Block 7 - Mycology Of The Lungs

Front 1

Mississippi River, around the Great Lakes, and in the southeast region of the United States.

Soil, rotting wood, feces of birds and bats

Dimorphic

Mycelia at 25C; typical pyriform microconidia

Yeast at 37C “broad based yeast”

Back 1

Blastomyces Dermatiditis

Front 2

In what percentage of Blastomyces Dermatiditis infections are patients symptomatic?

Back 2

< 50%

Front 3

Acute pulmonary: lobar segmental consolidation,
mimics bacterial pneumonia.

Chronic pulmonary lobar infiltrates: mimics bronchogenic carcinoma.

Extrapulmonary dissemination,
Skin and bones.

Hematogenous dissemination
prostate, liver, spleen, kidney, and central nervous system.

Back 3

Blastomyces Dermatiditis

Front 4

KOH preparation:
sputum, skin lesion, pus
broad based budding yeast

Back 4

Procedure for diagnosis of Blastomyces Dermatiditis

Front 5

What is the treatment for Blastomyces Dermatiditis

Back 5

Amphotericin B, Itraconazole & voriconazole

Front 6

South American Blastomycosis

This disease occurs from the middle of Mexico (North America) to Central and South America.

Most cases are reported from Brazil.

The ecological niche of this organism is probably the soil.

Back 6

Paracoccidiomycosis

Front 7

Dimorphic:

Mycelia 25C No typical pattern of sporulation

Yeast 37C “pilot’s wheel”(Multipolar) arrangement

Back 7

Paracoccidiodes Brasiliensis

Front 8

Granulomatous disease of mucous membranes, skin, and pulmonary system.

The organisms invade the mucous membranes of the mouth causing the teeth to fall out.

White plaques are also found in the buccal mucosa, and this along with the triad are now used to clinically differentiate between TB and ...............

Back 8

Clinical Syndrome of Paracoccidioidomycosis

Front 9

KOH preparation,
yeast with multiple buds, a thin cell wall, and a narrow base.

Histopathology and Histologically, one sees multiple buds forming a "Captain's wheel.“ or “Pilot’s wheel”

Back 9

Diagnosis and recognition of paracoccidiodes

Front 10

What is the treatment for Paracoccidiodes Brasiliensis?

Back 10

Amphotericin B.
Sulphonamide-trimethoprim or Itraconazole

Front 11

Geographic distribution of Histoplasmosis capsulatum var capsulatum?

Back 11

broad regions of the Ohio and Mississippi River valleys in the United States & Mexico and Central and South America.

Front 12

Geographic distribution of Histoplasmosis capsulatum var duboisisii?

Back 12

tropical areas of Africa.

Front 13

General habitat of Histoplasmosis?

Back 13

Soil with a high nitrogen content, such as that found in areas contaminated with bird or bat droppings.

associated with exposure to bird roosts, caves, and decaying buildings or urban renewal projects involving excavation and demolition

Front 14

Dimorphic

Mycelia at 25C; tuberculate macroconidia

Yeast at 37C

Live intracellular inside alveolar macrophage

Back 14

Histoplasmosis

Front 15

Acute pulmonary disease will develop with mild flu-like symptoms.

self-limited primary lung involvement resulting in a coin lesion on x-ray

chronic progressive secondary lung disease located in the apices

Lesions in extrapulmonary sites (adrenals, liver)

On some occasions, fully disseminated infections will occur. ( heal or fatal depending upon the host condition)

Back 15

Clinical Syndrome of Histoplasmosis

Front 16

Source for visualizing Histoplasmosis

Back 16

Peripheral blood: stained with Giemsa, GMS, or PAS

usually found in monocytes or in PMN's

appears as a small yeast about 5-6 microns in diameter. (I/2 the size of Blastomyces)

Front 17

What is the serology method for Histoplasmosis?

Back 17

antigen detection in blood and urine.

Front 18

What is the treatment regimen for Histoplasmosis?

Back 18

Amphotericin B
Itraconazole is now also being used for mild cases.

Front 19

Posada’s disease, San Joaquin valley fever, Valley fever and desert rheumatism

Sonoran desert, which includes the deserts of the Southwest (California, Arizona, New Mexico, Nevada, Utah and Texas) and northern Mexico

It is also found in small foci in Central and South America. 
Desert soil, pottery, archaeological middens, and rodent burrows

Back 19

Coccidioidomycosis

Front 20

Thermally Dimorphic fungus

Mycelia at 25C and Spherules at 37C

Back 20

Coccidioides Immitis

Front 21

Is found in sand as arthroconidia

South western USA

Back 21

Coccidioides Immitis

Front 22

Primarily a pulmonary disease.

60 % of the infections in the endemic area are asymptomatic.

Causes acute symptomatic flulike illness marked by fever, cough, chest pain, and weight loss.

