SA Med, E1, Systemic Mycosis

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SA Med, E1, Systemic Mycosis
2012-09-12 20:09:31
SA Med E1 Systemic Mycosis

SA Med, E1, Systemic Mycosis
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  1. What is the most common way to acquire systemic mycosis? are they contagious?
    • inhalation
    • no
  2. Which common systemic mycotic agent is not endemic to a specific region of the US?
    cryptococcosis (from pigeon droppings)
  3. Which systemic mycosis is more commonly found in cats? What is the most common presentation/clinical sign?
    • cryptococcosis
    • firm swelling over bridge of nose (chronic UR signs)
  4. where does crypto commonly disseminate to in the cat?
    • -direct extension through cribiform plate to CNS or to paranasal soft tissue
    • -hematogenous spread to skin, eyes, CNS
  5. Which mycotic agent resides in sandy, acidic soil near water?
  6. Extrapulmonary dissemination is common with blastomycosis. What are the common sites? which is specific to the cat?
    • lymph nodes, skin, eyes, bones
    • cat: CNS
  7. Where does histoplasmosis typically first invade? Then where/how does it spread?
    invades lungs then spreads to mononuclear phagocyte system --> to spleen, liver, etc
  8. What is the most common clinical form of histoplasmosis?
    subclinical (self limiting- stays confined to the lungs)
  9. does histoplasmosis usually present to the clinic as an acute or chronic pulmonary disorder? which is more fatal to the patient?
    • chronic more common
    • acute rare but more fatal (severe fulminate granulomatous pneumonia)
  10. is blastmycosis found intra- or extra-cellularly? what about histoplasmosis? Which agent is easier to spot on cytology?
    • blasto = Extracellular (more plentiful, easier to find)
    • histo = intracellular (in macrophages)
  11. What is the most common form of histoplasmosis found in cats?
    disseminated form (extrapulmonary)
  12. which mycotic agent and presentation is most likely to have drastically enlarged hilar lymph nodes?
    chronic pulmonary form of histoplasmosis
  13. Which part of the GIT is most often affected with histoplasmosis if they acquire it via ingestion? dogs or cats?
    • COLON, small intestine (not stomach)
    • -intractable diarrhea and wt loss
    • Dogs, not cats
  14. How do you definitively diagnose histoplasmosis?
    ID the organism on histopathology/cytology
  15. Is antigen or antibody helpful/effective at diagnosising histoplasmosis? What other diagnostic test is highly suggestive?
    • antigen (Ab not reliable)
    • rads if pulmonary form
  16. what is tx of choice for mycosis?
  17. What is tx for fulminate disseminated forms of mycosis?
    itraconazole plus amphotericin B
  18. What form of mycosis is fluconazole often used for?
    CNS and eye forms
  19. Which mycotic agent is easily identified by its psuedocapsule appearance once stained?
  20. what are the clinical forms of blastomycosis? (how does it differ from histo?)
    pulmonary and disseminated (no intestinal form like histo)
  21. Is it likely you will see radiographic evidence in the lungs of a patient with blastomycosis?
    yes, very likely (85% of cases)
  22. what are 4 common sites for disseminated form of blastomycosis?
    peripheral lymph nodes, skin, eye, bone
  23. Would you do an antigen or antibody test to help diagnose blasto? is this definitive?
    • antigen titer on urine/serum
    • only way to def. diag. is ID the organism on cytology
  24. What environmental conditions does coccidiomycosis like?
    dry desert like Southwest
  25. compare the incubation time of histo, blasto, and coccidio.
    • histo/coccio: 1-3 weeks
    • blasto: longer at 1-3 months
  26. Would you do an antigen or antibody test to help diagnose coccidio?
    antibody (do NOT recommend Ag for coccidio)
  27. What would you tell your client about the patient's prognosis with blasto? what situations are of special concern?
    • successful in 75% of cases, esp if they survive the fir 10 days of tx
    • -failure more likely if severe hypoxic pulmonary dz, CNS involved, or widespread (3+systems)
  28. what are 3 forms of coccidiomycosis?
    • subclinical
    • pulmonary
    • disseminated (bone is common)
  29. which disseminated form of coccidio is common in dogs? in cats?
    • dog: bone
    • cat: skin
  30. What should you tell your client to expect when treating coccidiomycosis?
    much longer tx than other mycosis- can be lifelong, esp. difficult if bone involved; 8-12 months of azoles then another 4-6 after clinical resolution
  31. What are some common non-specific CBC/chem findings that often coincide with mycosis?
    • anemia, thrombocytopenia
    • leukocytosis
    • hypercalcemia, incr. liver enzymes
    • hypOalbuminemia (if intestinal, disseminated)