Term
| What is a unicellular organism that reproduces asexually by budding (blastoconidia formation) or fission? |
|
Definition
|
|
Term
| What are branching thread like tubular filaments which grow by apical extension, an area of intense metabolic activity |
|
Definition
|
|
Term
| Which hyphae are hollow and multinucleate? |
|
Definition
|
|
Term
| Which hyphae are divided by partitions? |
|
Definition
|
|
Term
| Which hyphae are on or under the surface of the medium, and provide nutrients? |
|
Definition
|
|
Term
| Which hyphae often contain conidia which are easily airborne, involved in asexual reproduction and dissemination of spores? |
|
Definition
|
|
Term
| What is a mass of hyphae=mold? |
|
Definition
|
|
Term
| Which form of fungi can exist either hyphal (usual form on culture media at room temperature) or yeast form (pathogenic form which grows at body temp)? |
|
Definition
|
|
Term
| What type of fungal form are the following? blastomyces. coccidiodes. histoplasma. |
|
Definition
|
|
Term
| Which fungal form involves elongated yeast forms linked like sausages which appear hyphal in character? |
|
Definition
|
|
Term
| What is caused by inhalation of material contaminated by a variety of molds? |
|
Definition
|
|
Term
| Which form of hsn pneumonitis involves intermittent high level exposure; fever, chills, cough, SOB; 4-8 hrs after exposure? |
|
Definition
|
|
Term
| Which form of hsn pneumonitis involves a low level chronic exposure; insidious onset of cough, SOB and weight loss? |
|
Definition
|
|
Term
| What causes farmer's lung? |
|
Definition
|
|
Term
| What causes malt-workers lung? |
|
Definition
|
|
Term
| What causes maple bark-strippers lung? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What causes suberosis (cork workers)? |
|
Definition
|
|
Term
| What causes cheese-washers lung? |
|
Definition
|
|
Term
| What causes ventilator pneumonia (humidifiers, air conditioners)? |
|
Definition
|
|
Term
| During what season does hsn pneumonitis occur in farmers? |
|
Definition
| occurs in *late winter or early spring* when farmers are using *moldy stored hay* to feed their livestock |
|
|
Term
| Does hsn pneumonitis predominate in smokers or non-smokers? |
|
Definition
|
|
Term
| Regarding mushroom poisoning- mycetismus- commercial market is predominately limited to what? |
|
Definition
|
|
Term
|
Definition
| collects and eats wild mushrooms |
|
|
Term
| What common saying refers to mycophagists? |
|
Definition
| "there are *old* mushroom hunters and there are *bold* ones, but ther are no *old, bold* mushroom hunters" |
|
|
Term
| What mushroom causes *95% of N American fatalities*? |
|
Definition
| *amanita phalloides*, the "death cap" mushroom |
|
|
Term
| What is the principle toxin of amanita phalloides? What are its physical properties? |
|
Definition
| *alpha-amantin*, an inhibitor of RNA polymerase II, which is *heat stable and water insoluble* |
|
|
Term
| Which phase of amanita mushroom poisoning occurs 6-24 hrs after ingestion, and involves profuse watery diarrhea with nausea and vomiting? |
|
Definition
|
|
Term
| Which phase of amanita mushroom poisoning is quiescent? |
|
Definition
|
|
Term
| Which phase of amanita mushroom poisoning occurs 3-6 days after ingestion and is the onset of hepatic and renal failure w/a 50-90% mortality? |
|
Definition
|
|
Term
| What percentage of mushroom exposures from 1993-1997 were unintentional? |
|
Definition
|
|
Term
| What percentage of mushroom exposures from 1993-1997 were in children under 6 y/o? |
|
Definition
|
|
Term
| What percentage of mushroom exposures from 1993-1997 had symptoms? |
|
Definition
|
|
Term
| Which primary site of infection is limited to the outermost layers of the skin or hair and only rarely elicit an inflammatory response b/c they colonize non-living structures? |
|
Definition
|
|
Term
| Which primary site of infection is limited to keratinized tissue of the epidermis, hair and nails, and is more inflammatory? |
|
Definition
|
|
Term
| Which primary site of infection involves the mouth, esophagus, and vagina? |
|
Definition
|
|
Term
