19 - Pathology Fungi

Front 1

Fungi infections are common in these people

Back 1

IC'ed

Front 2

Diagnosis of fungi is based on ________

Back 2

tissue culture

Front 3

Opportunistic pathogens usually cause ______ infections

Back 3

systemic

Front 4

Superficial mycoses are limited to the ______ layer of the skin

Back 4

keratinous

Front 5

Cutaneous mycoses are limited to the ______

Back 5

dermis

Front 6

Easiest way of classifying fungi

Back 6

Anatomical location

Front 7

Yeast are __1__-cellular which reproduce by __2__

Back 7

1. uni-
2. budding

Front 8

Molds are __1__-cellular __2__ colonies

Back 8

1. multi-cellular
2. filamentous

Front 9

Branching structures of molds

Back 9

Hyphae

Front 10

Fungi can exist as what two life forms

Back 10

Yeast

Mold

Front 11

What are Dimorphic fungi

Back 11

exist as both mold and yeast forms

Front 12

the "fruiting body" characteristic of molds, which dissiminates "spores"

Back 12

Conidiaphore

Front 13

Name 2 opportunistic yeasts

Back 13

Candida albicans

Cryptococcus Neoformans

Front 14

Stool from a normal patient will usually contain what organisms?

Stool from a hospitalized patient on broad-spectrum antibiotics will have what organism in his stool?

Back 14

Anaerobic bacteria

Candida (commensal)

Front 15

Candida albicans usually appears with what kind of symptom?

Back 15

Oral thrush

Front 16

Complication of oral thrush

Back 16

can spread to Esophagus and cause Dysphagia

Front 17

Histology of Candida

Back 17

budding yeast with Pseudohyphae

Front 18

What can happen if a person is IC'ed and has thrush?

Back 18

Thrush can invade blood vessels and disseminate

(rarely happens in normal host)

Front 19

Fungus whose habitat is alkaline bird droppings

Back 19

Cryptococcus Neoformans

Front 20

Special structure on Cryptococcus Neoformans

Back 20

Mucinous capsule that prevents drying and phagocytosis

Front 21

Most common symptom of Cryptococcus Neoformans

Back 21

Meningitis

*pneumonia may occur as well

Front 22

Cryptococcus neoformans histologic appearance

Back 22

-budding yeast with mucinous capsule
-narrow budding

Front 23

Diagnosis of cryptococcus in normal hosts

Back 23

Antigen testing of CSF

Front 24

Diagnosis of cryptococcus in IC'ed hosts

Back 24

India Ink Prep

Front 25

Hyalohyphomycosis organism

Back 25

Aspergillus

Front 26

Aspergillus histology

Back 26

hyphae that branch at acute angles

Front 27

Way to differentiate Hyalohyphomycoses species

Back 27

culture

Front 28

3 clinical classifications of Aspergillosis

Back 28

1. Allergic aspergillosis
2. Aspergilloma
3. Disseminated (invasive) Aspergillosis

Front 29

Explain Allergic Aspergillosis

Back 29

-Common in a asthmatics

-not an infection: spores are inhaled -> IgE response -> bronchospasm

Front 30

Explain Aspergilloma

Back 30

-NON-INVASIVE "fungus ball"
-occupies previous anatomical empty space such as sinus cavity or abscess

Front 31

Describe Invasive Aspergillosis

Back 31

In IC'ed host aspergillus invades lung tissue and bloodstream --> occludes vessels --> infarction

Front 32

2 Most common Zygomycoses species

Back 32

Rhizopus (most common)

Mucor (most commly known to docs)

Front 33

Zygomycoses (Mucor) histo appearance

Back 33

BROAD Hyphae that branch at RIGHT ANGLES

Front 34

Zygomycosis usually affects this group of people

Back 34

Diabetics

Front 35

Commonly involved areas of Rhinocerebral Zygomycosis

Back 35

Sinus
Orbit
Frontal Lobe

Front 36

Systemic (deep) mycoses have this characteristic

Back 36

Dimorphic = have both yeast and mycelial form

*only yeast form occurs within human

Front 37

4 agents of Systemic (deep) Mycoses

Back 37

1. Histoplasma capsulatum
2. Blastomyces Dermatitidus
3. Coccidiodes Immitus
4. Paracoccidioides brasiliensis

Front 38

Agent most common in Ohio, Missouri, and Mississippi river valleys

Back 38

Histoplasmosis

Front 39

Histoplasma capsulatum usually causes this

Back 39

Self-limited Upper Respiratory tract infection

heals with Calcified granuloma similar to TB

Front 40

Histoplasma may present as this in an IC'ed host

Back 40

disseminated disease

Front 41

Histology of Histoplasma

Back 41

small, budding yeast at 37'C
within Macrophages

Front 42

Histoplasma elicits _______ formation

Back 42

granuloma

*similar to TB

Front 43

Found along the Mississippi and Ohio river valleys and Great Lakes

Back 43

Blastomyces dermatitidus

Front 44

Blastomyces:
-this leads to infectious aerosols
-primary route of infection

Back 44

1. disturbance of SOIL by construction

2. respiratory tract

Front 45

Histology of Blastomyces

-they usually form:

Back 45

LARGE, BROAD-BASED BUDDING

Granulomas

Front 46

Rarest yet most severe of the Systemic fungal infections

Back 46

Blastomyces dermatidis

Front 47

Where is Coccidioides Immitus found geographically?

