Clin med: fungal disease

Blastomycosis habitat

Blastomyces dermatitidis; lives in moist soil of woods, lakes, rivers, wetlands (not person-to-person)

eastern US

Blastomycosis: gold standard diagnosis

Fungal culture of sputum/skin — gold standard, but takes 2-6 weeks

Blastomycosis: mild/moderate treatment

Oral itraconazole x 6-12 months

Blastomycosis: severe/life-threatening treatment

IV Amphotericin B, then transition to oral itraconazole

Blastomycosis: disseminated disease sites

Skin and mucosa; fever/chills, weight loss, fatigue, night sweats, skin lesions

Blastomycosis: prevention (HDPD)

No vaccine; wear N95/KN95 mask when disturbing soil, stay indoors during windy/dusty conditions, cover skin in wooded endemic areas

Candidiasis: organism

Candida albicans — normal GI/GU flora that overgrows

Oral thrush: presentation & treatment

Friable white plaques that bleed when scraped; treat with nystatin swish and swallow

Esophageal candidiasis: presentation

Substernal pain, odynophagia, nausea/vomiting, often coexists with thrush

Esophageal candidiasis: diagnosis & treatment

Clinical or endoscopy; treat with oral fluconazole

Vaginal candidiasis: presentation

Vulvar pruritus, burning, white curd-like discharge

Vaginal candidiasis: diagnosis & treatment

Clinical exam or wet mount with KOH prep; treat with vaginal miconazole (OTC) or oral fluconazole (Rx)

Cutaneous candidiasis: presentation & treatment

Erythematous rash with scalloped borders and satellite lesions; treat with topical clotrimazole or nystatin

Fungemia: definition, diagnosis, treatment

Life-threatening bloodstream Candida infection; diagnosed by blood cultures; treated with IV Amphotericin

Coccidiomycosis: organism & habitat

Coccidioides; desert soil of southwest US and Central America — causes "Valley Fever"

Coccidiomycosis: primary presentation

65% symptomatic; mild flu-like illness (fever, chills, HA, cough, pleuritic CP, arthralgias, erythema nodosum/multiforme); CXR shows reticular infiltrates

Coccidiomycosis: disseminated disease

CNS meningitis (50% of disseminated cases), lungs, skin, lymph nodes

Coccidiomycosis: treatment

Fluconazole (Diflucan) for primary/Valley Fever; Amphotericin B for disseminated infection

Cryptococcosis: organism & transmission

Cryptococcus neoformans; transmitted via pigeon droppings; usually doesn't cause disease in healthy people; not person-to-person

Cryptococcosis: pulmonary presentation

Cough, chest pain, dyspnea, skin lesions (if disseminated)

Cryptococcosis: meningoencephalitis

Most common cause of fungal meningitis; HA, neck stiffness, photophobia, N/V

Cryptococcosis: diagnosis

Cryptococcal antigen screen, blood cultures, LP for CSF; India ink stain shows encapsulated yeast

Cryptococcosis: treatment

Amphotericin B + Flucytosine x 2 weeks, then prolonged oral fluconazole (up to 12 months)

Histoplasmosis: organism & habitat

Histoplasma capsulatum and H. duboisii; soil contaminated with bird/bat droppings, common in Ohio & Mississippi River valleys

Histoplasmosis: primary infection presentation

Most asymptomatic; symptomatic = mild flu-like illness (fever, cough, fatigue, mild central chest pain)

Histoplasmosis: disseminated disease

Most common in immunocompromised, poor prognosis; fever, weight loss, fatigue, lymphadenopathy

Histoplasmosis: diagnosis

Antigen tests (urine/blood), serum antibody tests, biopsy with culture (can take weeks)

Histoplasmosis: treatment

Asymptomatic/mild in immunocompetent: no treatment. Moderate: oral itraconazole 6-12 weeks. Severe/disseminated: IV Amphotericin B x1-2 weeks then oral itraconazole 3-12 months

Histoplasmosis: prevention

Avoid breathing dust from soil/areas contaminated with bird or bat droppings

Pneumocystis (PJP): organism & population

Pneumocystis jirovecii; yeast-like, spread via inhalation, does NOT respond to antifungals; most common opportunistic infection in AIDS (CD4 <200)

PJP: presentation

Fever, dyspnea on exertion, nonproductive cough, oxygen desaturation with activity

PJP: diagnosis

Respiratory cultures; CXR shows diffuse infiltrates in "bat wing" pattern

PJP: treatment

All patients: trimethoprim-sulfamethoxazole (Bactrim). If hypoxic: add steroids (e.g., prednisone)