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5 Written questions

5 Matching questions

  1. Histoplasma capsilatum Diagnosis
  2. Histoplasma capsilatum Treatment
  3. Coccidioides immitis Treatment
  4. Histoplasma capsulatum Morphology
  5. Coccidiodes immitis Diagnosis
  1. a 1. Itraconazole
    2. Amphotericin B (in immunocompromised patients)
  2. b 1. Lung biopsy
    A. Silver stain specimen
    B. Culture on Sabouraud's agar will reveal hyphae at 25 C, and yeast at 37 C
    2. Serology
    3. Skin test (tests for exposure only)
  3. c Only for disseminated:
    1. Fluconazole (1st choice)
    2. Ampothericin B (2nd choice)
  4. d 1. 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)
  5. e Dimorphic:
    1. Mycelial forms with spores at 25 C
    2. Yeast forms at 37 C
    3. NO Capsule 9despite name)
    4. Grow in macrophages

5 Multiple choice questions

  1. 1. Not clear what the predominant host response is
    2. Complement, antibody and cell mediated immunity are all involved
  2. 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. 1. Mississippi valley
    2. Present in bird and bat droppings
    3. Respiratory transmission
  4. 1. Mycelial forms with spores at 25 C
    2. Yeast forms at 37 C
  5. 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 True/False questions

  1. 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)

          

  2. Blastomyces dermatitidis ReservoirBlastomycosis
    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. Paracoccidioides brasiliensis 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
    -Men
    -Pregnant women
    -T-cell number / functional abnormalities

          

  4. Histoplasma capsilatum Clinical Disease1. fevers, sweats, weight loss
    2. in disseminated disease, skin & subcutaneous nodules and mucous membrane ulcerations are not unusual (tongue, larynx)

          

  5. Mechanism of Dimorphic SwitchCoccidioidomycosis 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