Fungi

Front 1

Coccidioides immitus:
Features

Back 1

DIMORPHIC

SPHERULE IN TISSUE

**SOUTHWEST (ARIZONA, CALI)

Front 2

Coccidioides immitus:
Transmission

Back 2

- Arthrospores inhaled and infect lungs
- Arthrospores form spherules
- Spreads via bloodstream
- Granulomatous lesions in bones and CNS (meningitis)

Front 3

Coccidioides immitus:
Pathogenesis

Back 3

- Inf of lungs is asymptomatic; evident only by + skin test & presence of Ab.
- Some develop ERYTHEMA NODOSUM – “valley fever” or “desert rheumatism” (red, tender nodules on extensor surf – ex. Shins) – but not unique to EN!

*Women in 3rd trimester also have ↑ incidence
*Affects mostly Filipinos & African Americans more b/c of geographic location
**LEFT SHIFT: acute bact inf will cause ↑ in both total # of mature neutrophils & less mature bands or stabs to respond to inf.

Front 4

Coccidioides immitus:
Lab Dx

Back 4

- SKIN TEST (bc + w/in 2-4 wks of infection & remains so for yrs but often – (anergy) in pts w/ disseminated disease
- Spherules seen in tissue specimens
- Skin tests w/ fungal extracts (coccidioidin or spherulin) cause at least a 5mm induration 48 hrs after injection (delayed hypersensitivity rxn)
- Hyphae w/ arthrospores in culture

Front 5

Coccidioides immitus:
Treatment

Back 5

- Azole drugs if NOT severe dz

- Amphotericin B if severe – used for lung lesions or diss dz – nephrotoxicity & Mg2+ & K+ wasting.

Front 6

Histoplasma Capsulatum:
Features

Back 6

DIMORPHIC

OVAL BUDDING YEAST INSIDE MACROPHAGE

Front 7

Histoplasma Capsulatum:
Transmission

Back 7

- Inhalation of airborne spores (microconidia)
- Inhaled spores are engulfed by macrophages and develop into yeast forms

Front 8

Histoplasma Capsulatum:
Pathogenesis

Back 8

- Intense exposure to a chicken house or bat-infested cave, pneumonia can manifest
- Affects liver & spleen; can also develop in AIDS pts

Front 9

Histoplasma Capsulatum:
Lab Dx

Back 9

- SKIN TEST; uses histoplasmin (a mycelia extract); becomes + & shows 5 mm of induration w/in 2-3 wks after inf and remains + for many yrs

Front 10

Histoplasma Capsulatum:
Treatment

Back 10

**azole drugs!

Front 11

Blastomyces:
Features

Back 11

DIMORPHIC

SINGLE BROAD-BASED BUD

Front 12

Blastomyces:
Trasnmission

Back 12

- Inhalation of airborne spores

*BBBY (broad based buddying yeast)

Front 13

Blastomyces:
Pathogenesis

Back 13

- Infection via respiratory tract

Front 14

Blastomyces:
Lab Dx

Back 14

- See single broad-based buds

Front 15

Blastomyces:
Treatment

Back 15

**azole drugs!

Front 16

Paracoccidioides Brasiliesnsis:
Features

Back 16

DIMORPHIC

MULTIPLE BUDS (PILOT WHEEL)

Front 17

Paracoccidioides Brasiliesnsis:
Transmission

Back 17

- Inhalation of airborne spores

Front 18

Paracoccidioides Brasiliesnsis:
Pathogenesis

Back 18

- Spores are inhale; early lesions occur in lungs

Front 19

Paracoccidioides Brasiliesnsis:
Lab Dx

Back 19

- Yeast cells w/ multiple buds (pilot’s wheel) seen in pus or tissues under microscope

Front 20

Paracoccidioides Brasiliesnsis:
Treatment

Back 20

- Itraconazole

**azole drugs!

Front 21

Dermatophytoses
(Tinea-Ringworm):
Features

Back 21

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Front 22

Dermatophytoses
(Tinea-Ringworm):
Transmission

Back 22

- Transmission: spread from infected persons by direct contact
- Also spread from animals such as dogs & cats.
- Tinea capitis → head, tinea cruris → genitals, tinea manuum → hands, tinea pedis → feet, tinea corporis → any other area of body

Front 23

Dermatophytoses
(Tinea-Ringworm):
Pathogenesis

Back 23

- caused by fungi that infect only superficial keratinized structures (skin, hair, nails)
- favored by heat & humidity (ex. Athlete’s foot, moist skin, jock itch)

Tina Versicolor: tan-to-pink spots or very faint on light-colored skin, and light or dark spots on dark skin all over body; skin looks patchy/flaking off.

