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Fungal Infections Slackers Facts by Mike Ori

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Fungal Infections. Slackers Facts by Mike Ori. Disclaimer. The information represents my understanding only so errors and omissions are probably rampant. It has not been vetted or reviewed by faculty. The source is our class notes. - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: Fungal Infections

Fungal Infections

Slackers Facts by Mike Ori

Page 2: Fungal Infections

Disclaimer

The information represents my understanding only so errors and omissions are probably rampant. It has not been vetted or reviewed by faculty. The source is our class notes.

The document can mostly be used forward and backward. I tried to mark questionable stuff with (?).

If you want it to look pretty, steal some crayons and go to town.

Finally…

If you’re a gunner, buck up and do your own work.

Page 3: Fungal Infections

What is a tinea

Page 4: Fungal Infections

A superficial fungal infection defined by its anatomical location

Page 5: Fungal Infections

List common tinea locations and names

Page 6: Fungal Infections

Name Location

Capitis Head

Barbae Beard/face

Faciei Face

Corpus Body (ringworm)

Cruris Inguinal (Jock itch, usually not scrotum/penis)

Pedis Foot (Athletes foot)

Manuum Hands – expect pedis to be present too

Unguium Nails/nail bed (onychomycosis)

Page 7: Fungal Infections

Etiologic agent: Itchy scrotum

Page 8: Fungal Infections

Candida

Page 9: Fungal Infections

Vaginal candidiasis predisposing factors

Page 10: Fungal Infections

DiabetesAntibiotic use

PregnancyHIV

Page 11: Fungal Infections

What is a woods lamp and why is it used

Page 12: Fungal Infections

It is a UV lamp that causes some fungal infections to fluoresce and hence serves as a

diagnostic tool.

Page 13: Fungal Infections

What is the slide mount prep for fungal infections

Page 14: Fungal Infections

KOH prep

Page 15: Fungal Infections

Etiologic agent: Angular chelitis

Page 16: Fungal Infections

Candida

Page 17: Fungal Infections

Etiologic agent: Erythematous depapillation in midline of lingua

Page 18: Fungal Infections

Candida

Page 19: Fungal Infections

Etiologic agent: pseudomembranous plaques in mouth

Page 20: Fungal Infections

Candida

Page 21: Fungal Infections

Candida treatment

Page 22: Fungal Infections

Topicals - Nystatin rinse (swish and swallow), OTC azoles

Systemics – Triazoles or amphotericin B

Page 23: Fungal Infections

Onychomycosis sx

Page 24: Fungal Infections

Opaque, yellow, thickened, chalky nails with debris accumulation

Page 25: Fungal Infections

Onychomycosis tx

Page 26: Fungal Infections

Usually long term systemic anti-fungals like fluconazole, itraconazole, terbinafine.

Page 27: Fungal Infections

Aspergilla source

Page 28: Fungal Infections

Environment - soil

Page 29: Fungal Infections

Aspergillosis categories

Page 30: Fungal Infections

• Non-invasive• Allergic reaction• Aspergilloma

• Invasive• Chronic necrotizing

aspergillosis• Invasive pulmonary

aspergillosis

Page 31: Fungal Infections

Aspergilloma tx

Page 32: Fungal Infections

Surgical removal if aspergilloma is problematic. Medical tx cannot adequately penetrate the

ball.

Page 33: Fungal Infections

Chronic necrotizing aspergilloma features

Page 34: Fungal Infections

Invades lung parenchyma but does not invade vasculature

Page 35: Fungal Infections

Chronic necrotizing aspergilloma epidemiology

Page 36: Fungal Infections

Lung disease accompanied by “some” immune suppression

Page 37: Fungal Infections

Invasive pulmonary aspergillosis characterization

Page 38: Fungal Infections

Destruction of the lung parenchyma with invasion into the vasculature (angio invasive)

Page 39: Fungal Infections

Invasive pulmonary aspergillosis epidemiology

Page 40: Fungal Infections

Prolonged neutropenia as in cancer tx

Page 41: Fungal Infections

Fusariosis characterization

Page 42: Fungal Infections

Commensal organism on many grains that causes keratitis in contact lens users. Infection

occurs by direct inoculation and may spread systemically in immunocompromised hosts.

