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5 Written Questions

5 Matching Questions

  1. Coccidioides immitis Immunity
  2. Paracoccidioides brasiliensis Diagnosis
  3. Histoplasma capsilatum Immunity
  4. Paracoccidioides brasiliensis Morphology
  5. Blastomyces dermatitidis Pathogenesis
  1. a 1. The main control of this organism is by cell mediated immunity
    -Mainly the T-cell activation of macrophages

    2. Neither B cells or antibody have a significant role
  2. b 1. Diagnosis is made by seeing the yeast with multiple blastoconidia (think of a ship's steering wheel)
    2. Measurement of antibodies have a 95% sensitivity
  3. c 1. Mycelial forms with spores at 25 C
    2. Yeast forms at 37 C
  4. d 1. Primary infection is by inhalation of the conidia
    2. A mixed inflammatory response occurs
    3. The organism then starts to grow as large yeasts with thick double walls
    4. Unlike Histoplasma, these yeasts are extracellular and much larger
  5. e 1. Life long immunity does develop
    2. Conidia can be phagocytosed and killed by PMNs
    3. The endospores cannot be handled until macrophages are activated by T-cells (Th1)
    4. Humoral immunity does not play a role
    5. Complement is not effective at opsonizing C. immitis

5 Multiple Choice Questions

  1. 1. Itraconazole (1st choice)
    2. Amphotericin B (2nd choice)
  2. Blastomycosis
    1. Asymptomatic (uncommon)
    2. Pneumonia: lesions rarely calcify (most common)
    3. Disseminated (uncommon): present with weight loss, night sweats, lung involvement, and skin ulcers
    4. Cutaneous: skin ulcers
  3. 1. The conidia are inhaled and are usually contained and cleared
    2. Chronic disease with pulmonary and/or lymph node involvement
    3. If a person develops pulmonary infection, they develop cough, fever, malaise, weight loss
    4. Can also affect mucous membranes of the mouth, larynx
  4. Coccidioidomycosis aka "Valley Fever"
    1. Asymptomatic (in most persons)
    2. Pneumonia
    3. Disseminated (<1%): can affect the LUNGS, SKIN, BONES, & MENINGES

    Note: a small percentage of individuals with this infection will develop painful erythematous nodular lesions called erythema nodosum
  5. 1. Central and S. America
    2. Brazil

5 True/False Questions

  1. Coccidiodes immitis Diagnosis1. Biopsy of affected tissue: lung, skin
    A. Silver stain or KOH prep
    B. Culture on Sabouraud's agar (warn lab!) 3-4 days
    2. Serology
    3. Skin tests (tests for exposire only)


  2. Histoplasma capsulatum Reservoir1. Itraconazole
    2. Amphotericin B (in immunocompromised patients)


  3. Histoplasma capsilatum Pathogenesis1. Conidia are inhaled and reach the alveoli
    2. The conidia then convert to yeasts
    3. Survive by capturing iron and calcium from the macrophage
    4. Grow within macrophages
    5. Granulomatous inflammation similar to TB (cell-mediated immunity)


  4. Coccidioides immitis TreatmentOnly for disseminated:
    1. Fluconazole (1st choice)
    2. Ampothericin B (2nd choice)


  5. Coccidioides immitis Clinical Symptoms1. "Valley Fever"
    A. malaise, cough, chest pain, fever, arthralgias
    B. lasts 2-6 wks
    C. chest xray is clear or has hilar adenopathy
    D. resolution is spontaneous 90%
    2. Dissemination
    A. skin, bone, meninges
    B. MENINGITIS (fever, headache, stiff neck)
    C. Risks:
    -African or Filipino ancestry
    -Pregnant women
    -T-cell number / functional abnormalities


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