| Which primary site of infection is limited to deeper skin structures, is non-invasive, and is often related to traumatic inoculation? |
|
Definition
|
|
Term
| Which primary site of infection is invasive? |
|
Definition
|
|
Term
| Where are superficial mycoses in the skin limited to? |
|
Definition
|
|
Term
| Pityriasis versicolor and tinea nigra are both what type of mycoses? |
|
Definition
| superficial mycoses: skin |
|
|
Term
| Superficial mycoses in the hair is limited to where? |
|
Definition
|
|
Term
| Black and white piedra are both what kind of mycoses? |
|
Definition
| superficial mycoses: hair |
|
|
Term
| What causes pityriasis (tinea) versicolor? What kind of organism is this? |
|
Definition
| caused by *malassezia furfur*, a *lipophilic dimorphic yeast* |
|
|
Term
| Where is malassezia furfur found? |
|
Definition
| part of the normal skin flora, *found in areas rich in sebaceous glands* |
|
|
Term
| What is characterized by *hyper- or hypopigmented lesions* on upper torso, arms and abdomen- light if the skin is dark; drk if skin is light? |
|
Definition
| pityriasis versicolor: clinical |
|
|
Term
| What is the appearance of pityriasis versicolor lesions? |
|
Definition
| *dry scaly, chalky appearance* |
|
|
Term
| What is the function of KOH? |
|
Definition
| *cover slip, add KOH which destroys tissue elements (chitin in the fungal cell wall is resistant to destruction by alkali)* |
|
|
Term
| What has a classic *spaghetti and meatballs* appearance? Of what is this a result? |
|
Definition
| KOH: classic *spaghetti and meatballs* as a result of combined yeast and hyphal elements: pityriasis versicolor |
|
|
Term
| What shows lesions that fluoresce yellow under *Wood's light*? |
|
Definition
|
|
Term
| Is a culture routine in pityriasis versicolor? why or why not? |
|
Definition
| culture: not routine, b/c of special media requirements (requires a medium supplemented w/fatty acids, e.g. peanut oil) |
|
|
Term
| Selenium sulfide, 2.5% applied for 7 days is a tx for what disease? How is this tx continued? |
|
Definition
| pityriasis versicolor. b/c of 60% relapse rate in 1st yr, repeat application on the 1st and 3rd days of the month for 6 mos. |
|
|
Term
| What is an alternative to selenium sulfide in pityriasis tx? |
|
Definition
| itraconazole 200 mg/day for 5-7 days followed by 200 mg on the 1st day of the month for 6 mos. |
|
|
Term
| What is the cure rate of a single dose of fluconazole in tx of pityriasis versicolor? |
|
Definition
| single dose of fluconazole had a 65% cure rate and was better than itraconazole |
|
|
Term
| For how long may depigmented patches remain in pityriasis versicolor? |
|
Definition
| depigmented patches may remain for mos, esp in the winter |
|
|
Term
| What is one of the most common human diseases? |
|
Definition
|
|
Term
| What is referred to as *keratinophilic* fungi? |
|
Definition
| dermatophytes possess *keratinases* and are referred to as *keratinophilic fungi* |
|
|
Term
| How do cutaneous mycoses differ from superficial mycoses? |
|
Definition
| differ from the superficial mycoses by evoking an inflammatory response |
|
|
Term
| What is also called ringworm? |
|
Definition
| cutaneous mycoses: dermatophytes |
|
|
Term
| What is most commonly called *tinea* plus the anatomic site? |
|
Definition
|
|
Term
| What is a dermatophyte infection of the feet? |
|
Definition
|
|
Term
| What is a dermatophyte infection of the scalp? |
|
Definition
|
|
Term
| What is a dermatophyte infection of the hands? |
|
Definition
|
|
Term
| What is a dermatophyte infection of the body? |
|
Definition
|
|
Term
| What is a dermatophyte infection of the nails? |
|
Definition
|
|
Term
| What is a dermatophyte infection of the groin? |
|
Definition
|
|
Term
| What is a dermatophyte infection of the beard? |
|
Definition
|
|
Term
| What are the three genera to which dermatophytes belong? |
|
Definition
| epidermophyton, microsporum, trichophyton |
|
|
Term
| Serious tinea capitis epidemics in the 1950's was caused by which sp? |
|
Definition
|
|
Term
| Now, tinea capitis is predominantly caused by what organism? |
|
Definition
|
|
Term
| Where are spores found in ectothrix? |
|
Definition
