Clinical Diagnostics Test 3-Immunology, Chemistry Labs, Mycology, And Parasitology

Front 1

def of mycology

Back 1

the study of fungi (yeasts and molds)

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characteristics of fungi

Back 2

eukaryotic
no chlorophyll
non-motile

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yeast

Back 3

'creamy'
grows at warmer temp (37*C)
contain blastospores and pseudohyphae

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mold

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'cottony'
contains spores and hyphae
grows at cooler temps (25*C)

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4 Types of fungal infections

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1. superficial mycoses
2. cutaneous mycoses
3. subcutaneous mycoses
4. systemic mycoses

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superficial mycoses

Back 6

limited to the keratinized layers of the skin and hair
-Tinea Versicolor

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cutaneous mycoses

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infections of the deeper layers of the EPIDERMIS and its integuments - the hair and nails

-think TINEA
Tinea capitis, tinea corporis, tinea barbarae, tinea cruris, tinea pedis, and tinea unguium

Front 8

subcutaneous mycoses

Back 8

involve the dermis , subcutaneous tissues, muscle, and fascia

-sporotricosis

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cause of pityriasis (tinea) versicolor

Back 9

malassezia furfur (lipophilic yeast)

Front 10

pityriassis (tinea) versicolor dx, tx, sx

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Superficial mycoses

DX: KOH prep, Wood's lamp
TX: antidandruff shampoo
SX:white and dark spots that should not be confused with vitiligo

"mantle distribution"

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KOH Prep

Back 11

use 10%-20% KOH solution
-take skin scraping and drop KOH on slide and examine under microscope - will see hyphae and buds

-KOH bursts the epidermal cells so the hyphae can be viewed

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H&E Stains

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hematoxylin and eosin stain- causes the nuclei to stain blue-black and the cytoplasm stains pink

Front 13

PAS

Back 13

periodic acid-schiff stain- used to stain cells with a high proportion of carbs (glycogen, glycoprotein, and proteoglycans)

-good for CT, mucus, and basal laminae

Front 14

wood's lamp

Back 14

ultraviolet light when shined on an infectious fungal organism it will fluoresce

Front 15

3 types of dermatophytic fungi
(cutaneous mycoses)

Back 15

trichophytan, epidermophyton and microsporum

Front 16

tinea capitis

Back 16

cutaneous mycoses
-scalp
causes areas of alopecia with little or no pruritis

Front 17

tinea corporis

Back 17

pruritic, annular, found on the body - classic ringworm with scaly elevated border

Front 18

tinea barbae

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barber's itch
-found on facial areas

Front 19

tinea cruris

Back 19

jock itch

Front 20

tinea pedis

Back 20

athletes foot
-looks like a hypersensitivity reaction on foot
-can lead to jock itch

Front 21

tinea unguium

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onychomycosis (thickened, discolored, brittle nails

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treatment and diagnosis of tinea infection

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TX: topical- (azoles) miconazole, clotrimazole, and terbinafine (oral and topical)
oral- terbinafine, griseofulvin, and fluconazole

DX- KOH prep, calcofluor white, and DTM (dermatophyte testing medium)

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what causes sporotrichosis

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sporothrix schenckii

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sporotrichosis who

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gardeners and landscapers

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sporotrichosis how

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puncture by a spinter or thorn
-the fungus is found in soil, plants, wood and moss

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sporotrichosis dx

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culture 2-5 days

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sporotrichosis sx

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incubation period of 1 week to 6 months
-subcutaneous nodule which develops into a necrotic ulcer which follows the lymphatics

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sporotrichosis tx

Back 28

oral potassium iodide if localized
amphotericin B if disseminated

Front 29

4 types of systemic mycoses

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1. histoplasmosis
2. coccidoides immitis
3. cryptococcus neoformans
4. blastomyces dermatidis

Front 30

histoplasmosis capsulatum how

Back 30

found bird and bat feces - inhalation of spores
-spelunker (is roaming caves a hobbie?)
-endemic to ohio and Mississippi river valley

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cultures for histoplasmosis capsulatum (5)

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takes 1-6 weeks
1. DNA probes (ID in 1-3 weeks)
2. Sputum (only positive in 10-15% of acute pulmonary disease)
3. serology (1:32 titers-75-95% will be positive 6 weeks after exposure)
4. RIA (radio-immuno assay)- use for immunodeficient pts
5. Skin test (not a culture or dx)- shows distribution of diease

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treatment for histoplasmosis capsulatum

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amphoteracin B and fluconazole

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coccidoides immitis how

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systemic mycosis
-transmitted through inhaled spores
-usually asymptomatic and no treatment is usually necessary
and lifetime immunity results

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coccidioides immitis sx

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erythema nodosum
erythema multiforme
symmetrical arthritis
**don't mistake for TB or syphilis

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coccidioides immitis labs

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dec WBCs (below 10,000), inc eosinophils, elevated ESR

-if antibody titer is greater than 1:16 it suggests an extrapulmonary infection
-if titer increases by more than 2 fold in 2-3 weeks then disseminated

