Buxton 10-2-07 Fungal

Front 1

Fungi:
Eukaryotic cells
Cell wall contains chitin and ______

Back 1

glucan

Front 2

Fungi:
Cell membrane contains _______ instead of cholesterol as in mammals

Back 2

ergosterol

Front 3

Endemic dimorphic fungi in US
(3)

Back 3

Blastomyces dermatitidis
Coccidioides immitis
Histoplasma capsulatum

Front 4

Opportunistic fungi (4)

Back 4

Candida sp
Aspergillus sp
Mucor sp.
Pneumoncystis jiroveci

Front 5

Dimorphic
Exist in 2 morphologically different forms:
1)? multicellular, thread-like hyphae found in environment (free-living phase)
2)? single cell form found in tissues (parasitic phase)

Back 5

1)Molds-
2)Yeasts-

Front 6

Histoplasma
Blastomyces
Paracoccidioides
Coccidioides
Penicillium

Back 6

Mold and yeast forms:
A, B, C, D, E?

Front 7

What Fungus?
Soil organism
Growth in soil enhanced by bird or bat guano (poop)
Specific types of environments
Caves
Chicken coops
Old buildings

Back 7

Histoplasma capsulatum

Front 8

Histoplasma capsulatum Endemic in parts of the central and eastern United States along _____________ river valleys.

Back 8

Ohio and Mississippi




Microfoci in Central and South America, Africa, India, and Southeast Asia.

Front 9

Histoplasma capsulatum:
Microconidia are inhaled
Transform into ______

Back 9

yeasts

Front 10

Histoplasma capsulatum:
Phagocytosed by macrophages but are not killed
Killing of intracellular yeast depends on Th1 cell activation of ________ through release of g-IFN
By this time, organisms have spread widely in lung

Back 10

macrophages

Front 11

Histoplasma capsulatum:
_________ form around infected macrophages
Later they calcify (can see this on CXR)
Organisms remain viable in granulomas for years
Can be reactivated if person becomes immune suppressed

Back 11

Granulomas

Front 12

Histoplama:
_____% of population living in endemic areas are skin-test positive.

Back 12

80

Front 13

miliary

Back 13

Chest radiograph showing
__________ densities in both lung fields plus thin-walled cavity with fluid level. Histoplasmosis.

Front 14

Diagnosis of histo

Back 14

Culture of sputum or lung tissue
Histologic examination of biopsied lung tissue shows yeast within macrophages

Front 15

Treatment of histo

Back 15

Severe infections- amphotericin B
Mild to moderate infections- itraconazole

Front 16

What fungus?
Soil organism
Found in decaying leaf litter
Found in southern and mid-western US
Infection follows inhalation of conidia

Back 16

Blastomyces dermatitidis

Blastomycosis

Front 17

Organism can enter blood and go to skin to form lesions
Blastomycosis

Back 17

?

Front 18

Diagnosis of Blastomycosis

Back 18

Histopathology
See budding yeast cells
Serology

Front 19

Treatment of Blastomycosis

Back 19

AmphoB or an azole for more mild disease

Front 20

What fungus?
Found in lower Sonoran life zone is semi arid regions of southwest US
Probably associated with burrows of desert animals
Grows rapidly following rain; drought and windy conditions spread organism large distances

Back 20

Coccidioides immitis

Coccidioidomycosis

Front 21

The ecological niche of C. immitis is the Sonoran desert, which includes the deserts of the _________ and northern Mexico (figure 18). It is also found in small foci in Central and South America.

Back 21

Southwest (California, Arizona, New Mexico and Texas)

Front 22

Pathogenesis of Coccidioidomycosis:
Inhalation of arthroconidia directly into ______

Back 22

alveoli

Front 23

arthroconidio

Back 23

what part of Coccidioidomycosis?

Front 24

Pathogenesis of Coccidioidomycosis:
arthroconidia transform into a spherule containing _______

Back 24

endospores

Front 25

spherule containing endospores.

Endospores can be released and travel through the body leading to extrapulmonary disease

Back 25

Describe this Coccidioidomycosis picture

Front 26

Coccidioidomycosis
AKA ____ fever

Back 26

Valley

Front 27

Diagnosis of Coccidioidomycosis

Back 27

Culture of fluid from any involved site
Will grow on many media in few days
Serology- see notes page
Histopathology
See spherules

Front 28

Treatment of Coccidioidomycosis

Back 28

Long term treatment required with Ampho B for severe disease or an azole for mild to moderate disease

Front 29

Candida _______ is responsible for most infections

Back 29

albicans

Front 30

Causes of Candida infection in certain situations

Back 30

T cell immune suppression
Antibiotic therapy
Insertion of catheter
Neutropenia

Front 31

Disease associations of infection with Candida

Back 31

Thrush
Vaginal yeast infections
Esophagitis
Candidemia
Pneumonia
Hepatospenic candidiasis