| spores surround the shaft due to destruction of the cuticle |
|
|
Term
| How does ectothrix fluoresce? |
|
Definition
| may be fluorescent or non-fluorescent |
|
|
Term
| How does ectothrix usually present? |
|
Definition
|
|
Term
| How does ectothrix clear patches of hair? |
|
Definition
| hairs break off just above the scalp leaving "gray patches" |
|
|
Term
| Where do spores appear in endothrix? |
|
Definition
|
|
Term
| What organisms cause endothrix? |
|
Definition
| produced by trichophyton spp, in the us most commonly t. tonsurans |
|
|
Term
| How does endothrix fluoresce? |
|
Definition
|
|
Term
| How do patches of hair clear in endothrix? |
|
Definition
| hair breaks off at the follicle leaving a "black dot"? |
|
|
Term
|
Definition
| boggy, purulent patches of alopecia, inflammatory- endothrix |
|
|
Term
| What organism causes favus? |
|
Definition
| trichophyton schoenleinii |
|
|
Term
| Where are hyphae found in favus? |
|
Definition
| hyphae course through the hair shaft w/air spaces |
|
|
Term
| What is the most serious form of dermatophytes? |
|
Definition
| favus most serious form, may lead to alopecia w/scarring |
|
|
Term
| Describe the border of tinea cruris. |
|
Definition
| typical scalloped, erythematous, scaling border |
|
|
Term
| Which is more common: tinea cruris or intertrigo of the groin? |
|
Definition
| much more common is intertrigo of the groin, cuased by candid albicans |
|
|
Term
| How is the incidence of onychomycosis changing? |
|
Definition
| incidence *increasing* (rare in US before WWII) |
|
|
Term
| Is onychomycosis more common in men or women? |
|
Definition
| more common in *men* than women |
|
|
Term
| Is onycomycosis more common in toenails or fingernails? |
|
Definition
| *toenails* 4x more commonly infected than fingernails |
|
|
Term
| What is the prevalence of onychomycosis among pts aged 40-60? |
|
Definition
|
|
Term
| What is the prevalence of onychomycosis among pts aged 60-70? |
|
Definition
|
|
Term
| What is the prevalence of onychomycosis among pts over age 70? |
|
Definition
|
|
Term
| What percent of pts with onychomycosis reported significant embarrassment which limited social interactions? |
|
Definition
|
|
Term
| What percent of pts w/onychomycosis reported the nail involvement made it difficult to work w/their hands or painful to wear shoes? |
|
Definition
|
|
Term
| What percentage of pts with onychomycosis found the disease limited their ability to walk? |
|
Definition
|
|
Term
| What percentage of onychomycosis is caused by dermatophytes? what are 3 causative organisms? |
|
Definition
| 90%: trichophyton rubrum. epidermophytom floccosum. trichophyton mentagrophytes. |
|
|
Term
| What percentage of onychomycosis is caused by yeasts? What is the causative agent? |
|
Definition
|
|
Term
| What percentage of onychomycosis is caused by nondermatophyte molds? What are the causative agents? |
|
Definition
| 2%: aspergillus, scopulariopsis, and others |
|
|
Term
|
Definition
Itraconazole *pulse* therapy: 200 mg, bid for 1 week ea month x 3
Terbinafine (lamasil) 250 mg, QD for 6 weeks (fingernails) or 12 weeks (toenails) or 7 days every 3 mos x 12 mos |
|
|
Term
| What are 2 topical nail lacquers used for onychomycosis? |
|
Definition
| *ciclopirox*, qd, and *amorolofine*, once weekly, are available as polymer film nail lacquers. also used as *combination therapy* w/itraconazole or terbinafine |
|
|
Term
| What presents as nodular and ulcerative lesions that develop along the lymphatics that drain the site of inoculation? What are these lesions called? |
|
Definition
| *sporotrichoid*, sporotrichosis |
|
|
Term
| What causes sporotrichosis? Who first described it? |
|
Definition
| caused by *sporothrix schenkii*, a dimorphic fungus first described by *bernard schenck, a second year medical student* |
|
|
Term
| Where can sporotrichosis be found? |
|
Definition
| sphagnum moss, splinters from rotting timbers and rose thorns (has been called the "alcoholic rose gardeners disease") are well described sources |
|
|
Term
| How are sporotrichosis organisms visualized? |
|
Definition