Patients with primary coccidioidomycosis may have a variety of allergic reactions (∼10%) as a result of immune complex formation, including an erythematous macular rash, erythema multiforme, and erythema nodosum.

Back 22

Coccidioides Immitis

Front 23

Clinical specimens include sputum, pus from skin lesions, gastric washings, CSF, and biopsy material from skin lesions.

Direct microscopic visualization of endosporulating spherules.

Back 23

Coccidioides Immitis

Front 24

The organism develops into spherules (30-60 microns)
are filled with endospores which are 3 to 5 microns in diameter.

A spherule will develop endospores within, then break apart, releasing the endospores.

Back 24

Tissue form of Coccidiodes Immitis seen in pus or histological sections

Front 25

What is the treatment of Coccidioides Immitis?

Back 25

Amphotericin B
Maintence therapy: Fluconazole or itraconazole

Front 26

Found in large number in pigeon and chicken droppings

Acidic mucopolysaccharide capsule

Phenol oxidase positive: blocks epinephrine

Back 26

Cryptococcus Neoformans

Front 27

What are the serotypes of Cryptococcus Neoformans?

Back 27

five serotypes (A, B, C, D, and AD)

Front 28

What are the two varieties of Cryptococcus Neoformans?

Back 28

C. neoformans var neoformans (serotypes A, D, and AD) and C. neoformans var gatti (serotypes B and C).

Front 29

The responses range from a harmless colonization of the airways and asymptomatic infection in laboratory workers to meningitis or disseminated disease.

Back 29

Clinical syndrome of cryptococcus neoformans

Front 30

........................ is a major opportunistic pathogen of patients with AIDS. Those individuals with CD4+ lymphocyte counts of less than 200/mm3 (usually <100/mm3) are at high risk for CNS and disseminated cryptococcosis

Back 30

C. neoformans var neoformans

Front 31

Infection may be subacute or chronic.

The highly fatal meningoencephalitis
symptoms may begin with vision problems and headache, which then progress to delirium, nuchal rigidity leading to coma and death.

Also infect lungs and skin. formation of a granulomatous reaction with giant cells.

Back 31

Cryptococcosis;Clinical symptoms & Disease

Front 32

Microscopic examination of CSF : characteristic encapsulated budding yeast cells.

Culture of clinical material : produce mucoid colonies comprised of round, urease-positive

Species identification can also be accomplished by directly testing for phenoloxidase activity (positive).

Back 32

Cryptococcosis diagnosis

Front 33

All patients should receive amphotericin B plus flucytosine acutely for 2 weeks (induction therapy), followed by 8-week consolidation with either oral fluconazole (preferred) or itraconazole.

AIDS patients generally require lifelong maintenance therapy with either fluconazole or itraconazole.

Back 33

Treatment strategy for Cryptococcus Neoformans

Front 34

Not a dimorphic fungus

Septate hyphae

Conidial arrangement helps in diagnosis

Dichotomous branching/ acute branching angle

Back 34

Aspergillus

Front 35

4 types of Aspergillus?

Back 35

A.fumigatus
A.flavus
A. niger
A. terreus

Front 36

Aspergilloma in patients with ...................... or chronic pulmonary disorders.

Back 36

pre-existing lung cavities

Front 37

With regard to Aspergillosis, ................... disease in the immunosuppressed patient when the fungus invades from the lungs.

Back 37

Disseminated

Front 38

Aspergillus fumigatus?

Back 38

Short fragment
of septate hyphae
that are branched at 45 degree angle (dichotomous)

Front 39

What is the general treatment strategy for Aspergillosis?

Back 39

Amphotertericin B,
Aspergilloma; surgical removal of the infected tissue

Front 40

Round cup shaped organism

Lacks ergosterol (Ribotyping
and DNA homology)

Obligate parasites of human (Extracellular: Alveolar epithelium)

Respiratory tract main portal entry

AIDS patients: pneumonia

Back 40

Pneumocystis Jiroveci

Front 41

The infection is a diffuse interstitial plasma cell pneumonia that at first resembles Mycoplasma pneumonias.

The yeast can be isolated from lung tissue and from aspirates from the lungs and related structures.
 

Back 41

Pneumocystis Jiroveci

Front 42

Methods for diagnosis of pneumocystic jiroveci

Back 42

Diagnosed by microscopy of biopsy specimen or bronchial alveolar lavage fluids

Is characterized on radiographs as having ground glass appearance

Gomori’s methenamine silver-stain: rounded cup shaped organism

Front 43

A foamy exudate is seen within the alveolar spaces with an intense interstitial infiltrate composed predominantly of plasma cells.

Other possible patterns include diffuse alveolar damage, noncaseating granulomatous inflammation, and infarct-like coagulative necrosis

Back 43

Histologic presentation of pneumocystis jiroveci

Front 44

What is the treatment for pnemocystic jiroveci?

Back 44

Trimethoprim sulfamethoxazole