Infectious diseases of the respiratory system which can easily result to Pneumonia

Pathologic X-rays

Patient is a 11 year old male presents with 4 months history of asthmatic symptoms. The usual asthmatic treatment brought no relief. Low dose steroids brought some improvement, but patients symptoms returned when the steroids were withdrawn.
Patient is a 11 year old male presents with 4 months history of asthmatic symptoms. The usual asthmatic treatment brought no relief. Low dose steroids brought some improvement, but patients symptoms returned when the steroids were withdrawn. | Source
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The Pulmonary diseases

These are systemic diseases affecting the Pulmonary system due to invasive manifestation of some microbes or substances, examples of which are the systemic fungal disease, Histoplasmosis, Coccidioidomycosis, systemic Candidosis, Aspergillosis and Actinomycosis. These are very important and relevant because they all can easily be the pre-disposing factors of Pneumonia, so the ability to diagnose and treat them specifically will go a long way in the treatment of resulting Pneumonia.

SYSTEMIC FUNGAL DISEASES

(Systemic Mycoses)

General Diagnostic Principles

Several considerations are important in the diagnosis of the deep mycoses.

1. Many of the causative fungi are "opportunists," not usually pathogenic un less they enter a compromised host. Opportunistic fungus infec tions are particularly apt to occur and should be anticipated in patients after ionizing (x-) irradiation and during therapy with corticosteroids, immunosuppressives, or antimetabolites; they also tend to occur in patients with azotemia, diabe tes mellitus, bronchiectasis, emphysema, TB, Hodgkin's disease or other lymphoma, leukemia, or burns. Candidosis, aspergillosis, phycomycosis, nocardiosis, and cryptococcosis are typical opportunistic infections.

2. Fungal diseases occurring as primary infections may have a typical geo graphic distribution. For example, in the USA, cocddioidomycosis is virtually confined to the southwest, while histoplasmosis occurs in the East and Midwest. especially in the Ohio and Mississippi River valleys. Blastomycosis is restricted to North America and Africa; paracoccidioidomycosis, often called South American blastomycosis, is confined to that continent. However, travelers can develop a symptomatic infection some time after returning from such endemic areas.

3. The major clinical characteristic of virtually every deep mycosis is its chronic course. Septicemia or an acute pneumonia is rare. Lung lesions develop slowly. Months or years may elapse before medical attention is sought or a diagnosis is

made.

4. Symptoms are rarely intense; fever, chills, night sweats, anorexia, weight loss, malaise, and depression may all be present.

5. When a fungus disseminates from a primary focus in the lung, the manifes tations may be characteristic. Thus, cryptococcosis usually appears as meningitis, progressive disseminated histoplasmosis as hepatic disease, and blastomycosis as a skin lesion.

6. Delayed cutaneous hypersensitivity tests and serologic tests are available for only 3 or 4 of the infections discussed in this chapter. Even in these, the tests become positive either so late (e.g., cocddioidomycosis) or so infrequently (e.g., blastomycosis) that they are of no diagnostic value for the acutely ill patient.

7. The diagnosis is usually confirmed by isolation of the causative fungus from sputum, bone marrow, urine, blood, or CSF, or from lymph node, liver, or lung biopsy. When the fungus is a commensal of man or is prevalent in his environment (e.g., Candida, Aspergjilus), it is difficult to interpret its isolation from such specimens as sputum, and confirmatory evidence of tissue invasion is necessary to attribute an etiologic role to it

8. In contrast to viral and bacterial diseases, fungal infections can be diagnosed histopathologically with a high degree of reliability. It is the distinctive fungal morphology, not the tissue reaction to the fungus, that permits specific etiologic

identification.

9. Even when the microorganism has been demonstrated histopathologically m tissues, the activity of the disease must be established before treatment is begun. Culture of the causative microorganism or such clinical and laboratory findings as fever, leukocytosis, elevated ESR, abnormal liver function, worsening of chest film findings, or elevated serum globulins are helpful as indications for therapy.

General Therapeutic Principles

General medical care, surgery, and chemotherapy constitute modes of treat ment for systemic fungus infections. Ketoconazole, a new antifungal imidazole derivative, appears to have major advantages: oral dosage, broad antifungal ac tivity, and minimal adverse effects; but testosterone synthesis may be blocked, usually transiently, and serious idiosyncratic hepatotoxidty may occur. Current usage is 200 to 400 mg orally once a day with a meal. It may be given for pro longed periods to establish and maintain clinical remission or to prevent reinfection. Because amphotericin B is used in many systemic mycoses. it is covered in detail here. Indications and directions for other therapeutic measures are given below in the discussions of specific mycoses.

Amphoteridn B, a fungicidal and fungistatic antibiotic, has reversed the progno sis of many fungal infections. An initial IV dose of 0.1 mg/kg/day is increased by 0.05 to 0.10 mg/kg every day until 1.0 mg/kg (but not exceeding 50 mg/dose) is given daily or every other day. The antibiotic is dissolved in 5% D/W (optimal concentration, 0.1 mg/ml). (CAUTION: Saline solution precipitates the drug and should not be used. Follow the manufacturer's instructions in preparing and storing solutions.)

The drug should be given over a 2- to 6-h period. Reactions are usually mild, but some patients may experience chills, fever, headache, anorexia, nausea, and, occasionally, vomiting, particularly with the initial injections. The severity of re actions may be reduced by giving aspirin or an antihistamine (e.g., diphenhydramine 50 mg) before, after 3 h, and at the end of treatment. If this therapy is ineffective, hydrocortisone 25 to 50 mg IV may be given at the beginning of the amphotericin B infusion.

Chemical thrombophlebitis may occur; adding heparin to the infusion (or into the tubing just prior to starting the injection) may lessen the incidence.

The BUN or serum creatinine should be determined before and periodically during treatment. A slight increase can be ignored. A moderate rise may be re versed by giving the drug on alternate days, but if not, treatment should be dis continued until the levels approach normal. If this requires only a few days, treatment can be resumed with the previous dose, but if a longer period is neces sary, therapy should be restarted with a smaller dose. Serum potassium should be determined regularly, since hypokalemia is common and occasionally is dramatic and dangerous. Oral liquid supplements are usually sufficient; rarely, potassium IV (not added to the amphotericin B infusion) may be necessary Intrathecal injection may be indicated in meningitis, but great care must be taken to ensure proper dose and volume: 50 mg of amphotericin B should be painstaikingly dissolved in 10 ml of sterile water. The total volume should then be diluted in a 250-ml bottle of 5% D/W from which 10 ml has been removed. From 0.5 ml (0.1 mg) to 5.0 ml (1.0 mg) should then be drawn into a 10-ml syringe, further diluted to 10 ml with CSF, and injected slowly (over at least 2 min). A lumbar, cisternal, or ventricular site may be used.

HISTOPLASMOSIS

An infectious disease caused byHistoplasma capsulatum, characterized by a pri mary pulmonary lesion and occasional hematogenous dissemination, with ulcerations of the oropharynx and GI tract, hepatomegaly, splenomegaly, lymphadenopalhy, and adrenal necrosis.

Etiology and Incidence

H. capsulatum in tissue is an oval budding cell 1 to 5 ft in diameter. Infection follows inhalation of dust that contains the spores. Severe disease is more fre quent in men.

Chest x-ray (picture 7-8) surveys in certain geographic areas have demonstrated many resi dents with symptomless, nontuberculous, occasionally calcified pulmonary le sions; delayed cutaneous hypersensitivity reactions to histoplasmin suggest widespread but subclinical infection. The highest incidence of such hypersensitiv ity is in the Ohio and Mississippi River valleys.

Symptoms and Signs

There are 3 recognized forms of the disease. The primary acute form causes symptoms (fever, cough, malaise) indistinguishable in endemic areas (except by culture) from otherwise undifferentiated URI or grippe-like disease. The progres sive disseminated form follows hematogenous spread from the lungs and is charac terized by hepatomegaly, lymphadenopathy, splenomegaly, and, less frequently, oral or GI ulceration. Addison's disease is an uncommon but serious manifestation. The lesions in the liver are granulomatous, show the intracellular fungus, and may lead to hepatic calcification. Addison's disease of other etiology, lymphoma, Hodgkin's disease, leukemia, and sarcoidosis must be differentiated. The chronic cavitary form produces pulmonary lesions indistinguishable, except by cul ture, from cavitary TB. The principal manifestations are cough, increasing dyspnea, and eventually disabling respiratory embarrassment. That histoplasmosis is a cause of uveitis has been postulated but not proved.

Diagnosis

Demonstration of H. capsulatum by culture is diagnostic. Specimens for culture may be obtained from sputum, lymph nodes, bone marrow, liver biopsy, blood, urine, or oral ulcerations. Tissues may also be examined microscopically after staining (Goroori's methenamine silver, periodic add-Schiff, or Gridley) picturtes 9-10, Delayed cutaneous hypersensitivity and CF tests are of no diagnostic value, since they are usually negative early in the disease.

Prognosis and Treatment

The acute primary form is usually benign; it is fatal only in those rare cases with massive infection. The progressive disseminated form has a high mortality. In the chronic cavitary form, death results from severe respiratory insufficiency.

Primary acute disease rarely requires chemotherapy (see amphotericin B and also ketoconazole in General Therapeutic Principles, above). The disseminated form responds to amphotericin B; in the chronic cavitary form, the fungi disap pear with therapy, but fibrotic lesions show little change.

COCCIDIOIDOMYCOSIS

(San Joaquin or Valley Fever)

An infectious disease caused by the fungusCoccidioides immitis, occurring in a primary form as an acute, benign, self-limiting respiratory disease, or in aprogressive form as a chronic, often fatal, infection of the skin, lymph glands, spleen, liver, bones. kidneys, meninges, and brain.

Etiology, Incidence, and Pathology

The disease is endemic in the southwestern USA and occurs most frequently in men aged 25 to 55. Infection is acquired by inhalation of spore-laden dust. Indi viduals contracting the disease while traveling through endemic areas may not develop manifestations until later, after leaving the area.

The basic pathologic change is an acute, subacute, or chronic granulomatous process with varying degrees of fibrosis. Lesions may show central necrosis; the organisms are surrounded by lymphoctyes and by plasma, epithelioid, and giant cells. Cavitation or granuloma ("coin lesion") formation may occur in chronic lung infection.

Symptoms and Signs

Primary pulmonary coccidioidomycosis, the more common form, may occur asymptomaucally, as a mild URI, as acute bronchitis, occasionally with pleural effusion, or as pneumonia. Symptoms, in descending order of frequency, include fever, cough, chest pain, chills, sputum production, sore throat, and hemoptysis. Physical signs may be absent, or occasional scattered rales and areas of dullness to percussion may be present. Leukocytosis is present and the eosinophil count may be high. Some patients develop "desert rheumatism," a more recognizable form with conjunctivitis, arthritis, and erythema nodosum.