| organisms usually not seen even w/special stains, but may have *asteroid bodies*, also called the *SplendoreHoppli phenomenon*. Budding cigar shpaed yeast in culture at 37 degrees C, but at 25 degrees C grows as delicate branching hyphae w/conidia at the ends of conidiophores in a rosette pattern. |
|
|
Term
| What disease is seen w/*asteroid bodies*? what is this called? |
|
Definition
| sporotrichosis, *Splendore-Hoeppli phenomenon* |
|
|
Term
| What disease is seen w/budding cigar shaped yeast with conidia at ends of conidophores in a rosette pattern? |
|
Definition
|
|
Term
| How is sporotrichosis tx? |
|
Definition
| saturated soln of KI (SSKI), *itraconazole*, amphotericin B |
|
|
Term
| What causes histoplasmosis? |
|
Definition
| caused by inhalation of conidia of *histoplasmosa capsulatum* |
|
|
Term
| Where does histoplasmosis occur? |
|
Definition
| Occurs worldwide; in the US most common in the midwest in the *Ohio and Mississippi River Valleys (up to 80% skin test reactivity), also endemic in VA and MD along eastern seaboard* |
|
|
Term
| Where does histoplasma capsulatum grow? |
|
Definition
| grows in soil enriched by fecal material of chickens, bats and birds, esp starlings |
|
|
Term
| With what have histoplasmosis outbreaks been associated? |
|
Definition
| spelunking, cleaning chicken coops, and demolishing buildings during urban renewal |
|
|
Term
| How is infection by histoplasmosis caused? |
|
Definition
| infection is by inhalation followed by transient fungemia which results in calcified ranulomas in the liver and spleen (commonly seen in xrays of persons from the midwest) |
|
|
Term
| How many persons are infected each year with histoplasmosis? What percentage of these are asymptomatic? |
|
Definition
|
|
Term
| What percentage of histoplasmosis pts develop a self limited illness w/ fever, cough, HA, myalgias, and anorexia? |
|
Definition
|
|
Term
| What percentage of histoplasmosis pts develop progressive disease, usually immunocompromised or lg inoculum? |
|
Definition
|
|
Term
| What is associated w/spelunking? |
|
Definition
| histoplasmosis: 20 additional cases were ID'd and traced to *cave exploration* at the convention |
|
|
Term
| What disease occured during students on *spring break* who had resided at the Calinda Beach Hotel in *acuapulco* that was undergoing construction? |
|
Definition
|
|
Term
| With what illness were 32 inmates and workers hospitalized for at the *Powhatan Correctional Center in VA*? |
|
Definition
| histoplasmosis outbreak- june 1993 |
|
|
Term
| What stage of histoplasmosis resembles TB w/cough weight loss, fever, dyspnea, and hemoptysis? |
|
Definition
|
|
Term
| What stage of histoplasmosis is due to efects in *cell mediated immunity* and varies from acute fulminant to subacute to insidious and chronic? |
|
Definition
|
|
Term
| In what population is accut disseminated histoplasmosis most frequent? |
|
Definition
| most frequent in pts w/defective T-cell immunity- hematologic malignancies, corticosteroids, AIDS, transplant recipients and infants |
|
|
Term
| What are the s/s of acute disseminated histoplasmosis? |
|
Definition
| fever, weight loss, hepatosplenomegaly, and pancytopenia |
|
|
Term
| How might AIDS pts present w/acute disseminated histoplasmosis? |
|
Definition
| AIDS pts may present w/a fulminating syndrome similar to bacterial sepsis- shock, ARDS and DIC |
|
|
Term
| Which stage of histoplasmosis has a more gradual onset of fatigue, weight loss, with less organomegaly? |
|
Definition
|
|
Term
| Over what time period do symptoms progress in *chronic disseminated* histoplasmosis? |
|
Definition
| mos (subacute) to yrs (chronic) |
|
|
Term
| What are some specific s/s of chronic disseminated histoplasmosis? |
|
Definition
| *oral ulcerations, adrenalitis*, and rarely endocarditis and meningitis |
|
|
Term
| What are tests for histoplasmosis? |
|
Definition
| *complement fixation*- std test to detect Abs. *immunodiffusion*- detects Abs to H and M agents. *Urine and blood polysaccharide *Ag* detection by radioimmunoassay and direct stains of *buffy coat* and tissue* |
|
|
Term
| What is cultured for histoplasmosis dx? |
|
Definition
| culture of blood (lysis centrifugation), bone marrow, and urine for disseminated disease |
