2025 – PAGE 309 – INFECTIOUS DISEASES
CRYPTOCOCCUS
Cryptococcus infections are associated with a history of bird exposure (pigeon droppings) or travel to the Northwestern U.S. Cryptococcus can cause pneumonia or meningitis, ESPECIALLY in the immunocompromised. Diagnose with India ink staining. For meningitis or disseminated cryptococcus, treat with AMPHOTERICIN first, and then you can switch over to fluconazole. For isolated pulmonary disease (pneumonia), you can use fluconazole alone.
MNEMONIC: Instead of cryptococcus, say crypto-CAW-cus (“CAW” to remind you of a bird).
MNEMONIC: Imagine a giant CAW-ing crow that’s wearing a huge RED TURBAN (RED = immunocompromised, TURBAN = India ink). The turban was put on by its mean Indian owner, Ashish. It’s SO heavy that it’s on the verge of breaking the crow’s neck. The NECK PAIN (meningitis) is so intense that the bird can’t stop CAW-ing and has to keep a STIFF NECK (meningitis) or it’ll break! (Thanks to LF, a PBR member for the “CAW” idea.)
BLASTOMYCOSIS
Blastomyces is described as a broad-based budding yeast and is usually found near water. Blastomycosis can present as a pneumonia or flu-like illness. It can also cause skin lesions. Treat with azoles (itraconazole is the first-line agent).
IMAGE: www.pbrlinks.com/BLASTOMYCOSIS1
MNEMONIC: It used to be called Chicago disease. The solution was to move the sewage away from any source of drinking water!
COCCIDIOIDOMYCOSIS
Coccidioidomycosis (sometimes called Valley Fever, or Cocci) can present as a pneumonia (possibly with pulmonary nodules) or as flu-like symptoms in someone living/traveling out west (Arizona, California, Texas, etc.). Treat with amphotericin or azoles (fluconazole or ketoconazole).
MNEMONIC: It’s sometimes called Valley Fever because it is so common in the central valley of California.
HISTOPLASMOSIS
Histoplasmosis presents as a flu-like illness. It is typically cleared by most patients without intervention. Those who do not clear it can get CALCIFICATIONS that look like tuberculous disease on X-ray. Patients can also get pulmonary fibrosis, HEPATOSPLENOMEGALY (HSM), and mediastinal/HILAR CALCIFICATIONS. Look for a history of exposure to bird droppings, or travel to OHIO or Mississippi. Treatment is with amphotericin or an azole (fluconazole or ketoconazole).
MNEMONIC: It used to be known as Cave Disease, or Ohio Valley Disease.
MNEMONIC: HIS TOE is wrapped with RED TAPE. There’s also a tag from the LIMITED on it, and it seems to be leaking CALCIUM FIBERS (fibrosis) onto his sock! (RED TAPE – use the color red as a symbol for immunocompromised patients).
MNEMONIC: (image) The drawing below is courtesy of LF, a PBR member. It shows bird droppings being spread across Mississippi and Ohio.