Progressive coccidioidomycosis develops from the primary form; evidence of dissemination may appear a few weeks, months, or, occasionally, years after pri mary infection or long residence in an endemic area. Symptoms include continuous low-grade fever, severe anorexia, and loss of weight and strength. Progressive cyanosis, dyspnea, and mucopurulent or bloody sputum are present in the pulmo nary type. The bones, joints, skin, viscera, brain, and meninges may be involved as the disease spreads.

Diagnosis

Coccidioidomycosis should be suspected in a patient with anobscure illness who has been or is in an endemic area. Diagnosis is established by finding the characteristic spherules of C. immitis in sputum, gastric washings, pleural fluid, CSF, pus from abscesses, biopsy specimens, or exudate from skin lesions by direct examination or culture. In the tissues, the fungus appears as thick-walled, non-budding spherules 20 to 80 fi in diameter.

A delayed cutaneous hypersensitivity reaction to coccidioidin or spherulin usu ally appears 10 to 21 days after infection, but is characteristically absent in pro gressive disease. Precipitating and CF antibodies are present regularly and persistently in the progressive form but only transiently in acute primary cases. X ray findings are on figures 1-2.

Prognosis and Treatment

For primary pulmonary Coccidioidomycosis, treatment is not needed and the outlook is excellent. The progressive type, however, is fatal in 55 to 60% of cases. Amphotericin B (see amphotericin B and also ketoconazole in General Therapeu tic Principles, above) is indicated in all patients with the progressive form. Results are less satisfactory than in blastomycosis or histoplasmosis. Meningitis requires prolonged intrathecal administration, usually for years. Untreated meningitis is fatal.


SYSTEMIC CANDIDOSIS

(Candidiasis; Moniliasis)

Etiology and Incidence

The infections are usually caused by C. albicans. Superficial candidosis is uni versal, but patients with leukemia, or with organ transplants, or receiving immunosuppressive or antibacterial therapy are especially prone to C. spp. septicemia. C. spp. (frequently C. parapsilosis) endocarditis is related to intravascular trauma such as cardiac catheterization, surgery, or indwelling venous catheters.

Symptoms and Signs

C. spp. endocarditis resembles bacterial disease, with fever, heart murmur, splenomegaly, and anemia; large vegetations and emboli to major vessels are fre quently present and are differential features. Renal involvement is usually found on laboratory and autopsy examination. C. spp. septicemia usually resembles gram-negative bacterial sepsis in frequency of fever, shock, azotemia, oliguria, renal shutdown, and fulminant course. C. spp. meningitis is chronic, like crypto-coccal meningitis, but lacks the latter" s usually fatal outcome when untreated. C. spp. pyelonephritis and pulmonary disease are less well characterized. Osteomyelitis is rarely encountered; it resembles that due to other microorganisms.

Diagnosis

Because C. spp. are commensals of man, their culture from sputum, mouth, vagina, urine, stool, or skin must be interpreted cautiously. To confirm the diag nosis, the culture must be complemented by a characteristic clinical lesion, exclu sion of other etiology, and histologic evidence of tissue invasion. Isolation from blood or CSF, however, establishes the presence of C. spp. infection and supports the appropriate clinical impression: septicemia, endocarditis, or meningitis.

Treatment

Such predisposing conditions as diabetic acidosis must first be controlled. In systemic candidosis, amphoteridn B IV is preferable therapy. As an alternative, flucytosine may be given as for cryptococcosis (see above) if the isolate is sensitive to it. Ketoconazole appears promising in investigational studies in this disorder.

ASPERGILLOSIS

Etiology, Symptoms, and Signs

The fungus, an "opportunist," appears after antibacterial or antifungal therapy (to which it is usually resistant) in bronchi damaged by bronchitis, bronchiectasis, or tuberculosis. The "fungus ball" (aspergilloma), a characteristic form of the disease, appears on the chest film as a dense round ball, capped by a slim menis cus of air, in a cavity; it is composed of a tangled mass of fibrin, exudate, and a few inflammatory cells. Aspergillomas usually occur in old cavitary disease (e.g., tuberculosis) or, rarely, in patients with rheumatoid spondylitis. Symptoms (cough, productive sputum, dyspnea) and findings on physical examination or chest film are usually those of the underlying disease. However, hemoptysis has been a disturbing and even occasionally fatal complication. In the presence of leukemia, organ transplantation, or corticosteroid or immunosuppressive therapy, dissemination to the brain and kidneys may occur. The clinical picture in this form is a typical septicemia: fever, chills, hypotension, prostration, and delirium.

Examination of the chest films (picture 11) reveals bilateral perihilar opacities centrally extending out into the mid-lung fields bilaterally. There is a pattern resembling “hotdogs” or “V shaped clusters of grapes” radiating from the hilus. This pattern is due to impaction of the bronchus by viscid secretions containing aspergillus hyphae. Dilation occurs distal to the bronchial plugs creating bronchiectasis which can be demonstrated by bronchography. Clinically, two primary presentations of allergic aspergillosis may be encountered. The disease may be superimposed upon life-long asthma, or may be an etiologic factor in the development of asthma in patients late in life. In addition to the presence of asthma and asthmatic attacks, the patients almost invariable have peripheral blood eosinophilia, fever, and a rather characteristic chest roentgenogram.

This condition responds dramatically to steroid therapy as steroids act to decrease host overresponsiveness, allowing bronchial edema to resolve.

Diagnosis and Treatment

Because it is a commensal of man, culture of A. spp. from sputum, mouth, or bowel must not be considered diagnostic unless a clinically compatible illness is present, other causes have been eliminated, and tissue invasion has been demon strated. In disseminated and pulmonary disease, amphotericin B should be given IV although tolerated doses are usu ally ineffective, since most strains are resistant.

ACTINOMYCOSIS

(Lumpy Jaw)

A chronic infectious disease characterized by multiple draining sinuses and caused by the anaerobic gram-positive microorganism Actinomyces israelii, often present as a commensal on the gums, tonsils, and teeth.

Incidence and Pathology

The disease is seen most often in adult males. In the cervicofacial form, the rnost common portal of entry is decayed teeth; pulmonary disease results from aspiration of oral secretions; abdominal disease, from a break in the mucosa of a diverticulum or the appendix.

The characteristic lesion is an indurated area of multiple, small, communicating abscesses surrounded by granulation tissue. Disease spreads to contiguous tissue and, rarely, hematogenously. Other anaerobic bacteria are usually also present.

Symptoms and Signs

There are 4 clinical forms of actinomycosis. (1) The abdominal form affects the intestines (usually the cecum and appendix) and the peritoneum. Pain, fever, vomiting, diarrhea or constipation, and emaciation are characteristically present. An abdominal mass with signs of partial intestinal obstruction appears, and draining sinuses and fistulas may develop in the abdominal wall. (2) The cervicofacial form usually begins as a small, flat, hard swelling, with or without pain, under the oral mucosa or the skin on the neck, or as a subperiosteal swelling of the jaw. Subsequently, areas of softening appear and develop into sinuses and fistulas with a discharge that contains the characteristic "sutfur granules" (rounded or spherical, usually yellowish, granules up to 1 mm in diameter). The cheek, tongue, pharynx, salivary glands, cranial bones, meninges, or brain may be affected, usually by direct extension. (3) In the thoracic form, involvement of the lungs resembles TB. Extensive invasion may occur before chest pain, fever, and productive cough appear. Perforation of the chest wall, with chronic draining sinuses, may result. (4) In the generalized form, hematogenous spread occurs to the skin, vertebral bodies, brain, liver, kidney, ureter, and (in women) the pelvic organs.

Diagnosis

This is based on clinical symptoms, x-ray findings (picture 12), and demonstration of A. israelii in sputum, pus, or biopsy specimen. In pus or tissue, the microorganism appears as tangled masses of branched and un-branched wavy filaments, or as the distinctive "sulfur granules." These consist of a central mass of tangled filaments, pus cells, and debris, with a midzone of interlacing filaments surrounded by an outer zone of radiating, club-shaped, hya line and refractive filaments that take the eosin stain in tissue.

Lung lesions must be distinguished from those of TB and neoplasms. Lesions in the abdomen occur most frequently in the ileocecal region and are difficult to diagnose, except at laparotomy or when draining sinuses appear in the abdominal wall. Aspiration liver biopsy should be avoided because of me danger of inducing a persistent sinus. A tender, palpable mass suggests appendiceal abscess or re­gional enteritis. Nodules in any location may simulate malignant growths.

Clinical presentation:
53 year old man with left side pain and a lump in the left axilla, dullness to percussion in the left lower chest. Had been treated for an infection 3 and 25 years before. Works as a fitter, cutting insulation by hand. Smokes 10 cigarettes a day.

The view is taken central. The size of the left lobe is reduced and the margins of left hemidiaphragm, the lower left heart margin and the costophrenic recess are obscured by a density that has a clear central margin as it extends into the left axilla, implying a pleural density. There is shadowing at the apex of both lungs. This is well-defined and irregular with calcifications. The right hilar vessels are vertical and sparse in both upper zones with elevation of the hilar point on both sides, implying loss of upper lobe volume. There is coarse linear calcification immediately above the diaphragm, well shown on the right and a little obscured on the left. In this particular view, no rib erosion is identified.

Prognosis and Treatment

The disease is slowly progressive. Prognosis relates directly to early diagnosis, is most favorable in the cervicofacial form, and is progressively worse in the pulmo nary, abdominal, and generalized forms.

Most cases will respond to medical treatment but, owing to the extensive indu ration and relatively avascular fibrosis, response is slow and treatment must be continued for at least 8 wk and occasionally for > 1 yr. Extensive and repeated surgical procedures may be required. Aspiration is indicated for small abscesses and drainage for large ones. Penicillin G, at least 12 million u./day IV, should be given initially; penicillin V 1 gm orally q.i.d. may be substituted after about 2 wk. Tetracycline 500 mg orally q 6 h may be given instead of penicillin. Treatment must be continued for several weeks after apparent clinical cure.