|
|
Term
| How is Histoplasmosis tx? |
|
Definition
| no tx for acute self lmtd. *amphotericin B* for severely or acutely ill. *itraconazole* for moderately ill and for chronic suppression as is needed for AIDS pts to prevent relapse |
|
|
Term
| What causes blastomycosis? |
|
Definition
| caused by inhalation of conidia of *blastomyces dermatitidis* |
|
|
Term
| To what is blastomycosis closely related? |
|
Definition
| closely related to *H. capsulatum*, is an ascomycete |
|
|
Term
| What is the sexual phase of blastomycosis? |
|
Definition
| sexual phase is *Ajellomyces dermatidis* |
|
|
Term
| Where is blastomycosis endemic? |
|
Definition
| endemic in Ohio and Mississippi River Valley regions, as well as the Missouri and Arkansas River basins |
|
|
Term
| In descending order of incidence, where is blastomycosis most frequently reported? |
|
Definition
| Kentucky, Arkansas, Mississippi, NC, Tennessee, Louisiana. Also found in Wisconsin, Minnesota, Illinois, VA (microfocus in *franklin, VA*) |
|
|
Term
| Outbreaks of what illness have *involved dogs and humans together, among raccoon hunters and their dogs in Southampton Co., VA)? |
|
Definition
|
|
Term
| 25-50% of blastomycosis cases involve what, clinically? |
|
Definition
| *osteomyelitis*, any bone may be involved |
|
|
Term
| After osteomyelitis, what are the next 2 most common sequellae of blastomycosis? |
|
Definition
| prostatitis and epididymo-orchitis |
|
|
Term
| In what disease might a pt have pulmonary infection that may be acute w/ARDS w/heavy inovulation, self lmt pneumonitis, or chronic disease? |
|
Definition
|
|
Term
| How are most blastomycosis dx made? |
|
Definition
| most dx made by ID of broad based budding yeast in tissue bx or purulent material or by culture |
|
|
Term
| Serologic tests and skin tests of blastomycosis are poor. Why? |
|
Definition
| high cross reactivity w/ *Histoplasma* and *Coccidioides* |
|
|
Term
|
Definition
| *itraconazole* is the drug of choice for non-life threatening disease. *amphotericin B* is the tx of choice for life threatening acute infections |
|
|
Term
| What causes coccidioidomycosis? |
|
Definition
| dimorphic fungus *Coccidioides immitus* |
|
|
Term
| How many new cases/yr are caused by coccidioidomycosis? |
|
Definition
|
|
Term
| Where does the mycelial phase of Coccidioides immitis grow? |
|
Definition
|
|
Term
| Is the mycelial phase of Coccidioides immitis infectious? |
|
Definition
|
|
Term
| About what should the lab be warned when dealing with Coccidioides immitis in the mycelial phase? |
|
Definition
| warn lab about potential isolate |
|
|
Term
| Where does the spherule phase of Coccidioides immitis occur? |
|
Definition
| parasitic, phase in humans |
|
|
Term
| Is the spherule phase of Coccidioides immitis infectious? |
|
Definition
|
|
Term
| What are 2 examples of teh spherule phase of Coccidioides immitis? |
|
Definition
|
|
Term
| What is the portal of entry for Coccidioides immitis? |
|
Definition
| lung: *inhalation of arthrospores in dust* |
|
|
Term
| What is the infective dose of Coccidioides immitis? |
|
Definition
|
|
Term
| Where is Coccidioides immitis endemic? |
|
Definition
| S CA, esp San Joaquin Valley. New Mexico. W TX. AZ. |
|
|
Term
| What disease was contracted by 35 church members from PA who traveled to Hermosillo, *Mexico* for 1 week to help *construct* a church? |
|
Definition
|
|
Term
| What disease was correlated with a *model airplane* event? |
|
Definition
|
|
Term
| What percent of Coccidioidomycosis pts present as a subclinical, asymptomatic primary infection, detected by a positive skin test? |
|
Definition
|
|
Term
| What percent of Coccidioidomycosis pts present with clinical pulmonary disease in the primary infection? |
|
Definition
|
|
Term
| Coccidioidomycosis causes what percent of all CAP in AZ, esp those who have lived in the area <10 yrs? |
|
Definition
|
|
Term
| what percent of Coccidioidomycosis primary infections are disseminated? |
|
Definition
|
|
Term
| What may be associated w/ a *hsn rxn*, such as *erythema nodosum* and arthralgias? How is this commonly known? |
|
