Fungal/

Fungal/

1. Candidiasis

   • risks
     • immunucompromised
     • DM, HIV, chemo, abx
   • types
     • cutaneous
       • mucosal/genital
         • fungemia
           • endocarditis
             • hepatosplenic
           • BAD
             • hepatosplenic dz
               • amphotericin B
               • RUQ pain, incr LFTs
               • CT lesions in liver/spleen
             • indwell cath
         • thrush
           • plaques scrape off
             • lig antifungals,
         • esoph= PO fluconazole
       • diaper rash
         • *satellite lesions, defined margins

2. Cryptococcus

   • encapsulated yeast in soil w/ dried pigeon poop
   • pulm & CNS dz
   • **Meningitis most common
     • mental status change, CN/visual abnorm
   • Dx
     • cryptococcal antigen in CSF/serum
   • Rx =amphotericin B

3. Histoplasmosis

   • dimorphic fungus in soil w/ bird & bat poop
   • Disseminated
     • poss fatal in wks, fever, cough, mouth ulcers, wt. loss, retinal deposits
   • chronic progressive pulm
     • older pt w/ COPD, calcified nodes
   • HIV risk high if CD4<100
   • DX
     • CXR = miliary infiltrates
   • Rx
     • long term itraconazole, amphotericin B

4. Pneumocystis jiroveci (was PCP)

   • **most common opportunistic inf. in HIV
   • S/S
     • **SOB, fever, non-product cough
     • can have Spontaneous PE
   • CXR diffuse interstitial infiltrates "**batwing pattern"
     • Labs= ABG (hypoxia, wide A-a gradient), incr. LDH
   • Dx
     • sputum or BAL
   • Rx = TMP/SMX
     • if pO2<70% steroids