Clinical pictures of these diseases

show an ill-defined opacity simulating lung cancer.
show an ill-defined opacity simulating lung cancer. | Source
Biofilm formations may include such oral bacterium as antinomyces viscousus, an anaerobic bacterium that is part of the human oral flora. The rod shaped bacteria occur around the teeth, gums and throat in healthy people. Species of this bacterium can
Biofilm formations may include such oral bacterium as antinomyces viscousus, an anaerobic bacterium that is part of the human oral flora. The rod shaped bacteria occur around the teeth, gums and throat in healthy people. Species of this bacterium can | Source
Histoplasmosis is a fungal infection caused by inhaling dust from spore-infected bird droppings. In the disseminated form, infection spreads throughout the body from the lungs. The death rate is fairly high for people with untreated widespread (disse
Histoplasmosis is a fungal infection caused by inhaling dust from spore-infected bird droppings. In the disseminated form, infection spreads throughout the body from the lungs. The death rate is fairly high for people with untreated widespread (disse | Source
This is a skin lesion resulting from disseminated histoplasmosis. Histoplasmosis occurs most frequently as a lung infection, however it can infect the skin or become distributed (disseminated) to internal organs.
This is a skin lesion resulting from disseminated histoplasmosis. Histoplasmosis occurs most frequently as a lung infection, however it can infect the skin or become distributed (disseminated) to internal organs. | Source
Disseminated coccidioidomycosis is caused by breathing in the spores of a fungus found in desert regions. The infection spreads throughout the body and is especially common in immunosuppressed people. Antifungals may help but the death rate is very h
Disseminated coccidioidomycosis is caused by breathing in the spores of a fungus found in desert regions. The infection spreads throughout the body and is especially common in immunosuppressed people. Antifungals may help but the death rate is very h | Source
The year 2001 has seen an interesting outbreak of this disease in Dinosaur National Monument, Utah.  Ten people who had been working at a 'dig' developed acute respiratory coccoidioidomycosis within two weeks of exposure.  All were treated with fluco
The year 2001 has seen an interesting outbreak of this disease in Dinosaur National Monument, Utah. Ten people who had been working at a 'dig' developed acute respiratory coccoidioidomycosis within two weeks of exposure. All were treated with fluco | Source
Candida albicans is one of many species of yeast that lives in the body. This yeast often grows within the vaginal tract and the intestinal tract while being held in check by good bacteria. At specific times during an individuals life that good bacte
Candida albicans is one of many species of yeast that lives in the body. This yeast often grows within the vaginal tract and the intestinal tract while being held in check by good bacteria. At specific times during an individuals life that good bacte | Source
Aspergillosis is a fungal disease of the respiratory tract of birds and mammals usually caused by Aspergillus fumigatus. A. flavus, A. niger, A. nidulans, A. terreus, A. glaucus and Penicillium sp. have also been identified as pathogenic. Aspergillos
Aspergillosis is a fungal disease of the respiratory tract of birds and mammals usually caused by Aspergillus fumigatus. A. flavus, A. niger, A. nidulans, A. terreus, A. glaucus and Penicillium sp. have also been identified as pathogenic. Aspergillos | Source
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Contributors and acknowledgement

The professors and staff of Internal Medicine department (Pulmonology), Pediatrics and Pharmacology. Professor Smiyan Svetlana, Dr. Andrei Lepyavko Andreivich and Dr. Sakarova (Ph.D) (Of Pediatrics Department)
The professors and staff of Internal Medicine department (Pulmonology), Pediatrics and Pharmacology. Professor Smiyan Svetlana, Dr. Andrei Lepyavko Andreivich and Dr. Sakarova (Ph.D) (Of Pediatrics Department) | Source
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Medical treatment

Fungal Pathogen: Histoplasmosis

Indication for Antifungal Therapy: Acute pulmonary histoplasmosis with hypoxia; prolonged moderate symptoms for more than 1 month; disseminated disease; immunosuppressed host

Mortality rate for untreated disseminated disease at 80%; reduced to 25% with treatment

Surgical Care and Other Treatments: Significant hemoptysis; recurrent pneumonia; repair of bronchopleural fistula

Corticosteroids in severe hypoxia

Anti-inflammatory agents to treat rheumatologic syndromes

Antifungal Drugs Used: Amphotericin B induces rapid response in patients who are severely ill

Azoles/triazoles in patients with milder illness

Fungal Pathogen: Coccidioidomycosis

Indication for Antifungal Therapy: Disseminated disease; chronic pulmonary disease; acute pulmonary infection with hypoxia or protracted morbidity (>1-2 mo); immunosuppressed host (worst outcome, 70% mortality).

Surgical Care and Other Treatments: Surgical debridement or resection of infective tissue often necessary adjunct to antifungal treatment

Anti-inflammatory agents for rheumatologic syndromes

Antifungal Drugs Used: Amphotericin B effective in more than 90% of cases

Fluconazole or itraconazole after improvement

Treatment less effective than in other endemic mycoses

Fungal Pathogen: Blastomycosis

Indication for Antifungal Therapy: Persistent or recurrent symptoms of acute or chronic pulmonary disease or with pleural involvement; disseminated disease.

Surgical Care and Other Treatments: N/A

Antifungal Drugs Used: Amphotericin B response rates of 77-90%

Itraconazole successful in 90%

Ketoconazole response of 80%; poor outcome in patients who are immunosuppressed

Fluconazole less effective, 65% response rate

Chronic maintenance treatment essential for all patients with AIDS or meningitis

Fungal Pathogen: Cryptococcosis

Indication for Antifungal Therapy: Patients who are immunosuppressed and symptomatic; patients who are immunocompetent with disease progression; any patients with meningitis or disseminated disease

Surgical Care and Other Treatments: N/A

Antifungal Drugs Used: Amphotericin B in patients who are severely ill

Fluconazole in milder cases or after clinical response to amphotericin B

Lifelong maintenance therapy in AIDS patients because of frequent recurrences when treatment stopped

Fungal Pathogen: Aspergillosis; mucormycoses

Indication for Antifungal Therapy: All patients with invasive disease; in patients who are immunosuppressed, early diagnosis and empiric treatment for persistent fever not responding to broad-spectrum antibiotics; high mortality once infiltrates and symptoms appear; prognosis ultimately linked to severity and outcome of underlying disease

Mortality rate of 50-60% in patients with AIDS; mortality rate as high as 85% in patients with prior bone marrow transplantation

Surgical Care and Other Treatments: Aggressive surgical debridement of necrotic tissue important in mucormycosis, especially if confined to lungs

Rapid tapering of immunosuppressive agents and corticosteroids and reversal of neutropenia (if possible)

Antifungal Drugs Used: Voriconazole is the new standard of care for invasive aspergillosis based on superiority over amphotericin B in primary therapy

Lipid formulations of amphotericin B have at least equal efficacy but less toxicity compared with amphotericin B desoxycholate

Oral voriconazole can be used to complete treatment with initial response to IV voriconazole or amphotericin B;Mucor species generally resistant to azoles

Caspofungin useful as salvage therapy

Fungal Pathogen: Candidiasis

Indication for Antifungal Therapy: All patients with invasive disease or dissemination; important to reverse factors affecting immune status

Surgical Care and Other Treatments: Rapid tapering of immunosuppressive agents and corticosteroids; important to remove indwelling infected intravenous lines or urinary catheters in setting of hematogenous spread

Antifungal Drugs Used: Amphotericin B is mainstay

Flucytosine may be of benefit when added to amphotericin B

Fluconazole use in pulmonary disease not studied but is effective in hepatosplenic candidiasis and candidemia

Echinocandins may be useful alternatives

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Comments 33 comments

msorensson profile image

msorensson 6 years ago

You are doing a great job.


D.Virtual.Doctor profile image

D.Virtual.Doctor 6 years ago from Europe Author

Thank you for your great encouragement and been the first to post a comment. I truly appreciate this. Its a community service and its meant for everyone. Keep on reading...


Cheeky Girl profile image

Cheeky Girl 6 years ago from UK and Nerujenia

This is a very detailed and information rich hub page. I found it quite technical in places, and felt quite immersed in names of diseases and conditions, as though I was attending a medical course. But great info here, no doubt. It's about time Doctors like yourself came on to Hub Pages and spread the medical advice around, as everyone can benefit. Cheers! Thanks for this.


D.Virtual.Doctor profile image

D.Virtual.Doctor 6 years ago from Europe Author

woow! Cheeky Girl....

Your comment is so encouraging and inspirational. I am so grateful for such and we will keep on doing the good work. I just felt that now that I am in med school with the fresh brain it would be nice to publish as many clinical cases as possible for better orientation and effective education to the general public and I think my goal is been achieved to the fullest. Thank you very much for the wonderful comment and keep on reading.


mayor clinic 6 years ago

Histoplasmosis is an infection transmitted by airborne spores that you breathe in when you work in or around soil that contains a fungus called Histoplasma capsulatum. It generally affects your lungs, but may spread to other organs or tissues outside your lungs.

Farmers, landscapers, construction workers and people who have contact with bird or bat droppings are especially at risk of histoplasmosis.

Most people with histoplasmosis never develop symptoms and aren't aware they're infected. But for some people — primarily infants and those with compromised immune systems — histoplasmosis can be serious. Effective treatments are available for even the most severe forms of histoplasmosis.

Several types of histoplasmosis exist, ranging from mild to life-threatening. The mildest form produces no signs or symptoms, but severe infections can cause serious problems throughout your body as well as in your lungs. When signs and symptoms do occur, they usually appear three to 17 days after exposure.

Asymptomatic primary histoplasmosis

This is the most common form of histoplasmosis and usually causes no signs or symptoms in otherwise healthy people who become infected. The only sign that you were ever infected may be small scars in the lungs.

Acute symptomatic pulmonary histoplasmosis

This form of histoplasmosis tends to occur in otherwise healthy people who've had intense exposure to H. capsulatum. Because the severity of the disease depends on the number of fungus spores inhaled, reactions may range from a brief period of not feeling well to serious illness. Typical signs and symptoms include:

Fever

Muscle aches

Headache

Dry cough

Chills

Chest pain

Loss of appetite

Sweats

In some cases, the following may also accompany acute symptomatic pulmonary histoplasmosis:

Arthritis.

Inflammation of the sac that surrounds the heart (pericarditis).

Severe acute pulmonary syndrome, a potentially life-threatening condition in which breathing becomes difficult. Also called spelunker's lung, this often occurs after prolonged exposure to bat excrement stirred up by explorers in caves.

Arthritis and pericarditis don't mean that the infection has spread outside your lungs. Instead, they develop because your immune system responds to the fungus with an unusual amount of inflammation.

Chronic pulmonary histoplasmosis

This type of histoplasmosis usually affects people with an underlying lung disease, such as emphysema. The disease is chronic and if left untreated may progress to disabling lung problems. Signs and symptoms include:

Fever

Night sweats

A cough that may bring up blood

Shortness of breath

Weight loss

Disseminated histoplasmosis

Occurring primarily in infants and people with compromised immune systems, disseminated histoplasmosis can affect nearly any part of your body, including your eyes, liver, bone marrow, central nervous system, skin, adrenal glands and intestinal tract. Untreated disseminated histoplasmosis is usually fatal. Depending on which organs are affected, people with this form of the disease may develop:

Fever

Weight loss

Enlarged spleen

Enlarged liver

Pneumonia

Inflammation of the sac surrounding the heart (pericarditis)

Inflammation of the thin membrane that covers the brain and spinal cord (meningitis)

Poorly functioning adrenal glands (adrenal insufficiency)

Ulcers of the mouth, tongue or intestinal tract

When to see a doctor

Contact your doctor if you live in an area where histoplasmosis is common — such as the Ohio and Mississippi river valleys of North America — and you develop chest pain, cough and a fever. Although many illnesses cause similar signs and symptoms, your doctor may want to test you for the presence of H. capsulatum. If your immune system has been weakened by illness or medications, and you develop any symptoms of histoplasmosis, seek medical care immediately.


coccidioidomycosis 6 years ago

The disease is usually mild, with flu-like symptoms and rashes. The Mayo Clinic estimates that half the population in some affected areas have suffered from the disease. On occasion, those particularly susceptible may develop a serious or even fatal illness from valley fever. Serious complications include severe pneumonia, lung nodules, and disseminated disease, where the fungus spreads throughout the body. The disseminated form of valley fever can devastate the body, causing skin ulcers, abscesses, bone lesions, severe joint pain, heart inflammation, urinary tract problems, meningitis, and often death. In order of decreasing risk, people of Filipino, African, Native American, Hispanic, and Asian descent are susceptible to the disseminated form of the disease.[6] Men and pregnant women, and people with weakened immune systems (as from AIDS) are more susceptible than non-pregnant women.