Definition
| Coccidioidomycosis; *Valley fever* or "*miners bumps*" |
|
|
Term
| In which populations is there a marked increase in the rate of disseminated Coccidioidomycosis? |
|
Definition
| African Americans (10-15x) and Filipinos (50x), pregnancy, immunosupressions and AIDS. |
|
|
Term
| What might persistent symptoms, negative skin tests, and rising *eosinophilia* indicate in Coccidioidomycosis? |
|
Definition
| disseminated Coccidioidomycosis |
|
|
Term
| What *ms delayed hsn; excellent prognosticator* of Coccidioidomycosis? |
|
Definition
|
|
Term
| What do rising and falling titers indicate with complement fixation used to dx Coccidioidomycosis? |
|
Definition
| rising titer of concern, falling titers w/tx or time is good prognostically. |
|
|
Term
| What is the tx of choice for disseminated Coccidioidomycosis? |
|
Definition
| *AMB* for fulminant or life threatening infection. *Fluconazole* for moderate disease and meningitis. Itraconazole may prove to be an alternative |
|
|
Term
| What type of organisms take advantage of an impaired host immune system? |
|
Definition
|
|
Term
| What underlying host defects are risk factors for fungal infections? |
|
Definition
| neutropenial. t-cell dysfuntion. diabetes. |
|
|
Term
| What immunosuppression problems are risk factors for fungal infections? |
|
Definition
| cytotoxic chemo. high dose corticosteroids. bone marrow/organ transplantation. |
|
|
Term
| What is the trend in fungal infectious agents? |
|
Definition
| trend is to increasing non-*C. albicans* and mold infections, esp. more resistant spp like *Scedosporium, Fusarium, and Zygomycetes* (increasing prophylaxis) |
|
|
Term
| Are outcomes of fungal infections more closely related to the fungal sp or the degree of immunosuppresion? |
|
Definition
| outcomes are more closely realted to the *degree of immunosuppression* rather than the particular fungus |
|
|
Term
| What skin areas does candidiasis involve? |
|
Definition
| warm moist skin- *intertriginous areas* esp. common in diabetics, skin folds of the obese |
|
|
Term
| Describe the skin lesions found in candidiasis. |
|
Definition
| erythematous, macerated skin w/vesiculopustular satellite lesions. |
|
|
Term
| What is the tx for candidiasis? |
|
Definition
| dry skin, azole creams (lotrimin, 1%, miconazole) |
|
|
Term
| What percent of women have suffered at least one episode of vulvovaginitis? |
|
Definition
|
|
Term
| What factors predispose to vulvovaginitis? |
|
Definition
| Abx, steroids, BCP, pregnancy, diabetes |
|
|
Term
| In what population is oral thrush prevalent? |
|
Definition
| neonates. recent Abx. denture wearers. inhaled corticosteroids. HIV/AIDS. |
|
|
Term
| What causes severe chronic cutaneous (skin and nails) and mucosal infections that is most commonly a narrow and specific problem with cell mediated immunity against the causative agent? |
|
Definition
| chronic mucocutanous candidiasis |
|
|
Term
| How frequently do pts w/chronic mucocutaneous candidiasis develop systemic or disseminated disease? |
|
Definition
|
|
Term
| What is the ease of disseminated candidiasis dx? |
|
Definition
| difficult to dx, 50% of proven autopsy cases have negative blood cultures |
|
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Term
|
Definition
| KOH or gram stain of mucosal scrapings. C. albicans is ID'd by the *germ tube test*- production of hyphal outgrowths (germ tubes) when grown in serum at 37 degrees C, examine at 2-3 hrs. |
|
|
Term
| On what lab media does candidiasis grow? |
|
Definition
| will grow rapidly as a yeast on most lab media. does not require a special fungal media or fungal blood cultures, although may improve yield. |
|
|
Term
| What is a *germ tube test*? |
|
Definition
| C. albicans is ID'd by the *germ tube test*- production of hyphal outgrowths (germ tubes) when grown in serum at 37 degrees C, examine at 2-3 hrs. |
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Term
|
Definition
| fluconazole for *C. albicans, C. tropicalis, C. parapsilosis*. B/c of increasing rates of *C. glabrata, caspofungin or mycafungin has become the empiric drug of choice* |
|
|
Term
