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

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