Front 36

cryptococcus neoformans

Back 36

systemic mycosis
PIGEON DROPPINGs
-usually seen in HIV pts
-presents with menigitis and a CD4 count below 100/uL then think cryptococcus
-forms a capsule
-stain with india ink

Front 37

dx: cryptococcus neoformans

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stain with india ink
cryptococcal antigen in blood or CSF
positive culture
-labs will show inc WBC and proteins but dec glucose

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tx for cryptocccus neoformans

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amphotericin B or Diflucan

Front 39

blastomyces dermatidis

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systemic mycosis
aka Gilchrist's disease
-found in decaying organic matter
-dogs and cats are ususally infected and infect humans
-endemic overlaps with histoplasmosis

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blastomyces dermatidis sx

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pustules all over face

Front 41

blastomyces dermatidis dx

Back 41

only specific fluorescently labeled antibody will react with histologic tissue section

Front 42

aspergillosis

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dangerous for immunocompromised pts (bone marrow transplant or AIDS)

Front 43

aspergillosis sx

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allergic reaction
superficial cutaneous infection
limited cutaneous infection

Front 44

treatment for aspergillosis

Back 44

amphoteracin B

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candidiassis

Back 45

the 4th most common cause of nosocomial bloodstream infection

found in GI tract, vagina, skin, and nails
-problem in ICU because it invades catheters and IV lines

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infecting dose

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the amount that the pt was exposed too

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length of exposure

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the amount of time the pt was exposed to pathogen

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chronicity

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depends on the life cycle of the organisms

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adhesin

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the way in which the parasite attaches to the intestinal wall

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pathogenesis (6 ways)

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1. infecting dose
2. length of exposure
3. chronicity
4. adhesins
5. cell and tissue damage
6. route of infection

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7 modes to collect a specimen

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1. duodenal aspirate
2. liver abscess aspirate
3. sputum
4. urine
5. genital
6. blood
7. stool

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O and P

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ova and parasites: test in stool after 3 day stool collection

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stool specimen

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-3 specimens every other day
- collect prior to the administration of antibiotics or anti-diarrheals
-wait 10 days after barium study

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3 ways of specimen processing

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1. centrifuge
2. flotation
3. filtering

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protozoa (types)

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single-cell eukaryotes
amoeba
flagellates
sporozoans

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helminths

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multicellular worms

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amebae examples

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entamoeba histolytica
balatdium coli

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life cycle of entamoeba histolytica

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amebic dysentery - results from poor sanitary conditions

mature cysts are ingested and eventually make their way to the right lobe of the liver where they cause extra-intestinal disease

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entamoeba histolytica symptoms

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fever, liver abscess, chills, hepatomegaly

Front 60

balatidium coli

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largest ciliated protozoan to infect humans
-comes from swine and monkeys

Front 61

balatidium coli sx

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an amoeba that causes abdominal pain and tenderness, nausea and anorexia, and erosion of the intestinal mucosa

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giardia lamblia
what
sx
dx
tx

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"old man cyst"- flagellate
-cyst-fecal-oral transmission

sx: diarrhea, foul-smelling stools, pain, bloating, flatulence, malabsorption and weight loss
dx: O&P and ELISA (giardia ag)
tx: flagyl (metronidazole)

Front 63

trichomonas vaginalis
stain
tx
sx
transmission

Back 63

STD that cases foul smelling discharge
stain: giemsa
tx: flagyl
sx: excessive foul-smelling discharge
can be transmitted on clothing and toilets

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typanosoma cruzi

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flagellate
causes african sleeping sickness
biten by tsetse fly
-may cuase induration of face and eye: Romana sign

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Leishmania species

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flagellate
biten by the sand fly and can cause a granulomatus group

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sporozoans

Back 66

most common type are plasmodium species that cause malaria

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anopheles gambiae

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the mosquito vector that carries plasmodium sp.
-takes 2 weeks for mosquito to become infected with plasmodium sp (ie if it bites an infected individual then the mosquito will become a malaria carrying vector in 2 weeks)

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mainline malaria

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malaria that is caused by human-to-human transmission by sharing infected needles

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congenital malaria

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infection that is passed from mother to fetus

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symptoms of malaria

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malaria rigors: fever and chills
infection of the RBCs (malaria invades the RBC, replicates inside, then ruptures the RBC)

Front 71

4 causes of malaria

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plasmodium vivax
plasmodium ovale
plasmodium malariae
plasmodium falciparum

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malaria stains

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giemsa

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malaria prophylactic therapy
adults
peds

Back 73

adults: larium (mefloquine)
-watch for long QT interval
Peds: Malarone

Front 74

toxoplasmosis

Back 74

develops from fecal oocysts in cats and improperly cooked meat
-can cross the placenta and infect babies
-can cause still birth or miscarriage

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diagnosis for toxoplasmosis

Back 75

serological diagnosis
direct identification of the parasite from peripheral blood, amniotic fluid or in tissue sections