silver stain for detecting hyphae
-dichotomous branching, septate, nonpigmented
What features of a chest radiograph may suggest invasive aspergillosis
-patchy peripheral infiltrates progressing to dens consolidation
-solitary or multiple nodules progressing to cavitated nodules
-wedge shaped pleural based lesions
What features of a CT scan may indicated invasive aspergillosis
-earlier and better assessment than radiography
-Halo sign= early manifestation, rim of ground glass attenuation surrounding nodule, corresponds to rim of hemorrhage surrounding pulmonary infarction
T/F you should be suspicious of cultures for histoplasmosis because positive results could be from environmental contamination
false. While this is a problem for aspergillous, Hc is never a contaminant
List some common sites/ manifestations of Hc
acute pumonary, disseminated, percarditis, meningitis, joints/bones
list some common sites/ manifestations of blastomycosis
pulmonary> skin> bone> brain, other
How might blastomycosis be diagnosed
traditional smear and culture- big broad based buds
urine antigen (galactomannan)
List some common sites/ manifestations of coccidioidomycosis
60% are asymptomatic/ self limited
pulmonary> CNS, bone, skin
List three ways to Dx coccidioidomycosis
1. antibodies
2. tube precipitin
3. complement fixation
How might cryptococcosis be Dx'ed
CSF smear with India ink looking for zone of exclusion => capsule
Where is a good place to look for histoplamosis antigen in disseminated disease
urine