Back 47

Desert SW
California

Front 48

How may Coccidioides Immitus present? (3)

Back 48

Skin rash
Erythema nodosum (red nodule)

Front 49

Unique feature of Coccidioides

Back 49

Arthroconidia = conidia which break off the mycelial hyphae and can be breathed in and are very infectious

Front 50

Histologic appearance of Coccidioides Immitus

Back 50

Spherules containing Endospores which provoke inflammatory rxn upon rupture

Front 51

Coccidioides immitus can be mistaken for this

Back 51

Toxoplasma gondii (coccidian parasite)

Front 52

Paracoccidioides Brasiliensis is also know as _______________

Back 52

South American Blastomycosis

Front 53

Primary infection of Paracoccidioides

Back 53

Pulmonary

Front 54

Histology of Paracoccidioides brasiliensis

Back 54

Wagon wheel with knobs on outside

Front 55

2 Filamentous Bacteria

Back 55

Actinomyces israelii

Nocardia

Front 56

Actinomyces israelii forms ____

Nocardia is a ________ organism

Back 56

1. sulfur granules

2. weakly acid fast

Front 57

Both nocardia and actinomyces are _______ bacteria

Back 57

Gram +

Front 58

4 distinct clinical syndromes of Actinomycosis

Back 58

1. Cervical-facial = results from dental surgery

2. Thoracic = results from aspiration

3. Abdominal = following trauma or surgical disruption of bowel

4. Pelvic = associated with IUDs

Front 59

Actinomycosis pathology:
-colonies are naked to the visible eye and present as __1__

-__2__ tracts are common, and may form __3__

Back 59

1. Sulfur granules
2. sinus
3. cutaneous fistulas

Front 60

Actinomyces commonly form a mass in the __1__ and may be mistaken for __2__

Back 60

1. neck

2. malignant tumors

*called the "most misdiagnosed disease" for confusion with neoplasms

Front 61

Nocardia asteroides are commonly found in the ______

Back 61

soil

Front 62

Nocardia enters via __1__, resulting in pulmonary infections, which may form __2__ or __3__ that can be mistaken for TB or Carcinoma

Back 62

1. soil -> Pulmonary route
2. broncho-pleural
3. cutaneous fistulas

Front 63

Nocardia colony morphology

Back 63

"molar tooth" appearance

Front 64

How to differentiate Nocardia from Actinomycetes

Back 64

Nocardia is weakly acid fast

(both are gram +)

Front 65

Aspiration of Nocardia usually involved this part of lung

Back 65

Right lower lobe

Front 66

Pneumocystis carinii replicates in the human ____ with a life cycle that includes the formation of ______

Back 66

Lung

Intra-alveolar cysts

Front 67

PCP primarily infects the __________

Back 67

immunocompromised

Front 68

Most of the population is infected with PCP by age ____

Back 68

5

Front 69

How is PCP infection acquired?

Back 69

aerosolized mouse urine

Front 70

HIV patients usually with this CD4 count require life-long chemo-prophylaxis to prevent PCP recrudescence

Back 70

<200

Front 71

PCP Chest X-ray shows ____ pneumonia with a characteristic "______" appearance

Back 71

patchy

ground-glass

Front 72

PCP sputum examination may be diagnostic, but a ______ has a higher yield

Back 72

Broncho-alveolar lavage

Front 73

Can PCP be cultured?

Back 73

nope, rely on special stains to make diagnosis

Front 74

Pneumocystis carinii

Back 74

What fungus?

Front 75

PCP prevention doc: __1__
Inhaled ___2___ is sometimes used

Back 75

1. Trimethoprim/Sulfamethoxazole (Bactrim)

2. Pentamidine

Front 76

Candida with pseudohyphae

Back 76

Fungus?

Front 77

Cryptococcus Neoformans
*pic on left is Meningitis
-bird droppings
-mucinous capsule
-Meningitis
-narrow-base budding
-Antigen testing in normal
-India Ink in IC'ed

Back 77

Fungus?
Special features?

Front 78

Aspergilloma

Back 78

What is the arrow pointing at?

Front 79

Aspergilla with acute (<45') hyphae branching

Back 79

Fungus?

Front 80

Aspergilla fumigatus

Back 80

Fungus?

Front 81

Aspergilla fumigatus

Back 81

Fungus?

Front 82

Rhinocerebral Zygomycosis

Back 82

Fungus?

Front 83

Histoplasma capsulatum

Macrophage (histiocytes)

Back 83

Fungus that causes this "coin lesion"

What cell are these fungi usually found in?

Front 84

Histoplasma capsulatum

Back 84

What fungus?

Front 85

Histoplasma capsulatum

Back 85

These finding were found in an AIDS patient...what fungus?

Front 86

Histoplasma

Back 86

Bone marrow: which is the best place for this fungus to grow

Front 87

Blastomyces dermatitidis

Back 87

Fungus that divides by Broad-based budding

Front 88

Blastomyces dermatitidis
-dermitis
-broad based budding
-can mimic carcinoma

Back 88

Fungus?

Front 89

Coccidioides immitus

(resembles Toxoplasma)

Back 89

Fungus with Spherules containing endospores

Front 90

Paracoccidioides brasiliensis

Back 90

Fungus?

Front 91

Actinomyces israelii
-sometimes can see Sulfur Granules

Back 91

Commonly forms fistulas

Front 92

Nocardia

acid fast

Back 92

What fungus?
What stain is used?

Front 93

Nocardia

Back 93

Commonly causes Pneumonia and Kidney/Brain abscesses