| What is commonly isolated from pigeon excreta? |
|
Definition
| Cryptococcosis- does not infect pigeons. |
|
|
Term
| What is closely associated w/Eucalyptus trees w/most cases in Australia, recent outbreak in Vancouver Island, Canada? |
|
Definition
|
|
Term
| What can cause acute and chronic pneumonia, and often appears as a mass lesion w/a pleural base? |
|
Definition
|
|
Term
| What has a predilection for CNS infection; most common cause of fungal meningitis; may also cause mass lesions? |
|
Definition
|
|
Term
| What is the most common cause of meningitis in AIDS pts? |
|
Definition
|
|
Term
| On what are serologic tests for Cryptococcosis based? |
|
Definition
| based on detection of the polysaccharide *Ag* by latex agglutination |
|
|
Term
| Rare false positives for serologic tests for Cryptococcosis are noted in what infections? |
|
Definition
|
|
Term
| Rapid dx of Cryptococcoal meningitis can be made how? |
|
Definition
|
|
Term
| What is the sensitivity of India ink preparation? |
|
Definition
| 50% sensitive; may be confused w/lymphocytes and other artifacts |
|
|
Term
| Cryptococcosis: in tissue, what will stain the capsule? |
|
Definition
| *mucicarmine* will stain the capsule, PAS and Hematoxylin and Eosin (H&E) do not stain the capsule |
|
|
Term
| In what type of tissue inflammation does cryptococcosis result? |
|
Definition
| results in minimal tissue inflammation, may be a mass of yeasts or meningitis w/o pleocytosis, esp in immunocompromised |
|
|
Term
| What type of agar may be used for Cryptococcosis? |
|
Definition
| *bird seed agar*, develops typical brown colonies |
|
|
Term
| What is very common in the environment which can result in contamination of specimens? |
|
Definition
|
|
Term
| What causes Aspergillosis? How is it manifested? |
|
Definition
| A broad spectrum of disease caused by spp of *Aspergillus*, may be *allergic* or *invasive* manifestations depending on the status of the immune system |
|
|
Term
| What presents as episodic asthma, expectoration of brown mucous plugs, pulmonary infiltrates? |
|
Definition
| allergic bronchopulmonary aspergillosis |
|
|
Term
| What presents with eosinophilia, immediate skin test reactivity to causative Ag's, elevated IgE Abs to causative agent, elevated total IgE |
|
Definition
| allergic bronchopulmonary aspergillosisi: immediate skin test reactivity to Aspergillus Ags, elevated IgE Abs to A. fumigatus |
|
|
Term
| How is allergic bronchopulmonary aspergillosis tx? |
|
Definition
| corticosteroids are the tx of choice |
|
|
Term
| What involves saprophytic colonization of old cavities; a mass of intertwined hyphae? |
|
Definition
| aspergillus- fungus balls |
|
|
Term
| What precipitins are present in serum in more than 90% and about 50% have positive sputum cultures? |
|
Definition
|
|
Term
| What is a *crescent sign*? |
|
Definition
| solitary, oval mass w/in a cavity which produces a *crescent sign*- aspergillus- fungus balls |
|
|
Term
| What is the most common symptom of aspergillus- fungus balls? |
|
Definition
|
|
Term
| What is associated w/profound immunosuppression w/prolonged neutropenia or crticosteroids, esp transplants AML, and multiple myeloma? |
|
Definition
|
|
Term
| What is an *angioinvasive* fungus leading to tissue infarction? |
|
Definition
|
|
Term
|
Definition
| nodular or patchy lung infiltration, single or multiple w/a surrounding ground-glass infiltrate ("*halo sign*"), which reflects hemorrhage secondary to blood vessel invasion *or* an area of tissue necrosis and cavitation "*crescent sign*" occurs later |
|
|
Term
| Which antibody and skin tests are useful to dx aspergillosis? |
|
Definition
|
|
Term
| When are blood cultures positive with aspergillosis? |
|
Definition
| blood cultures almost never positive even with widely disseminated disease or endocarditis |
|
|
Term
| What is a common problem with expectorated sputum samples when dx aspergillosis |
|
Definition
|
|
Term
| How can aspergillosis be dx? |
|
Definition
| bx of affected tissue w/culture or histologic examination for septate hyphae w/acute angel branching w/a 3 um diameter |
|
|
Term
| What has become the drug of choice for aspergillus? |
