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Chapter 84. Invasive Fungal Disease

Student Questions

A 28-year-old otherwise healthy patient from Tempe, Arizona, presents with a 4-week history of complaints of fever and malaise. A chest x-ray demonstrates several small nodular lesions in both lungs and mediastinal adenopathy. The patient's clinical history is most consistent with which fungal disease?

A. Histoplasma capsulatum

B. Blastomycosis dermatitidis

C. Coccidioidomycosis immitis

D. Cryptococcus neoformans

Answer: C

Option A: Incorrect. This fungal disease is endemic to the Mississippi, River Basin and areas surrounding the Great Lakes.

Option B: Incorrect. This fungal disease is endemic to the Mississippi, River Basin and areas surrounding the Great Lakes.

Option C: Correct. This fungal disease is endemic to the desert Southwestern states such as Arizona.

Option D: Incorrect. This patient has no predisposing immunosuppressive risk factors for developing severe infection with Cryptococcus neoformans (ie, severe lymphocytopenia).

A 39-year-old patient with acquired immunodeficiency syndrome presents to the clinic with confusion and headache. The CD4 count was 23 × 103/μL and HIV RNA was 211,000 copies/mL. The patient is taking trimethoprim-sulfamethoxazole and azithromycin and plans to start antiretroviral therapy in the coming week. The patient's clinical history is most consistent with which fungal disease?

A. Candida species

B. Cryptococcus spp.

C. Aspergillus spp.

D. Mucormycosis

Answer: B

Option A: Incorrect. Candida meningitis is uncommon with the exception of premature neonates in the intensive care unit.

Option B: Correct. The patient has a risk factor for cryptococcosis (severe lymphopenia, advanced AIDS) and is presenting with encephalitis-like symptoms.

Option C: Incorrect. Aspergillosis uncommon in AIDS patients who are not persistently neutropenic.

Option D: Incorrect. Mucormycosis is more common encountered only in patients who are severely immunosuppressed following transplantation or chemotherapy for hematological malignancies, or in patients with diabetic ketoacidosis.

A 38-year-old woman is admitted to the surgical intensive care unit with signs of systemic inflammatory response syndrome (SIRS) following an emergency exploratory laparotomy after a motor vehicle accident. The patient is started on broad-spectrum antibiotics but has remained persistently febrile. The patient's clinical history is most consistent with which fungal disease?

A. Candida species

B. Cryptococcus spp.

C. Aspergillus spp.

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