It has been known to infect humans, cattle, deer, dogs, elk, fish, mules, livestock, apes, kangaroos, wallabies, tigers, bears, badgers, otters and marine mammals.[7]

Symptomatic infection (40% of cases) usually presents as an influenza-like illness with fever, cough, headaches, rash, and myalgia (muscle pain).[8] Some patients fail to recover and develop chronic pulmonary infection or widespread disseminated infection (affecting meninges, soft tissues, joints, and bone). Severe pulmonary disease may develop in HIV-infected persons.[9]

An additional risk is that health care providers who are unfamiliar with it or are unaware that the patient has been exposed to it may misdiagnose it as cancer and subject the patient to unnecessary surgery

Types

Coccidioidomycosis may be divided into the following types:[11]:314-316

Primary pulmonary coccidioidomycosis

Disseminated coccidioidomycosis

Primary cutaneous coccidioidomycosis

Diagnostic test

The fungal infection can be demonstrated by microscopic detection of diagnostic cells in body fluids, exudates, sputum and biopsy-tissue. With specific nucleotide primers C.immitis DNA can be amplified by PCR. It can also be detected in culture by morphological identification or by using molecular probes that hybridize with C.immitis RNA. An indirect demonstration of fungal infection can be achieved also by serologic analysis detecting fungal antigen or host antibody produced against the fungus.

[edit]Treatment

There are no published prospective studies that examine optimal antifungal therapy for coccidioidomycosis. Mild cases often do not require treatment. Oral Fluconazole and intravenous Amphotericin B are used in progressive or disseminated disease, or in which patients are immunocompromised. Alternatively, itraconazole or ketoconazole may be used.[19] Posaconazole and voriconazole have also been used.


Blastomycosis 6 years ago

What is blastomycosis?

Blastomycosis is an uncommon, but potentially serious fungal infection. It primarily affects the lungs and skin and is caused by the fungus Blastomyces dermatitidis. The illness that can result from exposure to this organism is extremely variable. Infected individuals may not develop any symptoms or may develop mild and rapidly improving respiratory symptoms; a progressive illness involving multiple organ systems can occur in untreated patients.

What are the signs and symptoms?

Some persons infected with Blastomyces fungus never develop symptoms. Evidence of their infection is only found by chance on a chest x-ray or blood test. Other individuals may develop an acute lung infection that begins with a fever and dry cough and may progress to weight loss, chest pain, and a persistent cough associated with the production of a thick sputum. Other symptoms may include muscle aches, night sweats, coughing up blood, shortness of breath, and chest tightness. The time from a person's exposure to the fungus to the time that symptoms develop can vary from three weeks to several months. Signs or symptoms and the infection may disappear spontaneously without treatment. However, in a small percentage of cases the infection may spread by blood to the skin, bone, or other organs. Blastomycosis of the skin appears as enlarging raised lesions with ulcerating centers. These usually occur on the exposed parts of the body, including the face, hands, wrists, feet, and ankles. In more severe cases, blood-borne fungal lesions may also occur in bones, the prostate gland, testes, and kidneys.

How is blastomycosis diagnosed?

Infected symptomatic individuals usually have abnormalities present on their chest x-rays. However, these abnormalities are not unique to blastomycosis and may occur with many other respiratory illnesses. The diagnosis of blastomycosis can be confirmed by the identification of the fungus B. dermatitidis in a culture of the sputum, skin, or biopsy specimen of infected tissue. Blood specimens may also be used to determine if an individual has had a previous blastomycosis infection; however, blood tests will not identify all cases and on occasion may be falsely positive. Similarly, skin tests are not accurate in diagnosing blastomycosis.

How does a person develop blastomycosis?

Blastomycosis develops when spores of the B. dermatitidis are breathed in and establish a primary infection in the lung. In nature, the fungus probably resides in the soil in decaying foliage and vegetation. Only under quite specific conditions of humidity, temperature and nutrition can the fungus grow and produce the infecting particles, the spores. The spores become airborne when the soil in which the fungus is growing is disturbed. This aerosol is then inhaled by humans or other mammals. Thus, activities that involve disrupting the soil are likely to put a person at increased risk for acquiring blastomycosis.

Dogs may also develop blastomycosis because they also inhale the spores following disruption of the soil. Infected dogs cannot transmit the disease to humans, but do serve to indicate that an area may be infected with the fungus. Blastomycosis cannot be transmitted from person-to-person.

How is blastomycosis treated?

Once blastomycosis has been diagnosed, the disease can be treated with one of three anti-fungal drugs – itraconazole, amphotericin B, or fluconazole. For life-threatening blastomycosis or blastomycosis of the central nervous system, amphotericin B is the treatment of choice. Itraconazole or fluconazole are excellent for treatment of patients who are not critically ill or who have no central nervous system involvement.

How common is blastomycosis?

In spite of recent widespread publicity, blastomycosis is a relatively rare disease. From 1992 to 2000, an average of 86 cases of blastomycosis were reported to the Wisconsin Division of Public Health annually. It is likely that other persons are infected with the fungus but only develop minimal symptoms and are not diagnosed or reported to the Division of Health. Almost all cases of blastomycosis occur as isolated events and only rarely have outbreaks or clusters of cases been reported. Nationally, blastomycosis occurs along the Mississippi River Valley from Minnesota and Wisconsin to Arkansas, along the Ohio River Valley, and in the southeastern United States. Although cases of blastomycosis have been reported from all areas in Wisconsin, there appears to be an increase in the number of reported cases occurring in the northern and central counties. While B. dermatitidis is widely distributed geographically, the actual area infected with the fungus is likely to be small and may be limited to one rotting log or several square yards of infected soil. Depending upon environmental conditions, the area may be infected for only a brief time.

How can blastomycosis be prevented?

Currently, there is no way to identify areas where the organism exists. Therefore, until more is known about the existence of B. dermatitidis in nature, it cannot be successfully controlled in the environment. More effective skin and blood tests are needed to diagnose blastomycosis and to survey individuals in areas where blastomycosis is suspected to be prevalent. Through such surveys, high risk areas in the environment could be identified and hopefully the necessary environmental conditions for the growth B. dermatitidis characterized. Control efforts may then be possible.


Crptococcosis 6 years ago

Cryptococcosis is infection with Cryptococcus neoformans fungus.

Causes

Cryptococcus neoformans, the fungus that causes this disease, is ordinarily found in soil. It enters and infects the body through the lungs. Once inhaled, infection with cryptococcosis may go away on its own, remain in the lungs only, or spread throughout the body (disseminate).

Most cases are in people with a weakened immune system, such as those with HIV infection, taking high doses of corticosteroid medications, cancer chemotherapy, or who have Hodgkin's disease.

In people with a normal immune system, the lung (pulmonary) form of the infection may have no symptoms. In people with impaired immune systems, the cryptococcus organism may spread to the brain.

Neurological (brain) symptoms begin gradually. Most people with this infection have meningoencephalitis (swelling and irritation of the brain and spinal cord) when they are diagnosed.

Cryptococcus is one of the most common life-threatening fungal infections in people with AIDS.

Symptoms

Blurred vision or double vision (diplopia)

Bone pain or tenderness of the breastbone (sternum)

Chest pain

Confusion

Cough -- dry

Fatigue

Fever

Headache

Nausea

Skin rash -- pinpoint red spots (petechiae)

Sweating -- unusual, excessive at night

Swollen glands

Unintentional weight loss

Weakness

Note: People with a normal immune system may have no symptoms at all.

Exams and Tests

Sputum culture and stain

Lung biopsy

Bronchoscopy

Cerebrospinal Fluid culture and stain for Cryptococcus

Chest x-ray

Cryptococcal antigen test (looks for a certain molecule that the Cryptococcus fungus can shed into the blood)

Treatment

Some infections require no treatment. Even so, there should be regular check-ups for a full year to make sure the infection has not spread. If there are lung lesions or the disease spreads, antifungal medications are prescribed. These drugs may need to be taken for a long time.

Medications include:

Amphotericin B

Flucytosine

Fluconazole

Outlook (Prognosis)

Central nervous system involvement often causes death or leads to permanent damage.

Possible Complications

Infection comes back

Meningitis

Permanent brain or nerve damage

Side effects of medications (such as Amphotericin B) can be severe

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of cryptococcosis, especially if you have a weakened immune system.

Prevention

Take the lowest doses of corticosteroid medications possible. Practice safe sex to reduce the risk of getting HIV and the infections associated with a weakened immune system.


Aspergillosis 6 years ago

Background

Aspergillus species are ubiquitous molds found in organic matter. Although more than 100 species have been identified, the majority of human illness is caused by Aspergillus fumigatus and Aspergillus niger and, less frequently, by Aspergillus flavus and Aspergillus clavatus. The transmission of fungal spores to the human host is via inhalation. Also see the eMedicine articles Aspergillosis (dermatology focus), Aspergillosis (pediatric focus), and Aspergillosis, Thoracic (radiology focus).

Aspergillus may cause a broad spectrum of disease in the human host, ranging from hypersensitivity reactions to direct angioinvasion. Aspergillus primarily affects the lungs, causing 4 main syndromes, including allergic bronchopulmonary aspergillosis (ABPA), chronic necrotizing Aspergillus pneumonia (or chronic necrotizing pulmonary aspergillosis [CNPA]), aspergilloma, and invasive aspergillosis. However, in patients who are severely immunocompromised, Aspergillus may hematogenously disseminate beyond the lung, potentially causing endophthalmitis, endocarditis, and abscesses in the myocardium, kidney, liver, spleen, soft tissue, and bone. Aspergillus is second to Candida species as a cause of fungal endocarditis. Aspergillus -related endocarditis and wound infections occur in the context of cardiac surgery.

ABPA is a hypersensitivity reaction to A fumigatus colonization of the tracheobronchial tree and occurs in conjunction with asthma and cystic fibrosis (CF). Allergic fungal sinusitis may also occur alone or with ABPA. Bronchocentric granulomatosis and malt worker's lung are 2 hypersensitivity lung diseases that are caused by Aspergillus species, but they are rare.