Front 24

Dermatophytoses
(Tinea-Ringworm):
Lab Dx

Back 24

- Skin or nail scarpings → 10% KOH on glass slide → show hyphae
- lesions fluoresce when exposed to UV light from Wood’s lamp

**MICROSPORUM CANIS

Front 25

Dermatophytoses
(Tinea-Ringworm):
Treatment

Back 25

- Local antifungal creams w/ miconazole

**azole drugs

Front 26

Sporothrix schenckii:
Features

Back 26

DIMORPHIC

ROUND OR CIGAR-SHAPED BUDDING YEASTS

Front 27

Sporothrix schenckii:
Transmission

Back 27

- Caused by fungi that grow in soil & on vegetation
- Introduced into subcutaneous tissue through trauma

Front 28

Sporothrix schenckii:
Pathogenesis

Back 28

- “ROSE GARDENERS DISEASE”
- local pustule or ulcer w/ nodules along draining lymphatics (ex. Goes up the arm)

Front 29

Sporothrix schenckii:
Lab Dx

Back 29

- Round or cigar-shaped budding yeasts

Front 30

Sporothrix schenckii:
Treatment

Back 30

- Itraconazole

**azole drugs!

Front 31

Candida albicans:
Features

Back 31

OVAL YEAST W/ SINGLE BUD

Front 32

Candida albicans:
Transmission

Back 32

- Part of normal flora of skin, mucous mem, and GI tract

Front 33

Candida albicans:
Pathogenesis

Back 33

- Forms pseudohyphae when it invades tissue
- Yeast form prod germ tubes when incubated in serum at 37°C
- Predisposing factors: ↓ immune sys, suppression of normal flora
- Vaginitis due to ↓ in vagina flora by antibiotics → leads to overgrowth of Candida albicans

Front 34

Candida albicans:
Lab Dx

Back 34

- Yeasts & pseudohyphae
- Yeast form prod GERM TUBES

Front 35

Candida albicans:
Treatment

Back 35

**azole drugs!

Front 36

Cryptococcus neoformans:
Features

Back 36

NOT DIMORPHIC

OVAL, BUDDING YEAST W/ POLYSACC CAPSULE

Front 37

Cryptococcus neoformans:
Transmission

Back 37

- Inhalation of airborne yeast cells

Front 38

Cryptococcus neoformans:
Pathogenesis

Back 38

- Influenzalike syndrome or pneumonia
- spread via the bloodstream to the meninges

**HABITAT: IS SOIL, ESP. WHERE ENRICHED BY PIGEON DROPPINGS**

Front 39

Cryptococcus neoformans:
Lab Dx

Back 39

- Visual yeast cell surrounded by wide unstained capsule in INDIA INK preparation of spinal fluid
- Latex agglutination test detects polysacc capsular Ag in spinal fluid

Front 40

Cryptococcus neoformans:
Treatment

Back 40

- Amphotericin B plus flucytosine for meningitis

Front 41

Aspergillus fumigates:
Features

Back 41

“FUNGUS BALL”

45° Angle!!

Front 42

Aspergillus fumigates:
Transmission

Back 42

- Inhalation of airborne condidia

Front 43

Aspergillus fumigates:
Pathogenesis

Back 43

- invades BV, causing thrombosis & infarction
- Dz: “FUNGUS BALL” in lung & allergic bronchopulmonary aspergillosis
- Exist only as mold w/ septate hyphae that branch at a V-shaped angle

Front 44

Aspergillus fumigates:
Lab Dx

Back 44

- Can see septate hyphae & forms colonies w/ radiating chains of conidia

Front 45

Aspergillus fumigates:
Treatment

Back 45

- Amphotericin B for invasive asp.

Front 46

Mucor & Rhizopus species:
Features

Back 46

MOLDS W/ NONSEPTATE HYPHAE W/ RIGHT ANGLE BRANCHING

90° Angle!!

Front 47

Mucor & Rhizopus species:
Trasmission

Back 47

- Inhalation of airborne sporangiospores

Front 48

Mucor & Rhizopus species:
Pathogenesis

Back 48

- Ketoacidotic diabetic & leukemic pts
-Hyphae invades mucosa & goes into tissue & vessels → leads to necrosis & infarction
- Erode in bones of cranium → causes life threatening meningitis and/or encephalitis
- Dz: mucormycosis

Front 49

Mucor & Rhizopus species:
Lab Dx

Back 49

- Forms colonies w/ spores contain w/in a sporangium

Front 50

Mucor & Rhizopus species:
Treatment

Back 50

- Amphotericin B & surgical removal of necrotic inf tissue

Front 51

Pneumocystis carinii (jirovecii):
Transmission

Back 51

- Inhalation

Front 52

Pneumocystis carinii (jirovecii):
Pathogenesis

Back 52

- Organisms bilaterally in interstitial space & alveoli cause inflammation
- Immunosuppressd pts predisposed to dz

Front 53

Pneumocystis carinii (jirovecii):
Lab Dx

Back 53

- Organisms visible in silver stain of lung

Front 54

Pneumocystis carinii (jirovecii):
Treatment

Back 54

- TMP-SMX