Clinical medicine: Fungal, Parasitic, Mycobacterial, and Tick-Borne Illness

10mm

A PPD test of greater than what indicated active Mycobacterium marinum?

MAC (Mycobacterium Avium complex)

An HIV patient comes in with signs and symptoms of chronic productive cough, dyspnea, weight loss, fatigue, fever, LAD, GI upset, and hepatosplenomegaly. He has recently been working outdoors. His CD4 count is 50 and his Hemoglobin and hematocrit are low. What is this constant with?

children

Are children or adults more vulnerable to leprosy?

200

CD4 count related risk of pneumocystosis when the count is less than what?

unilateral

Do children who develop MAC (Mycobacterium Avium complex) have unilateral or bilateral lymphadenitis?

Lepromatous

Does Lepromatous and Tuberculoid leprosy have abundant acid fast bacilli in skin lesions and negative lepromin skin test?

Tuberculoid

Does Lepromatous and Tuberculoid leprosy have cellular immunity intact?

Lepromatous

Does Lepromatous and Tuberculoid leprosy have defective cellular immunity?

Tuberculoid

Does Lepromatous and Tuberculoid leprosy have few bacilli in skin lesions and positive lepromin skin test?

Tuberculoid

Does Lepromatous and Tuberculoid leprosy have macular skin lesions?

Lepromatous

Does Lepromatous and Tuberculoid leprosy have nodular skin lesions?

Tuberculoid

Does Lepromatous and Tuberculoid leprosy have sever asymptomatic nerve involvement?

insidious

Does mycobacterium leprae have an abrupt or insidious onset?

nasal secretions

How is mycobacterium leprae transmitted?

kittens, puppies, and people

How is tinea transmitted?

1-2 weeks

How long does it typically take for PCP (Pneumocystis jiroveci pneumonia) to develop?

negative culture for one year

How long should treatment be continued for MAC (Mycobacterium Avium complex)?

histoplasmosis

If an immunocompromised patient presents with undifferentiated fever, pneumonia, or mucocutaneous disease, what would you expect their diagnosis to be?

undifferentiated fever, pneumonia, or mucocutaneous disease

If an immunocompromised patient presents with what three things would you suspect histoplasmosis?

fungal culture or biopsy

If the KOH is negative when testing for Tinea, what are the other diagnostic test options?

low birth weight newborns or immunocompromised

In what populations is disseminated or invasive candidiasis common?

Tuberculoid

Is Lepromatous and Tuberculoid benign and less progressive?

Lepromatous

Is Lepromatous and Tuberculoid malignant and progressive?

Leprosy

The following describe lesions consistent with what: Pale anesthetic macular, discrete erythematous infiltrated nodules, and diffuse skin infiltration.

True

True or False: Corticosteroids prevent alveolar inflammation and exudation results from the killing of Pneumocystis organisms.

True

True or False: Esophagitis may be present with thrush?

True

True or False: For vaginal candidiasis, this requires alteration of the host vaginal environment for pathologic effects (Usually a pH of less than 4.5).

True

True or False: Invasive candidiasis can be fatal.

True

True or False: MAC (Mycobacterium Avium complex) rarely occurs if the CD4 count is less than 50.

True

True or False: Mycobacterium leprae has a low risk from casual and household contact.

True

True or False: Normal children may develop lymphadenitis associated with MAC (Mycobacterium Avium complex).

True

True or False: On microscopic exam of Mycobacterium marinum, organisms are rarely seen.

False (person to person transmission does not occur)

True or False: Person to person transmission commonly occurs in Histoplasmosis.

5

Under what age do children develop MAC (Mycobacterium Avium complex)?

pulmonary disease, cervical lymphadenitis, and disseminated disease

What 3 disease syndromes does MAC traditionally cause in humans?

ulnar neuropathy, disfigurement and nerve damage, keratitis, or iridocyclitis

What are some long term complication of leprosy?

Culture and PPD

What are the diagnostic test used for Mycobacterium marinum?

Ohio and Mississippi river valleys

What are the endemic areas for histoplasmosis?

Asia (India), Africa, Latin America (Tropical, subtropical areas), and sporadically in southern US

What are the endemic areas for leprosy?

Sputum stain or CXR

What are the lab tests used to diagnose PCP (Pneumocystis jiroveci pneumonia)?

Mycobacterium Leprae and Hansen's disease

What are the other names for leprosy?

underlying lung disease, HIV/AIDS, or severe immunosuppression

What are the risk factors for MAC (Mycobacterium Avium complex)?

Clarithromycin or ethambutol

What are the treatments of choice for Mycobacterium marinum?

M. avium and M. intracellulare

What are the two mycobacterium species making up MAC (Mycobacterium Avium complex)?

Lepromatous and Tuberculoid

What are the two types of leprosy?

Mycobacterium Leprae

What bacterium causes Leprosy?

satellite lesions

What differentiates candidiasis from tinea?

