tonystep1's version from 2017-08-12 19:38


Question Answer
CandidiasisTypical presentation is the mucocutaneous growth // Vagina-"yeast infection" -- This results in a thick, white, "cottage cheese-like" vaginal discharge. // Mouth, oropharynx-"thrush" -- This causes thick, white plaques that adhere to the oral mucosa // Cutaneous candidiasis -- This causes erythematous, eroded patches with "satellite lesions" // GI tract-e.g., esophagus -- Candida esophagitis may cause significant odynophagia or asymptomatic
Candidiasis Disseminated or invasive diseaseManifestations include sepsis/septic shock, meningitis, and multiple abscesses in various organs.
Allergic bronchopulmonary aspergillosisA type I hypersensitivity reaction to Aspergillus // It presents with asthma and eosinophilia. Recurrent exacerbations are common.
Pulmonary aspergillomaPulmonary aspergilloma is caused by inhalation of spores into the lung. // Patients with a history of sarcoidosis, histoplasmosis, tuberculosis, and bronchiectasis are at risk. //.It presents with chronic cough; hemoptysis may be present as well.
Invasive aspergillosisThis occurs when hyphae invade the lung vasculature, resulting in thrombosis and infarction. // Hosts are typically at-risk patients with acute leukemia, transplant recipients, and patients with advanced AIDS // It usually presents with acute onset of fever, cough, respiratory distress, and diffuse, bilateral pulmonary infiltrates. // It is transmitted via hematogenous dissemination, and may invade the sinuses, orbits, and brain.
CryptococcosisCNS disease-meningitis or meningoencephalitis; brain abscess is also possible // It should always be on the differential diagnosis of an HIV-positive patient with a fever and headache // Isolated pulmonary infection may also occur.
BlastomycosisAcquired through inhalation of spores // Disseminated infection -- chronic indolent disease, constitutional symptoms, LAN , pneumonia
HistoplasmosisTransmitted through exposure to bird/bat droppings // Flu- like symptoms erythema nodosum, hepatosplenomegaly
CoccidiomycosisAcquired through inhalation of spores // Asymptomatic or nonspecific respiratory symptoms // Dissemination causes focal CNS findings
SporotrichosisAcquired from invasion of skin by thorn or other plant material // Lymphocutaneous form, hard subcutaneous nodules -- ulcerate and drain. // Disseminated form causes pneumonia and meningitis


Question Answer
CandidiasisMucocutaneous candidiasis diagnosis is primarily clinical; KOH preparation demonstrates yeast. // Invasive candidiasis is diagnosed by blood or tissue culture.
AspergillusCXR reveals a dense pulmonary consolidation and sometimes a fungus ball. // Definitive diagnosis of invasive aspergillosis is by tissue biopsy
CryptococcosisLP is absolutely essential if meningitis is suspected. // Latex agglutination detects cryptococcal antigen in the CSF. // India ink smear shows encapsulated yeasts // Tissue biopsy is characterized by lack of inflammatory response
SporotrichosisVisualization of yeast in tissue or body fluids or serology


Question Answer
Oral CandidiasisClotrimazole troches (dissolve in the mouth) five times per day // Nystatin mouthwash ("swish and swallow") three to five times per day; only for oral candidiasis // Oral ketoconazole or fluconazole for esophagitis
Vaginal candidiasismiconazole or clotrimazole cream
Cutaneous candidiasisoral nystatin powder, keeping skin dry
Systemic candidiasisFor systemic candidiasis, use amphotericin B or fluconazole. New, alternative antifungal agents include voriconazole and caspofungin.
allergic bronchopulmonary aspergillosispatients should avoid exposure to Aspergillus; corticosteroids may be beneficial.
For pulmonary aspergillomapatients with massive hemoptysis may require a lung lobectomy.
invasive aspergillosistreat with IV amphotericin B, voriconazole, or caspofungin
CryptococcosisUse amphotericin B with flucytosine for approximately 2 weeks, followed by oral fluconazole.
BlastomycosisPO itraconazole // Amphotericin B for meningitis
HistoplasmosisPO itraconazole //amphotericin B for severe infection or immunocompromised host
CoccidioidomycosisPO fluconazole or itraconazole x 6 mo // IV amphotericin B for severe infection or immunocompromised host
SporotrichosisPotassium iodide x 1-2 mo or itraconazole x 3-6mo // Disseminated amphotericin B