Page 43: Fungal Infections

Fusariosis risk factors

Page 44: Fungal Infections

Prolonged neutropenia or immune suppression due to allograft transplants

Page 45: Fungal Infections

Bioterror potential of Fusariosis

Page 46: Fungal Infections

Mycotoxins have been weaponized

Page 47: Fungal Infections

Scedosporis characterization

Page 48: Fungal Infections

Dimorphic fungus with clinical disease similar to Fusariosis.

Page 49: Fungal Infections

Scedosporiosis risk factors

Page 50: Fungal Infections

Prolonged neutropenia, immune suppression due to allograft transplants, diabetes.

Page 51: Fungal Infections

Zygomycosis chracterization.AKA: Mucormycosis

Page 52: Fungal Infections

Nasal sinus infection extending into the brain or orbit as a result of Mucorales species.

Page 53: Fungal Infections

Zygomycosis epidemiology

Page 54: Fungal Infections

Immune compromised hosts with acidemia as occurs in diabetes. Also occurs in poor

nutrition, burns, and neutropenia.

Page 55: Fungal Infections

Zygomycosis tx

Page 56: Fungal Infections

Aggressive surgical debridement

Page 57: Fungal Infections

Identify Etiology: A patient complains of dry cough, dyspnea, and fevers. CXR shows

diffuse bilateral interstitial infiltrate. ABG shows hypoxemia and hypocarbia. HX

includes treatment for rheumatoid arthritis.

Page 58: Fungal Infections

Pneumocystis jirovecii

Page 59: Fungal Infections

Is it likely the PT above is HIV +?

Page 60: Fungal Infections

While PJP is most commonly associated with HIV, it can occur in situations of depressed

cellular immunity independent of HIV status.

Page 61: Fungal Infections

What is the tx for PJP?

Page 62: Fungal Infections

TMP-SMX both for TX and prophylaxis.

Page 63: Fungal Infections

What is the likely illness of an HIV + with a CD4 < 100 individual that cleans chicken coops?

Page 64: Fungal Infections

Cryptococcus neoformans meningitis

Page 65: Fungal Infections

Cryptococcal DX tests

Page 66: Fungal Infections

India ink stains showing encapsulated yeast.Serology

Page 67: Fungal Infections

Cryptococcus TX

Page 68: Fungal Infections

Amphotericin B followed by fluconazole

Page 69: Fungal Infections

A 30 year old female presents to your clinic with complaining of a yeast infection that “won’t go away”. She has tried OTC treatment. She

has not been sexually active for the last 4 years. She is has never used IV drugs. What

tests would you recommend?

Page 70: Fungal Infections

HIV test. Recurrent or intractable yeast infections can be a sign of HIV. Remember

HIV can take years to develop. (Not sure if you would culture the infection)

Page 71: Fungal Infections

What are the signs of thrush.

Page 72: Fungal Infections

Angular chelitisMidline lingual erythema

PsuedomembranesDysphagia

Odynophagia

Page 73: Fungal Infections

A patient in the ICU suffered a traumatic laceration to their bowel. They are receiving

TPN and antibiotics. They are currently tachycardic, hypotensive, and febrile. Three

blood cultures drawn 4 hours apart are negative for bacteremia. What is the likely

agent.

Page 74: Fungal Infections

Candida fungemia

Page 75: Fungal Infections

Lab tests identify Candida krusei. What possible agent would you administer to resolve the

fungemia.

Page 76: Fungal Infections

Triazoles amphotericin Bechinocandins

Page 77: Fungal Infections

You administer triazoles but the patient does not improve. Why?

Page 78: Fungal Infections

Candida krusei is increasingly resistant to triazoles through a Ca++ dependent efflux

pump.

Page 79: Fungal Infections

What are the major endemic mycoses?

