dxtxpx
Forum Guru
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Posts: 1,233
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33 yr female was diagnosed with an HIV infection two years ago and had undergone aggressive chemotherapy. Her CD4+ T cell count had dropped below 200 cells/mm3. She developed pneumonia infection that resulted in the sudden onset of fever, dyspnea, coughs and tachypnea.Xray revealed diffuse interstitial pneumonia. Bronchial lavage specimens did not grow bacteria. Other tests ruled out viral pneumonia
I) IC state of pt makes her a prime candidate for which of the respiratory pathogens
a) Candida albicans
b) Aspergillus fumigatus
c) Pneumocystis carnii
d) Histoplasma capsulatum
e) Blastomyces dermatitidis
II) Inhalation of organism into the lungs intially causes
a) cell necrosis
b) massive exfoliation of epithelial cells
c) inflammation and frothy exudate that blocks respiration
d) secondary bacterial infections
e) granuloma formation
III) Lab dx is also based on observation of which of the following silver-stained bronchial lavage specimens
a) mycelia
b) hyphae
c) cysts
d) spores
e) pigmented microcolonies
IV) Drug of choice in treating infection include
a) TMP-SMX
b) penicillin
c) Amphotericin B
d) sodium stibogluconate
e) cloroquine
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| peekay
Forum Guru
Topics: 102
Posts: 588
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pneumo carinni, exfoliation of epithelial linning and pigmented colonies and trimetoprimand sulfa is theTx
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| asmi
Forum Hero
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Posts: 4,609
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yes i agree with peekay but i think for 3. C should be the answer.
and just to add to it..if a pt is allergic to TMP-SMX then pentamidine is the drug of choice.
http://www.cdfound.to.it/HTML/lung.htm#pc6 good slides :wink:
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| dxtxpx
Forum Guru
Topics: 259
Posts: 1,233
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correct answers are
I) c [PCP]
II) c [inflam and a frothy exudate that blocks respiration]
III) c [cysts]
IV) a [TMP-SMX)
Immunocompromised pts are candidates for infection by fungus PCP. Cysts are inhaled in to lings where they germinate and releae 2-8 trophozoites. Each trophozoite eventually develops into a cyst. Antigens produced by the organism intiate an inflammatory response resulting in production of frothy mucucs material which interferes with normal oxygen transport, thus the observed difficulty in breathing.
A bronchial lavage or sputum specimen from a pt usually contains numerous cysts which are easily recognized in silver-stained preps or Giemsa stained smears. The cysts are nearly spherical but have flattened sides and usually appear in small clumps.
The fatality rate in untreated PCP approaches 100%. Vigorous therapy with TMP-SMX reduces the rate to 50%. The drugs inhibit parasite dihydrofolate reductase and dihydropteroate synthase activities. Most individuals have been exposed to fungus but experience only asymptomatic infections. This fungus is profoundly opportunistic in IC pts
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