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Fugal LRT Dickenson

Fungal LRT infections and hypersensitivity penumonitis- 1/17/2013

Opportunistic fungi occur predominantly in Immunocompromised patients
Non-dimorphic Exist as mycelium in nature and in the body (ex. Aspergillos)
Mycelium A mass of branching thread-like hyphae
Aspergillosis is spread by Inhaling spores
95% of human illnesses caused by Aspergillus are by which species? Aspergillus fumigatus
Aspergillus hyphae are septate and exhibit what type of branching? Acute angle (<90) branching
3 clinical forms of Aspergillosis Hypersensitivity, Colonizing, Invasive
Two major risk factors for Allergic bronchopulmonary aspergillosis Asthma and Cystic fibrosis
Allergic bronchopulmonary aspergillosis is often misdiagnosed as Asthma
Allergic bronchopulmonary aspergillosis (ABPA) presents with Prominent wheezing, cough, dyspnea, exercise intolerance, fever and expectoration of rubbery brown mucus plugs
ABPA Type1 hypersensitivity is characterized by An exaggerated IgE response to proteins associated with Aspergillus condidia and an immediate cutaneous reactivity to Aspergillus skin test antigen
Describe a Type 3 ABPA hypersensitivity reaction IgG binds Aspergillus antigen forming small immune complexes that result in 1. Macrophage and mast cell activation 2. Complement activation and 3. Neutrophil recruitment. The net result is inflammation and tissue damage
Does colonizing aspergillosis invade tissues? No
Pulmonary mycetoma/colonizing aspergilloma forms in a Preexisting lung cavity
Aspergilloma A mass of fungal mycelia that grows in preexisting lung cavities
Diseases that can cause formation of a lung cavity Tb, Emphysema, Cystic fibrosis, Sarcoidosis
Clinical manifestation of Aspergilloma Hemoptysis, productive cough, fever, dyspnea, bloody sputum with hyphae
Chest radiograph characteristic of Aspergilloma A crescent sign or Monod's sign, aka a solid mass surrounded by a radiolucent crescent
Greatest risk factor for invasive aspergillosis Myelosuppression
Sypmtoms of invasive aspergillosis Cough, high fever and pleuritic chest pain
Risk factors for invasive aspergillosis Stem cell transplantation, AIDS, Immunodeficiency, Corticosteroid use, Chemotherapy, prolonged neutropenia
Aspergillosis hyphea invade blood vessels and can cause Thrombosis, infarction and necrosis
Most common Mucormycosis etiologic agent Rhizopus
Morphology of Rhizopus Non-septate hyphae with broad, short stubby side branches at 90degree angles
Biggest predisposition for Mucormycosis Diabetic Ketoacidosis
2 Clinical manifestations of Mucormycosis Rhnocerebral and Pulmonary
Major clinical form of mucormycosis Rhinocerebral
Why do mucormycosis like diabetics? High blood glucose and low tissue pH favors fungal growth and inhibits neutrophil function
Rhinocerebral mucormycosis progression Begins in the nose and rapidly invades the palate, sinuses and orbits with eventual erosion into the cranium
Pulmonary mucormycosis progression Begins as an acute pneumonia with fever and cough and is followed by signs and symptoms of pulmonary infarction with pleuritic chest pain and hemoptysis
Sick House/Building syndrome is caused by which etiologic agents Stachybotrys, Aspergillus, Cladosporium, Penicillium, and Alternaria
Sick house/building syndrome manifestation Allergy, asthma, Gi and neurological symptoms, Pulmonary hemmorrhage and hemosiderosis
3 Presentations of Hypersensivity Pneumonitis Acute, Subacute, or chronic
Acute Pneumonitis Symptoms present after a brief, single, large exposure
Subacute Pneumonitis Insidious beginning over weeks with cough, dyspnea and weight loss
Chronic Pneumonitis From low-dose continuous exposure. Fatigue, cough, and weight-loss with gradual dyspnea. Development of fibrosis with an increased mortality
A lavage of the lungs of a patient with Hypersensitiviy Pneumonitis will contain mostly Mononuclear cells (Tcells and macrophages)
Treatment for hypersensitivity Pneumonitis Avoidance of allergen, oral corticosteroids, early diagnosis and treatment
Actinomyces causes which disease when inhaled Farmer's lung
Pathogenesis of hypersensitivity Pneumonitis Allergen activates Th1 cells which activate Macrophages and invade lungs. Large IgG antigen specific response is precipitated
Created by: mcasto