An aspergilloma is a fungus ball (mycetoma) that develops in a preexisting cavity in the lung parenchyma. Underlying causes of the cavitary disease may include treated tuberculosis or other necrotizing infection, sarcoidosis, CF, and emphysematous bullae. The ball of fungus may move within the cavity but does not invade the cavity wall; however, it may cause hemoptysis.

CNPA is a subacute process usually found in patients with some degree of immunosuppression, most commonly that associated with underlying lung disease, alcoholism, or long-term corticosteroid therapy. Because it is uncommon, CNPA often remains unrecognized for weeks or months and can cause a progressive cavitary pulmonary infiltrate.

Invasive aspergillosis is a rapidly progressive, often fatal infection that occurs in patients who are severely immunosuppressed, including those who are profoundly neutropenic, those who have received bone marrow or solid organ transplants, and patients with advanced AIDS1 or chronic granulomatous disease. This infectious process is characterized by invasion of blood vessels, resulting in multifocal infiltrates, which are often wedge-shaped, pleural-based, and cavitary. Dissemination to other organs, particularly the central nervous system, may occur.

Pathophysiology

Aspergillus causes a spectrum of disease, from colonization to hypersensitivity reactions to chronic necrotizing infections to rapidly progressive angioinvasion, often resulting in death. Rarely found in individuals who are immunocompetent, invasive Aspergillus infection almost always occurs in patients who are immunosuppressed by virtue of underlying lung disease, immunosuppressive drug therapy, or immunodeficiency.

Aspergillus hyphae are histologically distinct from other fungi in that the hyphae have frequent septae, which branch at 45° angles. The hyphae are best visualized in tissue with silver stains. Although many species of Aspergillus have been isolated in nature, A fumigatus is the most common cause of infection in humans. A flavus and A niger are less common. Likely, this relates to the ability of A fumigatus, but not most other Aspergillus species, to grow at normal human body temperature.

Human host defense against the inhaled spores begins with the mucous layer and the ciliary action in the respiratory tract. Macrophages and neutrophils encompass, engulf, and eradicate the fungus. However, many species of Aspergillus produce toxic metabolites that inhibit macrophage and neutrophil phagocytosis. Corticosteroids also impair macrophage and neutrophil function. Underlying immunosuppression (eg, HIV disease, chronic granulomatous disease, pharmacologic immunosuppression) also contributes directly to neutrophil dysfunction or decreased numbers of neutrophils. In individuals who are immunosuppressed, vascular invasion is much more common and may lead to infarction, hemorrhage, and necrosis of lung tissue. Persons with CNPA typically have granuloma formation and alveolar consolidation. Hyphae may be observed within the granulomata.

Frequency

United States

Although allergy to Aspergillus, as manifested by a positive skin test reaction to Aspergillus antigen, is present in approximately 25% of people with asthma and 50% of patients with CF, ABPA is much less common. From surveys and an ABPA registry, 0.25-0.8% of people with asthma and approximately 7% of patients with CF are estimated to have ABPA. The incidence of ABPA in people with asthma who are steroid-dependent or have associated central bronchiectasis is higher, estimated at 7-10%.

CNPA is rare. Frequently undetected in life and found at autopsy, the frequency of chronic necrotizing Aspergillus pneumonia may be underestimated.

The frequency of invasive aspergillosis reflects disease states and treatments that result in prolonged neutropenia and immunosuppression. Invasive aspergillosis is estimated to occur in 5-13% of recipients of bone marrow transplants, 5-25% of patients who have received heart or lung transplants, and 10-20% of patients who are receiving intensive chemotherapy for leukemia. Although it has been described in individuals who are immunocompetent, invasive aspergillosis is exceedingly uncommon in this population.

Aspergilloma is not rare in patients with chronic cavitary lung disease and CF. In one survey of patients with cavitary lung disease due to tuberculosis, 17% developed aspergilloma.

International

The incidence of ABPA in people with asthma appears to be higher in Great Britain compared with the United States.

Mortality/Morbidity

Invasive aspergillosis is associated with significant mortality, with a rate of 30-95%.

Chronic necrotizing Aspergillus pneumonia has a reported mortality rate of 10-40%, but rates as high as 100% have been noted because it often remains unrecognized for prolonged periods.

Aspergilloma is associated with hemoptysis, which may be severe and life threatening.

ABPA may cause problems with asthma control. Repeated episodes of ABPA may cause widespread bronchiectasis and resultant chronic fibrotic lung disease.

Age

The age distribution of aspergillosis is consistent with that of the various comorbid conditions with which it is associated.

Clinical

History

The 4 most common manifestations of Aspergillus lung disease (ie, ABPA, CNPA, aspergilloma, and invasive aspergillosis) have quite different clinical manifestations.

ABPA is a syndrome occurring in asthmatic persons and patients with CF that results from a hypersensitivity reaction to Aspergillus colonization of the tracheobronchial tree.

This syndrome may cause fever and pulmonary infiltrates that are unresponsive to antibacterial therapy.

Patients often have a cough and produce mucous plugs, which may form bronchial casts. They may have hemoptysis.

People with asthma who have ABPA may have poorly controlled disease and difficulty tapering off oral corticosteroids.

ABPA may occur in conjunction with allergic fungal sinusitis, with symptoms including chronic sinusitis with purulent sinus drainage.

Aspergilloma may manifest as an asymptomatic radiographic abnormality in a patient with preexisting cavitary lung disease due to sarcoidosis, tuberculosis, or other necrotizing pulmonary processes.

In patients with HIV disease, aspergilloma may occur in cystic areas resulting from prior Pneumocystis carinii pneumonia.

Of patients with aspergilloma, 40-60% experience hemoptysis, which may be massive and life threatening. Less commonly, aspergilloma


Candidiasis 6 years ago

Candidiasis or thrush is a fungal infection (mycosis) of any of the Candida species (all yeasts), of which Candida albicans is the most common.[1][2] Also commonly referred to as a yeast infection, candidiasis is also technically known as candidosis, moniliasis, and oidiomycosis.[3]:308

Candidiasis encompasses infections that range from superficial, such as oral thrush and vaginitis, to systemic and potentially life-threatening diseases. Candida infections of the latter category are also referred to as candidemia and are usually confined to severely immunocompromised persons, such as cancer, transplant, and AIDS patients.

Superficial infections of skin and mucosal membranes by Candida causing local inflammation and discomfort are common in many human populations.[2][4][5] While clearly attributable to the presence of the opportunistic pathogens of the genus Candida, candidiasis describes a number of different disease syndromes that often differ in their causes and outcomes

Candidiasis may be divided into the following types:[3]:308-311

Oral candidiasis (Thrush)

Perlèche (Angular cheilitis)

Candidal vulvovaginitis

Candidal intertrigo

Diaper candidiasis

Congenital cutaneous candidiasis

Perianal candidiasis

Candidal paronychia

Erosio interdigitalis blastomycetica

Chronic mucocutaneous candidiasis

Systemic candidiasis

Candidid

Antibiotic candidiasis (Iatrogenic candidiasis)

[edit]Signs and symptoms

Most candidial infections are treatable and result in minimal complications such as redness, itching and discomfort, though complication may be severe or fatal if left untreated in certain populations. In immunocompetent persons, candidiasis is usually a very localized infection of the skin or mucosal membranes, including the oral cavity (thrush), the pharynx or esophagus, the gastrointestinal tract, the urinary bladder, or the genitalia (vagina, penis).[1]

Candidiasis is a very common cause of vaginal irritation, or vaginitis, and can also occur on the male genitals. In immunocompromised patients, Candida infections can affect the esophagus with the potential of becoming systemic, causing a much more serious condition, a fungemia called candidemia.[4][5]

Children, mostly between the ages of three and nine years of age, can be affected by chronic mouth yeast infections, normally seen around the mouth as white patches. However, this is not a common condition.[citation needed]

Symptoms of candidiasis may vary depending on the area affected. Infection of the vagina or vulva may cause severe itching, burning, soreness, irritation, and a whitish or whitish-gray cottage cheese-like discharge, often with a curd-like appearance. These symptoms are also present in the more common bacterial vaginosis.[citation needed] In a 2002 study published in the Journal of Obstetrics and Gynecology, only 33 percent of women who were self-treating for a yeast infection actually had a yeast infection, while most had either bacterial vaginosis or a mixed-type infection.[6] Symptoms of infection of the male genitalia include red patchy sores near the head of the penis or on the foreskin, severe itching, or a burning sensation. Candidiasis of the penis can also have a white discharge, although uncommon.[citation needed] However, having no symptoms at all is common, and a more severe form of the symptoms may emerge later.[citation needed]

[edit]Causes

See also: Candida albicans

Candida yeasts are commonly present in humans, and their growth is normally limited by the human immune system and by other microorganisms, such as bacteria occupying the same locations (niches) in the human body.[7]

C. albicans was isolated from the vaginas of 19% of apparently healthy women, i.e., those that experienced few or no symptoms of infection. External use of detergents or douches or internal disturbances (hormonal or physiological) can perturb the normal vaginal flora, consisting of lactic acid bacteria, such as lactobacilli, and result in an overgrowth of Candida cells causing symptoms of infection, such as local inflammation.[8] Pregnancy and the use of oral contraceptives have been reported as risk factors,[9] while the roles of engaging in vaginal sex immediately and without cleansing after anal sex and using lubricants containing glycerin remain controversial.[citation needed] Diabetes mellitus and the use of anti-bacterial antibiotics are also linked to an increased incidence of yeast infections.[9] Diet has been found to affect rates of symptomatic Candidiases in some animal infection models,[10] and hormone replacement therapy and infertility treatments may also be predisposing factors.[11] Wearing wet swimwear for long periods of time is also believed to be a risk factor.[12]

A weakened or undeveloped immune system or metabolic illnesses such as diabetes are significant predisposing factors of candidiasis.[13] Diseases or conditions linked to candidiasis include HIV/AIDS, mononucleosis, cancer treatments, steroids, stress, and nutrient deficiency. Almost 15% of people with weakened immune systems develop a systemic illness caused by Candida species.[citation needed] In extreme cases, these superficial infections of the skin or mucous membranes may enter into the bloodstream and cause systemic Candida infections.

In penile candidiasis, the causes include sexual intercourse with an infected individual, low immunity, antibiotics, and diabetes. Male genital yeast infection is less common, and incidence of infection is only a fraction of that in women; however, yeast infection on the penis from direct contact via sexual intercourse with an infected partner is not uncommon.[14]

Candida species are frequently part of the human body's normal oral and intestinal flora. Treatment with antibiotics can lead to eliminating the yeast's natural competitors for resources, and increase the severity of the condition[citation needed]. In the western hemisphere approximately 75% of females are affected at some time in their life.

Diagnosis

Micrograph of esophageal candidiasis. Biopsy specimen; PAS stain.

Diagnosis of a yeast infection is done either via microscopic examination or culturing.

For identification by light microscopy, a scraping or swab of the affected area is placed on a microscope slide. A single drop of 10% potassium hydroxide (KOH) solution is then added to the specimen. The KOH dissolves the skin cells but leaves the Candida cells intact, permitting visualization of pseudohyphae and budding yeast cells typical of many Candida species.