Mycobacterium marinum

What does this describe: Nodular skin lesions following exposure to nonchlorinated water- ulceration of lesion may follow.

Tinea

What does this describe: Oval or circular patches on exposed skin surfaces, red papule with central clearing and raised borders. Pruritus, mild burning, and erythema.

Bactrim

What drug is recommended for prophylaxis for PCP (Pneumocystis jiroveci pneumonia)?

white plaques

What is characteristic of thrush?

satellite lesions

What is diagnostic of a diaper rash?

cavitary lesions in upper lobes, or nodules and bronchiectasis in muddle or lower lobes

What is found on the CXR of a patient with MAC (Mycobacterium Avium complex)?

diffuse bilateral interstitial infiltrates

What is seen on CXR of a person with PCP (Pneumocystis jiroveci pneumonia)?

Amphotericin B

What is the DOC for candidiasis invasive disease in newborns?

KOH microscopy

What is the diagnosis for Tinea?

KOH microscopy

What is the diagnostic test for candidiasis?

fresh, saltwater, and unchlorinater water

What is the exposure risks for Mycobacterium marinum?

Bactrim

What is the first line treatment of a patient with PCP (Pneumocystis jiroveci pneumonia)?

acid fast aerobic bacteria

What is the genus for all mycobacterial diseases?

1-3 weeks

What is the incubation period for histoplasmosis?

3-5 years

What is the incubation period for leprosy?

PCP (Pneumocystis jiroveci pneumonia)

What is the most common presenting manifestation of AIDS during the first decade of the epidemic?

MAC (Mycobacterium Avium complex)

What is the most commonly reported HIV bacterial infection?

Allylamines

What is the preferred treatment for TInea on the feet?

Azithromycin

What is the prophylactic DOC in an HIV patient to prevent MAC (Mycobacterium Avium complex)?

Fluconazole

What is the recommended treatment for candidiasis invasive disease in adults?

Azithromycin, Rifabutin, and ethambutol

What is the treatment for MAC (Mycobacterium Avium complex)?

Azoles (Miconazole or clotrimazole)

What is the treatment for Tinea corporis?

Clotrimazole cream

What is the treatment for Tinea on the body or face?

Terbinafine

What is the treatment for Tinea on the nails?

Oral griseofulvin

What is the treatment for Tinea versicolor on the scalp?

selenium sulfide (selsun blue)

What is the treatment for Tinea versicolor?

oral nystatin suspension or fluconazole (if immunocompromised or esophageal candidiasis)

What is the treatment for thrush?

Topical formulations (Clotrimazole or Miconazole) OR Fluconazole

What is the treatment for vulvovaginitis?

topical nystatin, miconazole, clotrimazole

What is the treatment of candidiasis of the skin?

mycobacterial disease

What is this common for: Most species are free living in soils and water, but the major habitat for some is the diseased tissue of warm blooded hosts.

Candidiasis

What is this type of rash common for: Red, well defined borders, scaling, itching, burning, pustules if severe and may have satellite lesions.

Histoplasmosis

What is this: Mold form found in moist soil and growth is facilitated by bat, bird, and chicken droppings.

beard-area, superficial folliculitis

What is this: Tinea Barbae.

Scalp infection

What is this: Tinea Capitis

Ringworm

What is this: Tinea Corporis

Jock itch

What is this: Tinea Cruris

Facial infection

What is this: Tinea Faciale

Hand infection

What is this: Tinea Manuum

athlete's foot

What is this: Tinea Pedis

Onychomycosis, toenail fungus

What is this: Tinea Unguium

uneven tanning on the trunk

What is this: Tinea Versicolor

Hemoglobin and hematocrit

What lab values are decreased in a patient with MAC (Mycobacterium Avium complex)?

Alkaline phosphatase

What lab values are increased in a patient with MAC (Mycobacterium Avium complex)?

C. Albicans

What organism is primarily responsible for causing Candidiasis?

chronic granulomatous

What type of infection is leprosy?

Tinea, Candidiasis, Histoplasma Capulatum, and PCP

What were the four fungal infections covered in lecture?

Mycobacterium marine, MAC, mycobacterium Leprae, and TB

What were the from mycobacterial disease covered in lecture?

CD4 counts <200

When is prophylaxis for PCP (Pneumocystis jiroveci pneumonia) indicated?

CD4 count <50

When is prophylaxis needed in a patient with MAC (Mycobacterium Avium complex)?

skin folds, thrush, vagina, disseminated or invasive

Where are the common locations of candidiasis?

cooler parts

Where does mycobacterium leprae grow best?

environment (water, soil, and food)

Where is MAC (Mycobacterium Avium complex) commonly found?

DM, antibiotic therapy, pregnancy, OCP use, poor nutrition, or immunocompromised

Who are those predisposed to to candidiasis?