Upper Respiratory Tract Infections

Upper Respiratory Tract Infections

Dr Patsy Lill
Professor Emerita
University of South Carolina School of Medicine

Kidney Transplant

A 53-year-old kidney transplant patient presented with increasing BUN and creatinine. He was treated by increasing his immunosuppressive medications. Eighteen days later he developed a persistant cough, dyspnea, pleuritic chest pain, hemoptysis and fever. He also had a heart murmur consistent with endocarditis. CT scan showed bilateral nodular infiltrates. Testing for TB, histoplasmosis and coccidioidomycosis was negative. Treatment with broad spectrum antibiotics did not improve his condition. Immune testing showed defective neutrophil function as well as suppression of lymphocyte and macrophage function. Sputum samples obtained by bronchoscopy showed the organism shown below. He was placed on Voriconazole but succumbed to the infection 2 weeks later. Autopsy disclosed the organisms shown below in his lungs and colonizing his mitral valve.

What is your diagnosis?

1. Mucormycosis
2. Aspergillosis
3. Candidiasis
4. Blastomycosis
5. Cryptococcal pneumonia

The fungus typically grows as
1. Hyphae branching at a 30 degree angle
2. Hyphae branching at a 45 degree angle
3. Hyphae branding at a 90 degree angle
4. Pseudohyphae

Which of the following growth characteristic of this fungus is the most damaging to the body?

1. Grows on the surface of respiratory epithelium
2. Grows as a ball within cavities in the lungs
3. Invades blood vessels
4. Usually invades the CSF
5. Commonly causes esophagitis

ANSWER

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Pathology questions by Dr Patsy Lill