For the culturing method, a sterile swab is rubbed on the infected skin surface. The swab is then streaked on a culture medium. The culture is incubated at 37 °C for several days, to allow development of yeast or bacterial colonies. The characteristics (such as morphology and colour) of the colonies may allow initial diagnosis of the organism that is causing disease symptoms.

[edit]Treatment

In clinical settings, candidiasis is commonly treated with antimycotics—the antifungal drugs commonly used to treat candidiasis are topical clotrimazole, topical nystatin, fluconazole, and topical ketoconazole.

For example, a one-time dose of fluconazole (as Diflucan 150-mg tablet taken orally) has been reported as being 90% effective in treating a vaginal yeast infection.[15] (Care should be taken by people who have allergic reactions to azole group of medicines; this medicine has different levels of contradictory reactions with other medicines as well. ) This dose is only effective for vaginal yeast infections, and other types of yeast infections may require different treatments. In severe infections (generally in hospitalized patients), amphotericin B, caspofungin, or voriconazole may be used. Local treatment may include vaginal suppositories or medicated douches. Gentian violet can be used for breastfeeding thrush, but when used in large quantities it can cause mouth and throat ulcerations in nursing babies, and has been linked to mouth cancer in humans and to cancer in the digestive tract of other animals.[16]

C. albicans can develop resistance to antimycotic drugs,[17] such as fluconazole, one of the drugs that is often used to treat candidiasis. Recu


systemic fungal diseases 6 years ago

Fungal infections are often classified as opportunistic or primary. Opportunistic infections are those that develop mainly in immunocompromised hosts; primary infections can develop in immunocompetent hosts. Fungal infections can be systemic or local. Local fungal infections typically involve the skin (see Fungal Skin Infections), mouth (see Approach to Dental and Oral Symptoms: Stomatitis), and vagina (see Vaginitis and Pelvic Inflammatory Disease (PID): Candidal Vaginitis) and may occur in normal or immunocompromised hosts.

Opportunistic fungal infections: Many fungi are opportunists and are usually not pathogenic except in an immunocompromised host. Causes of immunocompromise include AIDS, azotemia, diabetes mellitus, bronchiectasis, emphysema, TB, lymphoma, leukemia, other hematologic cancers, burns, and therapy with corticosteroids, immunosuppressants, or antimetabolites. Patients who spend more than several days in an ICU can become compromised because of medical procedures, underlying disorders, and undernutrition.

Typical opportunistic systemic fungal infections (mycoses) include

Candidiasis

Aspergillosis

Mucormycosis (zygomycosis)

Fusariosis

Systemic mycoses affecting severely immunocompromised patients often manifest acutely with rapidly progressive pneumonia, fungemia, or manifestations of extrapulmonary dissemination.

Primary fungal infections: These infections usually result from inhalation of fungal spores, which can cause a localized pneumonia as the primary manifestation of infection. In immunocompetent patients, systemic mycoses typically have a chronic course; disseminated mycoses with pneumonia and septicemia are rare and, if lung lesions develop, usually progress slowly. Months may elapse before medical attention is sought or a diagnosis is made. Symptoms are rarely intense in such chronic mycoses, but fever, chills, night sweats, anorexia, weight loss, malaise, and depression may occur. Various organs may be infected, causing symptoms and dysfunction.

Primary fungal infections may have a characteristic geographic distribution. This is especially true for the endemic mycoses caused by certain dimorphic fungi. For example,

Coccidioidomycosis: Confined primarily to the southwestern US and northern Mexico

Histoplasmosis: Occurring primarily in the eastern and Midwestern US

Blastomycosis: Confined to North America and Africa

Paracoccidioidomycosis (formerly, South American blastomycosis): Confined to that continent

However, travelers can manifest disease any time after returning from endemic areas.

When fungi disseminate from a primary focus in the lung, the manifestations may be characteristic, as for the following:

Cryptococcosis: Usually, chronic meningitis

Progressive disseminated histoplasmosis: Generalized involvement of the reticuloendothelial system (liver, spleen, bone marrow)

Blastomycosis: Single or multiple skin lesions or involvement of the prostate

Diagnosis

Cultures and stains (typically for fungi and mycobacteria)

Sometimes serologic tests (mainly for Aspergillus, Candida, Coccidioides, and Cryptococcus)

Rarely biopsy

If clinicians suspect an acute or a chronic primary fungal infection, they should obtain a detailed travel and residential history to determine whether patients may have been exposed to certain endemic mycoses, perhaps years previously.

Pulmonary fungal infections must be distinguished from TB, tumors, and chronic pneumonias caused by nonfungal organisms. Specimens are obtained for fungal and acid-fast bacilli culture and histopathology. Sputum samples may be adequate, but occasionally bronchoalveolar lavage, transthoracic needle biopsy, or even surgery may be required to obtain an acceptable specimen.

Fungi that cause primary systemic infections are readily recognized by their histopathologic appearance. However, identifying the specific fungus may be difficult and usually requires fungal culture. The clinical significance of positive sputum cultures may be unclear if they show commensal organisms (eg, Candida albicans) or fungi ubiquitous in the environment (eg, Aspergillus sp). Therefore, evidence of tissue invasion is required for a diagnosis of candidiasis, aspergillosis, or other opportunistic fungal infections (eg, fusariosis, pseudallescheriasis) because these fungi may not be causing the symptoms.

Serologic tests may be used to check for many systemic mycoses if culture and histopathology are unavailable or unrevealing, although few provide definitive diagnoses. Particularly useful tests include the following:

Measurement of organism-specific antigens, most notably from Cryptococcus neoformans, Histoplasma capsulatum, and Aspergillus sp

Measurement of histoplasmin in urine to diagnose histoplasmosis

Complement fixation assays and newer enzyme immunoassays for anticoccidioidal antibodies, which are satisfactorily specific and do not require proof of rising levels (high titers confirm the diagnosis and indicate high risk of extrapulmonary dissemination)

Detection of antibodies in CSF in patients with chronic meningitis to confirm the diagnosis

Most other tests for antifungal antibodies have low sensitivity, specificity, or both and, because measurement of acute and convalescent titers is required, cannot be used to guide initial therapy.


Actinomycosis 6 years ago

Actinomycosis is an infection caused by a bacterium called Actinomyces israelii (A. israelii).

Description of Actinomycosis

Actinomycosis (also known as Rivalta disease, big jaw, clams, lumpy jaw or wooden tongue) is an infection, commonly of the face and neck, that produces abscesses (collections of pus) and open-draining sinuses (tracts in the skin).

Actinomycosis is caused by a bacterium called Actinomyces israelii (A. israelii). It occurs normally in the mouth and tonsils. This bacterium may cause infection when it is introduced into the soft tissues by trauma, surgery or another infection. Once in the tissues, it may form an abscess that develops into a hard red to reddish purple lump. When the abscess breaks through the skin, it forms pus-discharging lesions.

There are at least five (5) types of actinomycosis:

Cervicofacial actinomycosis occurs in the mouth, neck and head region. The bacterium enters through the periodontium (the tissues surrounding and supporting the teeth), soft tissue wounds or salivary gland ducts. It is believed that infection may arise after a tooth extraction, from tooth decay or abscess, as a part of periodontal disease, from a nonpenetrating jaw trauma, poor dental hygiene, or mucosal injuries.

Cervicofacial actinomycosis develops slowly. The area becomes hard, the overlying skin becomes reddish and swelling appears in the mouth and neck. Abscesses develop within and eventually drain to the surface where sulfur granules (yellowish gray masses), masses of filamentous (long, threadlike structure) organisms, may be found in the pus.

Thoracic actinomycosis involves the lungs and mediastinum (region between the two lungs). The disease begins with fever, cough, and sputum production. The patient becomes weak, loses weight and may have night sweats and shortness of breath. Multiple sinuses may extend through the chest wall, to the heart, or into the abdominal cavity. Ribs may be involved. Occasionally, cervicofacial and thoracic disease may result in nervous system complications - most commonly brain abscesses or meningitis.

Abdominal actinomycosis are mostly preceded by surgery such as laparotomy for acute appendicitis, perforated ulcer, or gallbladder inflammation. Infection usually begins in the gastrointestinal tract and spreads to the abdominal wall. Spiking fever and chills, intestinal colic, vomiting, and weight loss, a palpable (can be felt) mass and an external sinus are evident in this type of actinomycosis. This type of actinomycosis may be mistaken for Crohn's disease, malignancy, tuberculosis, Amebiasis (an infection of the intestine or liver), or chronic appendicitis.

Pelvic actinomycosis affects the women's pelvic area and may cause lower abdominal pain, fever, and bleeding between menstrual periods. This form of the infection has been associated with the use of IUDs (intra-uterine devices) that do not contain copper.

Generalized actinomycosis may involve the skin, brain, liver and urogenital system

Diagnosis of Actinomycosis

Actinomycosis may be hard to diagnose at onset. There are lab tests that may isolate actinomyces in pus or tissue specimens.

Treatment of Actinomycosis

Treatment for actinomycosis is long term, generally with up to one month of intravenous penicillin G, followed by weeks to months of penicillin taken by mouth. Additionally, surgical excision and drainage of abscesses may be necessary.

Questions To Ask Your Doctor About Actinomycosis

How serious is this?

How extensive is the damage to the tissue at this point?

What type of treatment will you be recommending?

How long will the treatment be?

How expensive will it be?

How effective is this treatment for a condition such as this?

Will you be recommending surgery?


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D.Virtual.Doctor 6 years ago from Europe Author

Thank you all. I have gone through your websites and they are all awesome and self explanatory and as well very comprehensive about these diseases. What I do not understand is; is someone from wikipedia posting the comments linked to wikipedia or a different individual does this and adds the wikipedia link? Well, which ever way, both hub and comments are all educative.

As for mayor clinic, I really do appreciate the support here, but permit me to complete your comment by copying the remaining part of Histoplasmosis and paste it here, as you copied just a part of it.

Histoplasmosis is caused by the reproductive cells (spores) of the fungus Histoplasma capsulatum. The spores are extremely light and float into the air when dirt or other contaminated material is disturbed.

Histoplasmosis and your lungs

Because the spores of H. capsulatum are microscopic in size, they can easily enter your lungs and settle in the small air sacs. There, the spores are trapped by macrophages — immune system cells that attack foreign organisms. The macrophages carry the spores to lymph nodes in your chest, where they continue to multiply. This may lead to inflammation, scarring and calcium deposits. In cases of heavy infection, the lymph nodes may become so enlarged that they obstruct your esophagus or your lungs' airways.

Most often, however, you're not likely to have noticeable signs and symptoms, and the infection clears on its own without treatment. But if your immune system isn't able to eliminate the spores, they can enter your bloodstream and travel to other parts of your body. In that case, you may develop a variety of severe problems that can be fatal if not diagnosed and treated quickly.

