Week 227 Fungal Disease

Front 1

How does Candida normally present?

Back 1

'Thrush' (white thick mucus in white plauqes) in the oral cavity, oesophagus, vagina and glans penis (balanitis), systemic candidiasis only occurs in those who are immunosuppresed

Front 2

How can Candida be identified histologically (which stain)?

Back 2

PAS stain, confirm with biopsy

Front 3

What are the 3 non-invasive Aspergillus forms?

Back 3

Heavy exposure in normal patients - hypersensitivity pneumonitis

Asthma or cystic fibrosis patients at low dose- Allergic bronchopulmonary aspergillosis (ABPA)

Pre-exisiing caviating lung disease - mycetoma (colonisation of cavities)

Front 4

How does hypersensitivity pneumonitis normally present?

Back 4

Dyspnoae, cough, fever and flu-like symptoms 4-6 hours following exposure, symptoms abate when contact is reduced

Front 5

What type of hypersensitivity reaction is hypersensitivity pneumonitis?

Back 5

A mixture of type 3 and type 4 hypersensitivity reactions

Front 6

How can hypersensitivity pneumonitis be treated?

Back 6

Prevent further exposure, if severe use immunosuppresants but symptoms should improve following hospital admission, if untreated it leads to fibrosis requiring IPF-like care

Front 7

Allergic Bronchopulmonary aspergillosis is what type of hypersensitivity reaction?

Back 7

ABPA is a mixture of type 3 and type 4 reaction, asthma is due to type 1

Front 8

How may Allergic Broncho-Pulmonary Aspergillosis appear on CXR?

Back 8

Mucus plugged airways leading to finger-in-glove appearance

Front 9

How can a Allergic Bronch-Pulmonary Aspergillosis diagnosis be confirmed?

Back 9

Hyphae in the sputum, eosinophillia, raised IgE, positive skin test for Aspergillus protein, bronchiectasis in time

Front 10

How can Allergic Bronch-Pulmonary Aspergillosis be treated?

Back 10

ABPA requires oral steroid to reduce immune effect, manage the asthma, physiotherapy and bronchoscopy to remove mucoid plugs

Front 11

Mycetoma is also known as a...

Back 11

Aspergilloma

Front 12

Which compound released from the hyphae causes erosion of blood vessels and subsequent haemoptysis?

Back 12

Oxalic acid

Front 13

Invasive Aspergillosis usually occurs in which patients?

Back 13

Neutropenic patients (immunosuppresed, those on steroid, AIDs, DM)

Front 14

How does a patient with invasive aspergillosis patient present?

Back 14

Typically very ill, rapid necrosis and cavitation of lung, copious blood staining lung

Front 15

How can a patient with invasive aspergillosis be treated?

Back 15

Amphotericin plus flucytosine

Front 16

Aspergillus is associated with which tumour and by which mechanism?

Back 16

Hepatocellular Carcinoma (HCC) due to Aflatoxin produced by the Aflatoxin

Front 17

How can superficial and cutaneous mycoses be identified?

Back 17

Wood's lamp

Front 18

Dermatophytosis of these regions is known as tinea... Corporis, pedis, barbae and cruris

Back 18

Corporis (head), Pedis (foot), barbae (beard line) and cruris (groin)

Front 19

How does a fungal nail present?

Back 19

Thickened, deformed, friable and discoloured nail

Front 20

Pityriasis Versicolor is an infection of which skin layer?

Back 20

Stratum corneum, skin becomes hyperpigmented respectively

Front 21

In which specific patient groups is invasive candidiasis a concern?

Back 21

Bone marrow transplant, organ transplant and burns

Front 22

What is the difference between the formation of miliary tuberculosis and cavitating re-activation tuberculosis

Back 22

Miliary TB requires lower immunity, poorly formed granuloma, widespread lesions and abundant bacteria