Page 80: Fungal Infections

HistoplasmosisBlastomycosis

CoccidioidomycosisParacoccidioidomycosis

SporotrichosisPenicillosis

Page 81: Fungal Infections

Describe the endemic mycoses morphology

Page 82: Fungal Infections

They are dimorphic and exist as yeast forms at body temperature.

Page 83: Fungal Infections

Histoplasmosis epidemiology

Page 84: Fungal Infections

Worldwide distribution with concentrations in the Mississippi and Ohio river valleys. In

particular areas with high nitrogen content such as bat caves.

I am the bat!!

Page 85: Fungal Infections

Histoplasmosis histology

Page 86: Fungal Infections

Macrophages with intracellular yeast that may be confused for ingested RBC’s

Page 87: Fungal Infections

Histoplasmosis DX

Page 88: Fungal Infections

HistologySerology

Page 89: Fungal Infections

Histoplasmosis treatment caveats

Page 90: Fungal Infections

Primary pneumonia usually does not require tx. Disseminated disease usually responds to intraconazole or amphotericin B if severe

Page 91: Fungal Infections

Blastomycosis epidemiology

Page 92: Fungal Infections

South and north central US in outdoorsy people with exposure to wooded areas. Hunters and

nudists (?).

Page 93: Fungal Infections

Blastomycosis histology

Page 94: Fungal Infections

Broad based budding yeast

Page 95: Fungal Infections

Blastomycosis serology caveats

Page 96: Fungal Infections

Serology is not useful as cross reactions to other common pathogens occurs.

Page 97: Fungal Infections

Coccidioidomycosis epidemiology

Page 98: Fungal Infections

Endemic in the soils of the San Joquin valley and parts of the southwestern US and northern

Mexico.

Page 99: Fungal Infections

Coccidioidomycosis histology

Page 100: Fungal Infections

Endospore containing spherule forms

Page 101: Fungal Infections

Coccidioidomycosis sx

Page 102: Fungal Infections

PneumoniaEosinophilia

Hilar and mediastinal lymphadenopathyNight sweats

FatigueWeight lossMeningitis

Page 103: Fungal Infections

Coccidioidomycosis meningitis prognosis and TX

Page 104: Fungal Infections

Universally fatal if not treated. TX with lifelong Fluconazole or itraconazole

Page 105: Fungal Infections

Describe role of anti-fungals in cocci

Page 106: Fungal Infections

Most primary cocci pneumonia resolves without TX so TX is reserved for prolonged disease

with high IgG titer and significant weight loss.

Page 107: Fungal Infections

Describe the utility of delayed type sensitivity testing in cocci diagnosis

Page 108: Fungal Infections

Not particularly useful as most people are seropositive. IgG titers are used to follow

course of disseminated disease.

Page 109: Fungal Infections

Compare the culture growth rate of Cocci, hist, blasto.

Page 110: Fungal Infections

Cocci – fast (days)Hist – slow (weeks)

Blasto – slow (weeks)

Page 111: Fungal Infections

Paracoccidioidomycosis epidemiology

Page 112: Fungal Infections

Endemic to Brazil

Page 113: Fungal Infections

Paracoccidioidomycosis sx

Page 114: Fungal Infections

Ulcerating skin, nasal, and oral lesions in middle aged and older males.

Associated with EtOH and tobacco use

Page 115: Fungal Infections

Paracoccidiodomycosis histology

Page 116: Fungal Infections

Steering wheel yeast forms

Page 117: Fungal Infections

Sporotrichosis epidemiology

Page 118: Fungal Infections

Occupational or recreational exposure to fungus living trees, shrubs, and soil. Commonly

associated with punctures from rose thorns.

Page 119: Fungal Infections

Sporotrichosis sx

Page 120: Fungal Infections

Lymphocutaneous disease with pustules, ulcers, and lymphangitic spread moving away from

site of injury.

Page 121: Fungal Infections

Clsssic sporotrichosis tx

Page 122: Fungal Infections

Potassium Iodide