Even if you've had histoplasmosis in the past, you can still get the infection again. However, if you contract histoplasmosis again, the illness will likely be milder than the initial infection.

Where the fungus lives

Histoplasma capsulatum is primarily found in the temperate regions of the world. It's very common in the Ohio and Mississippi river valleys of North America, where many people have already been exposed to the fungus.

It thrives in damp soil that's rich in organic material, especially the droppings from birds and bats. For that reason, it's particularly common in chicken and pigeon coops, old barns, caves and parks.

Birds themselves aren't infected with histoplasmosis — their body temperature is too high — but they can carry H. capsulatum on their feathers, and their droppings support the growth of the fungus. Birds commonly kept as pets, such as canaries and parakeets, aren't affected. And although bats, which have a lower body temperature, can be infected, you can't get histoplasmosis directly from a bat or from another person.

Anyone exposed to H. capsulatum is likely to become infected. People who inhale a huge number of spores — those who work with heavily infected soil or have close contact with bat droppings, for example — are more likely to develop signs and symptoms.

Most at risk of infection

Farmers

Pest control workers

Poultry keepers, especially when cleaning chicken coops, pigeon roosts, and bat-infested barns or lofts

Construction workers, especially those who work around old buildings with roosting birds

Roofers

Landscapers and gardeners

People involved in building roads and maintaining bridges

People who monitor bird populations or who have contact with bats or bat caves

Archeologists

Geologists

Most at risk of severe infection

Because their immune systems are weakened, the following people are most likely to develop disseminated histoplasmosis, the more serious form of the disease:

Infants and very young children

Older adults

People with HIV or AIDS

People receiving chemotherapy or long-term treatment with corticosteroid drugs such as prednisone

People who have had organ transplants and are taking anti-rejection medications

Histoplasmosis can cause a number of serious complications, even in otherwise healthy people. For infants, older adults and people with compromised immune systems, the potential problems are often life-threatening.

Enlarged lymph nodes. Most people with histoplasmosis have some involvement with the lymph nodes in the central part of the chest. This region lies between your lungs and contains the trachea, esophagus, heart and many small lymph nodes. In a small percentage of people with acute pulmonary histoplasmosis, the lymph nodes may enlarge enough to obstruct the airways or esophagus, making it difficult to breathe or swallow. Sometimes the pulmonary arteries and veins — the large blood vessels in the lungs — also may be blocked.

Severe scarring. A rare, severe late complication of histoplasmosis called fibrosing mediastinitis occurs when scar tissue from lymph nodes in the chest invades and blocks adjoining structures, especially the esophagus and large blood vessels. Signs and symptoms, such as a cough that brings up blood, chest pain and breathlessness, usually don't appear until the disease is quite advanced. When structures in both lungs are affected, fibrosing mediastinitis can be life-threatening.

Heart problems. Inflammation of the pericardium, the sac that surrounds your heart, is called pericarditis. Normally, this sac contains a small amount of fluid. But when the pericardium becomes inflamed, the amount of fluid in the sac may increase, which can interfere with the heart's ability to pump blood efficiently. Pericarditis that occurs as a complication of histoplasmosis usually results from inflammation in nearby lymph nodes, rather than from actual infection of the pericardium itself.

Arthritis. Joint inflammation, sometimes in conjunction with a skin rash (erythema nodosum), is a common complication of acute pulmonary histoplasmosis. Women are far more likely to be affected than are men.

Adrenal insufficiency. Your adrenal glands, which are located just above your kidneys, produce hormones that give instructions to virtually every organ and tissue in your body. A histoplasmosis infection can cause destruction of the adrenal glands. When the glands don't provide enough of these hormones, serious, and potentially life-threatening, problems can occur. Untreated adrenal insufficiency (Addison's disease) is fatal.

Meningitis. An infection and inflammation of the membranes (meninges) and fluid (cerebrospinal fluid) surrounding your brain and spinal cord, meningitis can be life-threatening. As a complication of histoplasmosis, meningitis occurs primarily in people with compromised immune systems, although it occasionally develops in otherwise healthy people.

You're likely to start by first seeing your family doctor or a general practitioner. However, you may then be referred to a doctor who specializes in infectious diseases. Depending on your symptoms and the severity of your infection, you may also see other doctors, such as a lung specialist (pulmonologist) or a heart specialist (cardiologist).

Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.

Write down key personal information, including any possible exposure to areas with numerous birds or bats.

Make a list of all medications, vitamins and supplements that you're taking.

Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For histoplasmosis, some basic questions to ask your doctor include:

What's the most likely cause of my symptoms?

How could I have gotten this infection?

What kinds of tests do I need? Do these tests require any special preparation?

Will this infection get better on its own or do I need treatment?

What treatments are available, and which do you recommend?

What types of side effects can I expect from treatment?

Are there any alternatives to the primary approach that you're suggesting?

I have other health conditions. How can


Oxford University 6 years ago

Bacteria are the most common causes of pneumonia, but these infections can also be caused by other microbial organisms. It is often impossible to identify the specific culprit. Many bacteria are categorized by the staining procedure used to visualize bacteria under a microscope. The stains determine if they are gram-negative or gram-positive bacteria. This gives the physician an idea of the severity of the pneumonia and how to treat it.

Gram-Positive Bacteria.These bacteria appear blue on the stain. The following are common gram-positive bacteria:

• The most common cause of pneumonia is the gram-positive bacterium Streptococcus pneumoniae(also called S. pneumoniae orpneumococcal pneumonia ). It was thought to cause 95% of community-acquired bacterial infection, but research now indicates it is far less, accounting for about half of all cases.

• Staphylococcus aureus , the other major gram-positive bacterium responsible for pneumonia, accounts for about 10% of bacterial cases. It is one of the main causes of pneumonia that occurs in the hospital (nosocomial pneumonia). It is uncommon in healthy adults but can develop about five days after viral influenza, usually in susceptible individuals, such as people with weakened immune systems, very young children, hospitalized patients.

• Streptococcus pyogenes or Group A Streptococcus.


Edinburgh University 6 years ago

Gram-Negative Bacteria. These bacteria stain pink . Gram negative bacteria are common infectious agents in hospitalized or nursing home patients, children with cystic fibrosis, and people with chronic lung conditions.

• The most common gram-negative species causing pneumonia is Haemophilus.

• Klebsiella pneumoniae may be responsible for pneumonia in alcoholics and in other people who are physically debilitated

• Pseudomonas aeruginosa is a major cause of pneumonia that occurs in the hospital (nosocomial pneumonia).

• Moraxella catarrhalis is found in everyone's nasal and oral passages. Experts have identified this bacteria as a cause of certain pneumonias, particularly in people with lung problems, such as asthma or emphysema.

• Neisseria meningitidis is one of the most common causes of meningitis (central nervous system infection), but the organism has been reported in pneumonia, particularly in epidemics of military recruits.

• Other gram-negative bacteria that cause pneumonia include E. coli (a cause in newborns),Proteus (found in several damaged lung tissue), and Enterobacter.


University of Dundee 6 years ago

Atypical Pneumonia

Atypical pneumonias are generally caused by tiny nonbacterial organisms called MycoplasmaorChlamydia pneumoniae and produce mild symptoms with a dry cough. Hospitalization is uncommon with pneumonia from these organisms.

• Mycoplasma pneumoniae ( M. pneumoniae ) is the most common nonbacterial pneumonia. The condition is usually mild and is commonly known as walking pneumonia. Estimates of its prevalence in community acquired pneumonias in adults range from 1.9% to 30%. In one study, it accounted for over a third of pneumonia cases in children.

• Another small non-bacterial organism, Chlamydia pneumoniae ( C. pneumoniae ), is now thought to cause 10% of all community-acquired cases of pneumonia. It is most common in children, where it is usually mild. In one study, it was the cause of 14% of cases in a group of children with pneumonia.

• Legionnaire's disease, first diagnosed in 1976, is caused by the organism Legionella pneumophila, and is acquired by breathing droplets of contaminated water.


University of Cambridge 6 years ago

Viruses

Viruses that can cause or lead to pneumonia include influenza, respiratory syncytial virus (RSV), herpes simplex virus, varicella-zoster (the cause of chicken pox), and adenovirus. Outbreaks usually occur between January and April.

• Influenza is associated with pneumonia directly or by altering the mucous blanket and making a person susceptible to bacterial pneumonia.

• Respiratory syncytial virus (RSV) is a major cause of pneumonia in infants and people with damaged immune systems. Studies indicate that RSV pneumonia may also be more common than previously thought in adults, especially the elderly.

• Adenoviruses have been implicated in about 10% of childhood pneumonia.

• In adults, herpes simplex virus, adenoviruses, and varicella-zoster (the cause of chicken pox) are generally causes of pneumonia only in people with impaired immune systems.


University of Manchester 6 years ago

Aspiration Pneumonia and Anaerobic Bacteria.

The mouth harbors a mixture of bacteria that is harmless in its normal location but can cause a serious condition called aspiration pneumonia if it reaches the lung. This can happen during periods of altered consciousness, often when a patient is affected by drugs or alcohol, or after head injury or anesthesia. In such cases, the gag reflex is diminished, allowing these bacteria to enter the airways to the lung. These organisms are generally different from the usual microbes that enter the lung by inhalation. Many are often anaerobic (meaning they can live in the absence of oxygen).

Opportunistic Pneumonia.

Impaired immunity leaves patients vulnerable to serious, even life-threatening, pneumonias known as opportunistic pneumonias. They are caused by microbes that are harmless to people with healthy immune systems. Infecting organisms include the following: Pneumocystis carinii, Fungi, such as Mycobacterium avium.Viruses, such as cytomegalovirus (CMV). AIDS is a major risk factor for opportunistic pneumonia, as are other conditions including lymphomas, leukemias, and other cancers. Long-term use of corticosteroids and other medications that suppress the immune system increase the susceptibility to these pneumonias.

Incubation:The incubation period for pneumonia varies, depending on the type of virus or bacteria causing the infection. Some common incubation periods are: respiratory syncytial virus, 4 to 6 days; influenza, 18 to 72 hours.

Duration:With treatment, most types of bacterial pneumonia can be cured within 1 to 2 weeks. Viral pneumonia may last longer. Mycoplasmal pneumonia may take 4 to 6 weeks to resolve completely.


UCL Medical school 6 years ago

ACUTE PNEUMONIA

Clinical Presentation

Typical symptoms include cough, fever, and sputum production, usually developing over days and sometimes accompanied by pleurisy. Physical examination may detect tachypnea and signs of consolidation, such as crackles with bronchial breath sounds. This syndrome is commonly caused by bacteria, such as S. pneumoniae and H. influenzae.

• Non-specific clinical features:

• fever, lethargy, anorexia

• meningism (especially upper lobe)

• abdominal pain (especially lower lobe)

• Respiratory manifestations:

• tachypnoea, respiratory distress, grunt

• cyanosis

• localised auscultatory signs

• cough absent unless airway involvement

• associated effusions and pneumatoceles (especially Staph aureus).

