Fungal Pneumonias
This is the only endemic fungal infection that you always treat
Blastomycosis
This is the most common pathogen causing NTM pulmonary infections?
Mycobacterium Avium Complex (MAC)
Other than the hallmark "barking cough", this physical exam finding is commonly found in croup
Inspiratory stridor
This is the hallmark symptom that an adult patient with pertussis will state while taking their history
"Cough so hard I throw up"
Little miss meemaw is feeling more tired than usual after receiving her yearly flu shot.
What type of vaccine is most likely causing her symptoms?
Live vaccine
A 49-year-old man from Ohio presents with fever, cough, and chest pain after cleaning his barn. Chest imaging reveals patchy infiltrates. Fungal antigen detection is positive.
What is the treatment for the most likely pathogen?
Itraconazole
(Amphotericin B for severe cases)
What is the most common population of people (appearance, age, etc.) infected with nontuberculous mycobacterium?
Older, slender, non-smoking females
A 2-year-old boy presents with hoarseness, inspiratory stridor, and a “barking” cough that began after 2 days of nasal congestion. He is afebrile and in mild distress. CXR reveals a steeple sign from subglottic narrowing.
What is the most likely causative organism?
Parainfluenza Type 1
This is the first line treatment for Bordatella pertussis infection
Macrolides
Non-live vaccines are injected intramuscularly. Why is this?
More dendritic cells within muscle tissue, causing a more effective immune response
An HIV-positive man presents with progressive dyspnea and cough. CXR shows bilateral perihilar infiltrates with a “ground-glass” pattern. ABG confirms hypoxemia.
What is the treatment of choice for this patient?
Trimethoprim-Sulfamethoxazole (Bactrim)
NTM infections are commonly seen in patients with these comorbid lung conditions
(Be specific)
Emphysema and bronchiectasis (structural lung diseases)
A 3-year-old girl develops acute inspiratory stridor and a barking cough at night but is asymptomatic the following morning. She has a history of seasonal allergies.
What is the appropriate treatment for this patient?
No pharmaceutical treatment; comfort the child and administer humidified air
What phase of pertussis has the highest risk of transmission?
Catarrhal
This type of vaccine is no longer widely used as it does not provoke cellular (adaptive) immunity and only stimulates B cells
Unconjugated polysaccharides
This manifestation of Aspergillosis is seen most commonly in immunocompetent individuals with chronic lung disease
Aspergilloma ("Fungal Ball")
A 72-year-old slender, non-smoking woman presents with chronic cough, sputum production, and fatigue for several months. HRCT reveals bronchiectasis and multiple small nodules in the right middle lobe and lingula. Sputum culture grows acid-fast bacilli that are negative for M. tuberculosis.
What is the treatment regimen for this condition?
3 drug regimen of macrolides, aminoglycosides, and rifampin for at least 12 months
A 4-year-old child presents with fever, toxic appearance, and respiratory distress. The cough sounds coarse rather than barking. CXR shows irregular tracheal narrowing with membranes.
What is the appropriate treatment for this patient?
Hospitalization and IV abx
This age group is at highest risk of death from pertussis infection
Infants < 6 months old
Children vaccinated prior to turning 1 year old will most likely need to be vaccinated again. Why is this?
Antibody responses created before 12 months of age drop quickly, likely due to limited survival of plasma cells in their bone marrow
A 52-year-old man with AIDS presents with cough, fever, and headache for two weeks. Physical exam shows mild nuchal rigidity. CXR shows patchy infiltrates.
Unlike other fungal pneumonias, this pathogen is diagnosed by fungal culture from...
CSF and/or blood
A 58-year-old female presents with fatigue, cough, and fever unresponsive to empiric antibiotics. CXR shows a single dominant upper-lobe cavity. Sputum smears show acid-fast bacilli, but cultures are negative for M. tuberculosis.
What finding listed above is an indication that this NTM infection should be treated?
Cavitary lesion in the upper lobe
A 15-month-old presents with seal-like cough and mild stridor. Parents report a low-grade fever and 3 days of nasal congestion before symptoms started. He is treated with dexamethasone and improves within 24 hours.
How long does croup typically persist?
3-7 days
A 7-year-old girl presents with 2 weeks of severe, repetitive coughing fits followed by vomiting. Parents note she “coughs so hard she turns red.” She was vaccinated as a child but never received a booster.
What testing can be done to confirm diagnosis?
Nasopharyngeal/throat culture, PCR, and/or serology
(Bonus point: what are we required to do as providers once we confirm this specific diagnosis)
Aluminum salts are a common addition to vaccines due to their ability to boost the immune response.
What type of excipient are aluminum salts?
Adjuvants