Sm. Ani. Med- Systemic Mycoses 2

untimely's version from 2015-10-03 15:05


Question Answer
what is the causative agent of cryptococcus?Cryptococcus neoformans OR Cryptococcus gattii
which is more virulent- Cryptococcus neoformans or Cryptococcus gattii? And how so?C. gattii more virulent and CNS invasive
which type of crypto is CNS invasive?C. gattii
what kinda fungi is cryptococcus?Saphrophytic yeast
WHERE (geographically) do you find cryptococcus?World wide, esp Southern US, California, Australia
*WHERE (enviro) do you find cryptococcus?Avian habitats-- esp PIGEON DROPPINGS
***who does cryptococcus affect most often?Most common fungal infection of cats!!!!!
Where does Cryptococcus like to live in the body?Nasal cavity, skin, sinuses, paranasal tissues, and lungs.
where does cryptococcus usually invade locally? how do it move systemically?(1) Locally: Skin, eyes, CNS (bc usually start at nose/inhaled, nose is connected to brain) (2) systemically: starts from lungs and moves out
what are the 3 main types of CS associated with cryptococcus?(1) Upper Respiratory/Nasopharyngeal (more on this in another card) (2) CNS, ocular (3) Depression and anorexia (Additional signs associated with systemic dissemination)
what are the main Upper Respiratory/Nasopharyngeal clinical signs associated with a cryptococcus infection?Discharge, proliferative masses, Snoring, stertor, dyspnea
how useful is CBC/chem for crypto?variable helpfullness
what kinda imaging would you like to do?Rads, PLUS CT because it is good for bone
If you want to do Cytology and culture, what kinda sample do you want? what sample DONT you want?CNS TAP is the best way to get a good sample. Serology is Not particularly useful because there is No humoral response
how well does crypto hide from the immune system?No humoral response
what are three methods of Organism identification?(1) Cytology (2) Histopathology (3) culture
if you want to do cytology on cryptococcus, what type of stains can you use?Gram, india ink
what kinda sample(s) will you need for an Antigen Test of cryptococcus? When is the antigen test sig?Serum (blood!), CSF, urine. Sig is >1:10
what are two special other tests UC davis provides to test for cryptococcus?Molecular typing and Anti-fungal Susceptibility
What are the three treatment options/drugs for cryptococcus, and what calls for the differences?(1) If in the CNS, Fluconazole!!! (can penetrate the BBB!!!!) (2) itraconazole in general (3) if systemic you will do a COMBO tx of Azole, Amphotericin B + flucytosine (*CAUTION IN RENAL FAILURE)
If you wish to use fluconazole to treat cryptococcus topically, what should you keep in mind, and do?MUST do CT to make sure cribiform plate is intact! You do not want a topical on the brain...horrible horrible burning will ensue
what should you absolutely keep in mind if you are treating a systemic cryptococcus infection with a combo therapy? (what is the combo therapy drugs and why this cause concern)systemic means combo therapy of azole, Amphotericin B + flucytosine. CAUTION WITH KIDNEY PTS (and lots of cats are) bc amphoB is RENAL TOXIC
how long do you treat for cryptococcus?2 months past CS resolution
you can monitor the treatment by looking at a serum antiGEN test....what is a promising amount of change?2-4 fold decrease/month
During treatment, how often should you recheck, and what is a good parameter to look at?every mo, look at chem
if the cryptococcus infection is severe enough to have fungal plaques, what should you consider?Should consider surgical debridement for fungal plaques


Question Answer
what is the causative agent of aspergillosis?Aspergillus fumigatus (A. terreus, deflectus, flavipes, fumigatus)
If i say aspergillus, you say where? (trigger answer)DOG NOSES
what kinda fungi is aspergillus?Ubiquitous filamentous fungi
is aspergillus local or disseminated?could be either
where does aspergillus LIKE to live in the body?nasal passages and frontal sinuses (esp of dogs, esp if they are immunocompromised)
WHO is most likely to get aspergillosis? is there any breed disposition?Young to middle aged mesaticephalic (regular length nose) and dolichocephalic (long nose) breeds. German shepherds tend to get this more because they tend to have inherited immunodeficiencies (IgA defeciency) (remember, IgA= mucosal surfaces)
how would you describe the bh of the fungus?Progressive and invasive
what are the 6 main CS of aspergillosis?(1) Facial pain (2) Nasal discharge (3) Anorexia (4) sneezing (5) Neurologic or ocular (6) Masticatory muscle atrophy
how would you describe the nasal discharge of a dog infected with aspergillus?Mucoid to hemorrhagic, crusting
what odd clue on a dogs nose might hint you towards suspecting aspergillosus?DEPIGMENTATION (depig is either fungi or autoimmune, and then it's dog nose, so high chance it's asper)
what imaging techniques might you use to help dx aspergillosus?Skull films or CT (CT more helpful), Endoscopy
If you want to do a biopsy to determine if the dog is infected with aspergillus, what must you keep in mind/do?CLOTTING TEST--- NASAL BIOPSIES BLEED LIKE A BITCH
why might you want to do a CT before determining if you want to locally treat a dog for aspergillus?CHECK PATENTCY OF CRIBIFORM PLATE-- you dont want antifungals on the brain
what drugs can you use to treat aspergillosis TOPICALLY? what might you want to add orally?Topical clotrimazole (1% )/enilconazole. +/- oral Itraconazole or fluconazole + terbinafine (Combo therapy in cats as well)
If the dog is immunocompromised, how might you want to treat the aspergillus (what drugs?)Azoles, +/- Amph B lipid complex, surgical removal of granulomas
what is the prognosis of a immunocompromised pt with aspergillosus?poor
(discussed with pictures) how could you go about locally treating aspergillosus of the nasal passages?ensure cribiform is intact. run tube with cuff through mouth, and inflate cuff above soft palate so it blocks the nasal passages from the nasopharynx. Then fill the nasal passages with the antifungal, and rotate dog a 1/4 turn every 10 or so minutes so all the fungus is contacted by the drug. effective the 1st time in 85% of dogs.