Diagnosis

• Clinical features and chest X-ray:

• may help distinguish viral from bacterial.

• Identification of responsible organisms:

• Viral

• nasopharyngeal aspirate (immunofluorescence and culture)

• serology: not useful in babies; useful in older children.

• Bacterial

• blood culture

• pleural fluid culture

• lung aspiration

• urinary or pleural fluid antigen.

• Atypical

• serology/cold agglutinins.


Imperial College, London 6 years ago

Defining Pneumonia by Locations in the Lung

Pneumonia is sometimes defined in one of two ways according to its distribution in the lung:

• Lobar Pneumonia (occurs in one lobe of the lung).

• Bronchopneumonia (tends to be patchy).

Defining Pneumonia by Origin of Infection

Pneumonia is often classified into two categories that may help predict the organisms that are the most likely culprits.

• Community-acquired (pneumonia contracted outside the hospital). Pneumonia in this setting often follows a viral respiratory infection.

• Hospital-acquired pneumonia. Pneumonia that is contracted within the hospital is callednosocomial pneumonia. Hospital patients are particularly vulnerable to gram-negative bacteria and staphylococci, which can be very dangerous.


University of Arbedeen 6 years ago

Disease Process Leading to Pneumonia

Infectious agents reach the lungs and cause pneumonia through different routes:

• Most often, organisms that cause pneumonia enter the lungs after being inhaled into the airways.

• Sometimes the normally harmless bacteria present in the mouth may be aspirated into the lungs, usually if the gag reflex is suppressed.

• Pneumonia may also be caused from infections that spread to the lungs through the bloodstream from other organs.

Under normal circumstances, however, the airways that take air in and pass through the upper part of the body have very effective mechanisms that protect the lung from infection by bacteria and other microbes.

Bacteria or other infectious agents that evade the airway defense system are attacked in the alveolar sacs by defenders from the body's immune system, particularly macrophages, large white blood cells that literally eat foreign particles.

These strong defense systems normally keep the lung sterile. If these defenses are weakened or damaged, however, bacteria or other organisms, such as viruses, fungi, and parasites, can gain the upper hand, producing pneumonia.

Contagiousness:The viruses and bacteria that cause pneumonia are contagious and are usually found in fluid from the mouth or nose of an infected person. Illness can spread when an infected person coughs or sneezes on a person, by sharing drinking glasses and eating utensils, and when a person touches the used tissues or handkerchiefs of an infected person.

Outlook for High-Risk Individuals

Severity varies widely depending on individual factors, including the following:

• Hospitalized Patients. For patients who require hospitalization for pneumonia, the mortality rate is between 10% and 25%. If pneumonia develops in patients already hospitalized for other conditions, the mortality rates are higher. They range from 50% to 70% and are greater in women than in men.

• Very Young Children. About 20% of stillborn and very early infant mortality deaths are due to pneumonia. Small children who develop pneumonia are at risk for developing lung problems in adulthood.

• Patients with Impaired Immune Systems. Pneumonia is particularly serious in people with impaired immune systems, particularly AIDS patients, in whom pneumonia causes about half of all deaths.

• Patients with Serious Medical Conditions. The disease is also very dangerous in people with diabetes, cirrhosis, sickle cell anemia, multiple myeloma, and in those who have had their spleens removed.


University of Leeds 6 years ago

Risk by Organisms

Lower-Risk Organisms. The following organisms usually cause pneumonias that are responsive to treatment or mild. S. Pneumonia is the most common organism and, although it can cause severe pneumonia, it is very responsive to many antibiotics. Mycoplasma andChlamydia are common causes of pneumonia in children and young adults. They are generally mild and rarely require hospitalization when they are appropriately treated, although recovery may still be prolonged. Severe and life-threatening cases are more likely to occur in elderly people with other medication conditions.

High-Risk Organisms. The following are high-risk infecting organisms that pose a particular risk for dangerous pneumonia:

• High-risk gram positive bacteria. Staphylococcus aureus. Poses a higher risk for multiple small abscesses in the lung and necrosis (tissue death).

High-risk gram-negative bacteria include the following: Pseudomonas aeruginosa. Klebsiella pneumonia.. Legionella pneumophila . Particularly virulent and can cause damage throughout the body.

Viral pneumonia is usually very mild but there are exceptions.

• Influenza pneumonia can be very serious.

• Respiratory syncytial virus (RSV) pneumonia rarely poses a danger for healthy young adults. However, between 22,000 and 44,500 children are hospitalized each year because of pneumonia from RSV and the incidence seems to be increasing.


Leicester University Medical School 6 years ago

Signs and Symptoms:

Pneumonia is a general term that refers to an infection of the lungs, which can be caused by a variety of microorganisms, including viruses, bacteria, and parasites.

Often pneumonia begins after an upper respiratory tract infection (an infection of the nose and throat). When this happens, symptoms of pneumonia begin after 2 or 3 days of a cold or sore throat.

Symptoms of pneumonia vary, depending on the age of the child and the cause of the pneumonia. Some common symptoms include: fever ,chills ,cough ,unusually rapid breathing,breathing with grunting or wheezing sounds,labored breathing that makes a child's rib muscles retract (when muscles under the rib cage or between ribs draw inward with each breath) ,vomiting ,chest pain,abdominal pain ,decreased activity,loss of appetite (in older children) or poor feeding (in infants),in extreme cases, bluish or gray color of the lips and fingernails.

Sometimes a child's only symptom is rapid breathing. Sometimes when the pneumonia is in the lower part of the lungs near the abdomen, there may be no breathing problems at all, but there may be fever and abdominal pain or vomiting.

When pneumonia is caused by bacteria, an infected child usually becomes sick relatively quickly and experiences the sudden onset of high fever and unusually rapid breathing. When pneumonia is caused by viruses, symptoms tend to appear more gradually and are often less severe than in bacterial pneumonia. Wheezing may be more common in viral pneumonia.

Some types of pneumonia cause symptoms that give important clues about which germ is causing the illness. For example, in older children and adolescents, pneumonia due toMycoplasma(also called walking pneumonia) is notorious for causing a sore throat and headache in addition to the usual symptoms of pneumonia.


Newcastle University 6 years ago

Symptoms of Common Pneumonias

General Symptoms.

• The symptoms of bacterial pneumonia develop abruptly and may include chest pain, fever, shaking, chills, shortness of breath, and rapid breathing and heart beat.

• Symptoms of pneumonia indicating a medical emergency include high fever, a rapid heart rate, low blood pressure, bluish-skin, and mental confusion.

• Coughing up sputum containing pus or blood is an indication of serious infection.

• Severe abdominal pain may accompany pneumonia occurring in the lower lobes of the lung.

• In advanced cases, the patient's skin may become bluish (cyanotic), breathing may become labored and heavy, and the patient may become confused.


University of Glasgow 6 years ago

Symptoms of Pneumonia Causes by Anaerobic Bacteria

People with pneumonia caused by anaerobic bacteria such as Bacteroides, which can produce abscesses, often have prolonged fever and productive cough, frequently showing blood in the sputum, which indicates necrosis (tissue death) in the lung. About a third of these patients experience weight loss.


Peninsula Medical School 6 years ago

Symptoms of Atypical Pneumonia

General Symptoms for Atypical Pneumonias. Atypical nonbacterial pneumonia is most commonly caused by Mycoplasma and usually appears in children and young adults.

• Symptoms progress gradually, often beginning with general flu-like symptoms, such as fatigue, fever, weakness, headache, nasal discharge, sore throat, ear ache, and stomach and intestinal distress.

• Vague pain under and around the breast bone may occur, but the severe chest pain associated with typical bacterial pneumonia is uncommon.

• Patients may experience a severe hacking cough, but it usually does not produce sputum.


King's College London, School of Medicine 6 years ago

Specific Risk Factors for Recurrent Pneumonia in Children

Certain children have a higher than normal risk for pneumonia and its recurrence. Conditions that predispose infants and small children to pneumonia include the following:

• Impaired immune system.

• Gastroesophageal reflux disorder.

• Inborn lung or heart defects.

• Abnormalities in muscle coordination in the mouth and throat.

• Asthma.

Certain genetic disorders. They include sickle-cell disease, cystic fibrosis (which causes mucus abnormalities), and Kartagener's syndrome (which results in malfunctioning cilia, the hair-like cells lining the airways).


The University of Sheffield 6 years ago

HOW IS PNEUMONIA DIAGNOSED.

In many cases of mild-to-moderate community-acquired pneumonia, the physician is able to diagnose and treat pneumonia based solely on a history and physical examination. Often, however, a diagnosis is not straightforward, particularly in hospitalized patients.


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D.Virtual.Doctor 6 years ago from Europe Author

wow! Thanks alot. Everything is moving as planned. Great comments from the various UK universities


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RNMSN 6 years ago from Tucson, Az

never mind them Dr Virtual Doctor, obviously you made an impression and there are many green eyed persons out there!

I am so bookmarking this article, my nurse friends will really learn and love to learn from it!better than going to an infection control seminar on an off day! this is a wonderful article and you need to submit it to a medical magazine or the one the CDC puts out! Its a wealth of knowledge presented in a new light and not just copied off other sites!! you did a great piece of writing her Dr D :)

you keep on "doing the Good Work" thank the Lord there are young people still coming into a service oriented profession with a service oriented work ethic!what a relief! I was beginning to feel like a dinasaur! haven't heard the term Good Work in decades! thank goodness for you and your fresh attitude and new brain and loving hands!! and thank you so much for your support of this old nurse on my hubpages by the way/ isn't often a doctor will say "way to go" to a nurse and I thank you! love to you and delete the copy and paste people/they arent worth you bothering your brain over! much love to you and yours and keep on working :)barbara b


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D.Virtual.Doctor 6 years ago from Europe Author

wooooow! Seriously, I do not know what to say, RNMSN your comment alone has added more than 600 ATP molecules to my body system. I am so grateful for this and I wish to continue this work and even work harder. Yeah, Please this is a community service and you are encouraged to share it to as many as possible. If you want, you can go to the "share" tool and click on 'print', then from there, you can download it in pdf format and save it. You then can have a copy of your own and use it anytime you want to. My sole aim is to reach out to people while studying, so that it will be part of my DNA and organelles, even when serving professionally as a medical doctor. I am so grateful and happy to read this and it is a thing of joy and pride for me. One of such comments is far better than a thousand of some one word or one phrase comments and seriously, I have been motivated. We'll keep in touch and I will definitely keep following your hubs as well. Once again, thanks a lot. Cheers!

D.Virtual.Doctor


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Eileen Hughes 6 years ago from Northam Western Australia

Wow this is very detailed thats for sure. But you lost me with the big names in the hub itself. thanks for sharing


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D.Virtual.Doctor 6 years ago from Europe Author

Thanks Eileen Hughes! I will try to make subsequent ones as simple as possible for all readers to enjoy... Its nice you came by

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