Front 32

Diagnosis of Candida infection

Back 32

Culture of blood or biopsied lung tissue
Blood agar or Sabouraud’s agar

Front 33

Most common species causing human disease: Aspergillus ______ and A. _______

Back 33

A. fumigatus, A. flavus

Front 34

Pts At risk for aspergillus: - neutropenic, transplant patients, patients on long term ________

Back 34

corticosteroids

Front 35

Most common manifestation of Aspergillus

Back 35

sinusitis, pneumonia

Front 36

Histopathology of Aspergillus infection-

Back 36

see acutely branching septate hyphae; may see fruiting bodies in lung

Front 37

Agar for diagnosis of aspergillus

Back 37

Sabouraud’s agar

Front 38

Treatment of Candida and Aspergillus

Back 38

Increase neutrophil count with rG-CSF if patient is neutropenic
Anti-fungals:
Amphotericin B, voriconazole, caspofungin

Front 39

What fungus?
Once thought to be a protozoan, now classified as fungus
May be part of normal flora
May be acquired by inhalation of air-borne cysts
Most individuals acquire the organism by 3 yrs of age

Back 39

Pneumocystis jiroveci

Front 40

Pts at risk for Pneumocystis jiroveci

Back 40

HIV infected with CD4 cell counts <200/cmm
Occasionally seen in other severely immune suppressed patients

Front 41

Pathogenesis of P. jiroveci:
Replicates in the ______ layer above the alveolar epithelium

Back 41

surfactant

Front 42

Pathogenesis of P. jiroveci:
Replicates in the surfactant layer above the alveolar epithelium
Forms trophozoites and _____

Back 42

cysts

Front 43

Diagnosis:
Pneumocystis jiroveci

Back 43

Microscopic examination of BAL fluid stained with Giemsa, toluidine blue, methenamine silver
See thin walled trophozoites and thick walled cysts containing 4-8 nuclei

Front 44

Treatment and prevention
Pneumocystis jiroveci

Back 44

TMP/SMX

Front 45

A 25-year-old man was admitted to a Colorado hospital with a 12-day history of fever, weight loss, fatigue, arthralgias, and productive cough. He had been treated by a private physician with two antibiotics during the preceding 8 days. On hospital admission, a computed tomography (CT) scan demonstrated bilateral pulmonary diffuse nodular opacities. A subsequent open lung biopsy revealed small budding yeasts. After 10 days of culture, Blastomyces dermatitidis was identified and confirmed by DNA probe (GenProbe, San Diego, California *), both at the local hospital laboratory and at CDC. The patient was treated with intravenous (IV) ___________ for 10 days, followed by a prescribed 6-month course of oral ________.

Back 45

amphotericin B


itraconazole

Front 46

One week later, a 35-year-old man sought care for a 15-day history of fever, fatigue, shortness of breath, arthralgias, skin lesions (punctate lesions on arms and trunk and lesions resembling erythema nodosum on legs), cough, chest pain, and weight loss. His symptoms did not improve after 9 days of treatment with two antibiotics, and he was admitted to the same hospital as patient 1. A CT scan revealed diffuse, bilateral pulmonary nodules. The consulting physician for this patient also had seen patient 1; on the basis of work history and clinical course of the disease, the consultant suspected a fungal pneumonia. Specimens obtained by transbronchial biopsy/lavage were negative for fungal elements by microscopic examination and culture. Open lung biopsy specimens revealed small budding yeasts morphologically indistinguishable from those found in patient 1. Biopsy specimens grew B. dermatitidis after 21 days of culture. The patient received IV __________ for 14 days, and at discharge, a 6-month prescribed course of oral __________.

Back 46

amphotericin B


itraconazole

Front 47

On March 30, 2001, CDC was notified by Pennsylvania Department of Health (PDH) of an acute respiratory febrile illness in 44 students from two colleges who traveled to Acapulco, Mexico, for spring break vacation during March 3--18. Within 7--14 days of their return from Acapulco, 21 students presented to health-care providers with illness characterized by fever, chills, dry cough, chest pain, and headache. Two students were hospitalized. On the basis of clinical symptoms and chest radiographs that revealed bilateral, nodular patchy infiltrates, acute pulmonary ____________ was the suspected illness.

Back 47

histoplasmosis

Front 48

The number of cases of Coccidioidomycosis in Arizona has increased in recent years
1995 reported as 14/100,000 (2X more than in previous yrs
Most of new cases were in elderly patients who developed more serious disease
Why?

Back 48

More elderly moving to AZ from areas where this fungus is not endemic