Question Answer
what is the causative agent of coccidiomycosis?Coccidioides immitis (or posadasii)
what is another name for coccidiomycosis (the dz)?Valley Fever/Rheumatism
what is the primary route of infection? other route of infection?Inhalation primary route, Cutaneous with trauma
WHERE (geography) is coccidiomycoses most common?ARIZONA!!!!!!! and southern-mid USA
**how should you culture coccidioides?TRICK QUESTION- NEVER CULTURE EVER EVER! Super DANGEROUS and zoonotic! REPORTABLE IN HUMANS!
explain the lifecycle of coccidioides (roughly)there is a saphrophytic cycle in the environment, and then a PARASITIC cycle in a host (spores inhaled, develop into immature sphericules--> ensporulating sphericule--> ruptures--> spores infect other tissue)
How do clinical signs present for coccidiomycoses? (vague)Host immunocompetence plays a big role. Mild clinically silent pulmonary disease can be one presentation, or can be Fatal multisystem dissemination. CSs can also depend on areas of dissemination
who is most at risk for developing coccidiomycoses?Young, male intact, medium to large outdoor large breed dogs (most likely to free roam)
what are the main clinical signs for coccidiomycoses? (specific)Cough, Lethargy, Anorexia, Fever, Chronic lameness, Cervical or head pain, Weight loss
coccidiomycoses can cause degenerative/proliferative bone lesions which look similar to osteosarcoma. how might you be able to tell them apart?osteosarc usually doesnt cross joint spaces, but fungi CAN and WILL
how do you dx coccidiomycoses if you live in an endemic area?(ARIZONA) Often just CS with lymphadenopathy
what imaging techniques might you use to try to dx coccidiomycoses?Thoracic radiographs (resp signs), perihilar lymphadenopathy (enlargement of the mediasteinal LNs, around the base of the heart)
what is a test you can use to dx coccidiomycoses? what are you testing and what can it tell you?Precipitin test is useful EARLY IN THE DZ, since testing for IgM Abs (the first responders). If you test again and find persistance, this can mean there is Persistence can indicate dissemination going on
what does the precipitin test test for?IgM Abs (first responders) (Persistence can indicate dissemination)
what would you test for with Complement fixation if you want to know if the pt has coccidiomycoses?IgG!!!!
which drugs would you use to tx a coccidiomycoses infection?Azoles, can combine with a amphB lipid complex also.
how long do you treat coccidiomycoses for?Minimum of 4-6 months BEYOND clinical cure AND relapse is common!!!


Question Answer
what is the causative agent of this infection?Sporothrix schenckii
what kinda fungi is sporothrix?Dimorphic, saprophytic
how does the immune system react to sporothrix?Chronic granulomatous disease (MACROPHAGES!!!! risk of hypercalcemia)
WHO is most suseptible to sporothrix? after that?Cats > dogs > veterinarians (Gloves!!!)
is sporithrix zoonotic?YES!! GLOVES!!!!
what is the most common entry point of sporothrix?SKIN (HENCE GLOVES), esp post-trauma
what are the three main presentations of sporothrix?Cutaneous, lymphocutaneous, disseminated
what are three ways to dx sporothrix?cytology, histopathology (special stains/IFA), culture
if you want to culture sporothrix, what kinda sample would you want?if have a draining tract, use the deep material. REMEMBER-- CAUTION!! ZOONOTIC!
who is easier to tx for this dz?Cats much harder to treat than dogs.... (go fig bc cats are main carrier)
what drugs can you use to tx sporothrix?itraconazole, can also use potassium iodide BUT ONLY IN DOGS NOT CATS

misc small sections

Question Answer
where does candidiasis live normally?NATRUAL INHABITANT
what is the main way an animal will get candidiasis?common in Immune suppressed animals or with animals who are on chronic abx
how does candidiasis behave when it spreads systemically?spreads via Hematogenous route, causing microabscesses everywhere it goes
what are the drug options you have for treating candidiasis?Itraconazole/fluconazole, Amph B lipid complexed
what causes pythiosis?an Oomycetes
WHERE do you usually find pythiosis?SE USA (she mentioned alabama a lot)
what are the body systems phythiosis likes to affect?GI AND CUTANEOUS (GI mostly dogs, cutaneous usually horses)
what are some ways to dx phythiosis?Histology and Culture, Antibody ELISA, PCR
what are the treatment options for phythiosis?Surgical resection, Itraconazole and terbinafine (<20%.....prog aint great for dogs)
lagendiosis is caused by what organism?Oomycetes Lagenidium
lagendiosis usually affects what body systems?Cutanous and Lymphatic, can also cause a vasculitis--> great vessel rupture
why do animals with lagendiosis usually die really fast?VASCULITIS--> Great vessel rupture (so all around the giant vessels around the heart and causes a vasculitis. (aortic vasculitis-> it ruptures and you die)
what will you see on imaging which would suggest the animal is suffering from lagendiosis?Perihilar lymphadenopathy (around the great vessels)
how do you tx lagendiosis? prog?Surgical resection/amputation if not disseminated....POOR prognosis
examples of types of Zygomycetes?Basidiobolus, Conidiobolus, Rhizopus, Mucor and others
portal of entry of most zygomycetes species?Cutaneous esp after trauma, also nasopharyngeal
possible treatment for zygomycetes?Surgical resection and itraconazole, AmphB lipid complex
Map of areas of where fungi like to live (thank you monica)

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