|
Definition
|
|
Term
| How does aspergillus respond to amphotericin? especially which sp? |
|
Definition
| poor response with amphotericin, esp. *A. terreus* |
|
|
Term
| What are risk factors for zygomycosis? |
|
Definition
| **metabolic acidosis. hyperglycemia*. corticosteroids. profound leukopenia. *deferoxamine therapy. long term prophylaxis w/voriconazole** |
|
|
Term
| In what pt population is rhinocerebral zygomycosis most common? |
|
Definition
| most common in *diabetics w/ketoacidosis*, also pts w/metabolic acidosis from other causes. |
|
|
Term
| Where does rhinocerebral zygomycosis originate? |
|
Definition
| originates in *paranasal sinus, spreads to orbit, hard palate and brain* |
|
|
Term
| What causes *periorbital edema, proptosis, epistaxis, necrotic black eschars in the nares or on the hard palate*, cranial nn palsies, obtundation, and death? |
|
Definition
| zygomycosis: rhinocerebral |
|
|
Term
| What is an **angioinvasive** fungus which results in *tissue infarction, necrosis and hemorrhage*? |
|
Definition
|
|
Term
| Zygomycosis may cause invasive pulmonary and disseminated syndromes identical to what organism? |
|
Definition
|
|
Term
| What serologic or skin test is useful in dx zygomycosis? |
|
Definition
| no serologic or skin test |
|
|
Term
| What would a histologic examination of zygomycosis reveal? |
|
Definition
| histologic examination of bx of involved tissue w/broad irregular, non-septate hyphae w/wide angle branching, "ribbon-like" |
|
|
Term
|
Definition
| *correction of underlying metabolic abnormality*, *amphotericin B, high dose but responses are low w/mortality of 75%*, *Posaconazole* is a new azole, available for compassionate use. *surgical debridement, often extensive and mutilating* |
|
|
Term
| What is the cost/day of AMB? |
|
Definition
|
|
Term
| What is the cost/day of Abelcet? |
|
Definition
|
|
Term
| What is the cost/day of Ambisome? |
|
Definition
|
|
Term
| What is indicated for pts w/pre-existing renal insufficiency, who develop nephrotoxicity on AMB or who are receiving other nephrotoxic drugs? |
|
Definition
| use **Abelcet (ABLC)** b/c it is intermediate in cost ($400/day) and usually well tolerated |
|
|
Term
| What is indicated for pts who have baseline near normal renal function and who are not receiving other nephrotoxic medications? |
|
Definition
| **AMBb** b/c it is very inexpensive ($10/day) and many pts will tolerate it well |
|
|
Term
| When is Ambisome indicated? |
|
Definition
| Limit the very expensive **Ambisome** ($1000/day) to those that have **both** severe infusion related toxicity and nephrotoxicity |
|
|
Term
| Most Commons: What is the most common cause of invasive fungal infection in stem cell or organ transplant patients. |
|
Definition
|
|
Term
| Most Commons: What is the most common cause of fungal meningitis? |
|
Definition
| Cryptococcosis is the most common cause of fungal meningitis. |
|
|
Term
Most Commons: What infection is one of the most important causes of seizures in the developing world and in
immigrants to the United States from endemic countries? |
|
Definition
Cysticercosis infection is one of the most important causes of seizures in the developing world and in
immigrants to the United States from endemic countries |
|
|
Term
Most commons: What is the most common site of Actinomyces infection?Cervicofacial or
thoracic disease may occasionally involve the central nervous system, most commonly as what? |
|
Definition
The most common site of Actinomyces infection is the cervicofacial area (about 60% of cases). Cervicofacial or
thoracic disease may occasionally involve the central nervous system, most commonly as a brain abscess or
meningitis. |
|
|
Term
| Book ?: Does blastomycosis occur more commonly in immunocompetent or immunocompromised individuals? |
|
Definition
| immunocompetent. however, if infection occurs in an HIV involves rapid progression and frequent dissemination |
|
|
Term
| Book ?: What is the most common cause What is the most common cause of invasive fungal infection in stem cell or organ transplant pts? |
|
Definition
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