Micro Iii Systemic Mycoses

Front 1

whats endemic mycoses

Back 1

same as systemic

they are dimorphic (warm, yeast. cool, mold) soli fungi (geography is KEY) and cause respiratory and granulomatous infections. they have the potential to disseminate

** KNWO the gegraphical location

Front 2

wht are the 4 systemic mycoses

Back 2

1. Cocci immutis

2. Histoplasma capsulatum

3. blastomyces dermatitdits

4. Paracoccidioides brasilliensis

can attack immunocpmpetent as well as immunocomprimised pts

Front 3

where do we see cocci

immitis
posadasii

Back 3

in the S west and latin america

Valley fever, san joaquin valley fever
Dimorphic spherule

Immitis- cali only
posadasii- SW, outside of cali

Front 4

if you see paracoccidioides brasillenisis on a test...

Back 4

its the wrong answer

seen in peru and brazil

Front 5

whats seen in mississippi

Back 5

histoplasma capsulatum

Front 6

whats the morphology of cocci

Back 6

spherule w endospores
dimorphic (mold and yeast)
Arthoconidium (tennis bracelt) this is enfective

Front 7

whats the infectous form of cocci

Back 7

arthrocondidium, disjointed looking.

the hypha fragment easily and release arthrocondidia
spherule with endospores

Front 8

what happens if a cocci spherule ruptures

Back 8

releases endospores

there are arthrocondidia that are inefections (recall that thye are disjointed, they are seperated by disjuncter cells that are space holders, dont do anything)

Front 9

if you see a spherule with endospores in it, what systemic mycoses might you think of, where might the person live

Back 9

cocci

southwest

Front 10

what gives a person a + skin test for cocci

Back 10

coccidioidin, its the AG used in latex agglutination and complement fixation

Coccidiodin and Spherulin both used for immunodx

__broth filtrate from culture, cross reacts with histoplasma and paracoccidiodies

Front 11

what are coccidioidin and spherulin? what is a good prognostic marker in this disease

Back 11

AG used for immunodx of coccidiocomycoses

they are made in brothe when mycelium grows (mat of hypha)

good prognosis when there is erythema nodosum. this means T cells are working

Front 12

what is "the great immitator"

Back 12

cocci

pulm involvement with flu like sx- fever, malaise, cough, lymphadenopathy
can develop into diffuse pneumonia.

self limited OR
disseminated,

erythema nodosum is a good dx marker

can have extra pul in the meningies, joint, bones

Front 13

in cocci what happens when endospores are released from the spherule

Back 13

inhaled (arthrocondium)
endospores are released and make new spherules- sometimes septate hypha and arthrocondidia are sometimes associated with spherules in the pulm cavity

Front 14

22-year-old man presents to the ER w/ what appears
to be a scaly, verrucous rash involving the side of his
nose, his left shoulder, the right side of his back, & the
left posterior aspect of his thigh. Approximately 4 wk
prior to presentation, the patient had been treated in the
ER for the same rash. At the time of the initial visit, he
denied fevers, night sweats, & chills. During the review
of the history, he stated that he had recently moved to
Las Vegas from Southern California, but he denied
having any unusual exposures & was not taking any
medications at that time. MRSA was initially diagnosed,
& the patient was treated w/ a 10-day course of TMP-
SMX & rifampin & discharged to home. Several weeks after the initial presentation, the
patient returns to the ER because the rash is not
improving & he is now experiencing night sweats,
arthralgia, & back pain. whats the dx

Back 14

coccidioidomycosis

clues: las vegas, disseminated to nose, etc

Cultures grew Coccidioides.An immunoassay (spherulin, coccidionin)
revealed a complement fixation (CF) titer of 1:128,
w/ positive IgG & IgM (recent) antibodies

SPHERULE!!!! with endospores in it

Front 15

A Mexican patient who works as a landscaper in Phoenix presents w/ a buccal abscess at the extraction site of a molar. The molar was removed 30 days earlier & now an adjacent molar has started to loosen. Microscopic views of the infected tissue (PAS stained) is shown. What is the most likely diagnosis

1 Gingivostomatitis
2 Streptococcal cellulitis
3 Ulcerative gingivitis
4 Disseminated coccidioidomycosis
5 Candidal periodontal disease

Back 15

disseminated coccidioidomycosis

will have spherule with endospores. BE ABLE TO RECOGNIZE

Front 16

who is more apt to disseminated cocci

Back 16

1. Ethnic- mexican. asian, african american, native american

Preg: increased estradiol and progesterone

Innunodeficient: AIDS defining illness

Chorioetinitis

Front 17

what happens to a preg black woman with cocci

Back 17

highly probable to disseminate

More likely to disseminate
preg
black, mexican, asiain, native american,
AIDS
Chorioretinitis

**pooly understood racial connection
**tought that deficient cell mediated immunity in AIDS
**thought thtat increased estradiol and progesterone in preg

Front 18

in what disease might we see erythema nodosum? is this good or bad

Back 18

cocci

its a good sign, it means T cells are working

**allergic respose, happens 1 mo after infection, allergic response, no organisms are present

Front 19

how can you get cocci

Back 19

be in SW
breath it, NON communicable!!!
arthrocondia are in soil and in LAB...

more susceptible if you are preg, black, asain, indian, hispanic, AIDS

Front 20

hwo can you ID cocci

Back 20

spherule with endospores

1. KOH fresh samples
2. PAS for fixed tissue

Cuture 25* mold, BWARE OF ARTHROSPORES can be inhaled

IgG IgM to coccidiodin/spherulin

Front 21

whats the DOC for cocci

Back 21

-azole (fluconazone) or amphotericin B (both target egesterole)

long term tx, supporative

Front 22

how can you control cocci infections

Back 22

dust control, pave roads, plang vegetation to keep soil down

NO VACCINE

Front 23

what is teh dx feature of histo

Back 23

it has both micro and macro conidium, but the MACRO have PROJECTIONS, tuberculate macrocondidium

take 3 mo to grow!!!

Front 24

what is the infective form of histoplasma, whats the dx form

Back 24

infective: microconidium

dx: tuberculate macroconidium (its the projections off of the macro)

Front 25

what is the AG that is good for immunodx of histoplasma

Back 25

histoplasmin

**made in broth that mycelium grows

Front 26

whats the pathogenesis of histoplasma

Back 26

you inhale MICROconidia and they develop into yeast cells in you, the can he phago and disseminated

will cause flu like lung disease, reticuloendothelial disease

Front 27

which endemic mysocses is a reticuloendothelial disease

Back 27

histoplasma

often seen as a yeast within a macro, recall yeast will bud

The MICROcondidia is inhaled but then grows as a yeast within us

Front 28

if you have a granulomatous foci with a miliary apprearance on CXR what type of endemic mycoses may be present

Back 28

histoplama

if you see giant cells, think fungus, can be disseminated in skin and gums

Front 29

what are hte virulence factors associated with histoplamsa

Back 29

release urease to increase pH so PMN cant kill!!! phagolysosome wont work

BUT... the host has fungistatic activity. there can be CMI against this intracellular bug and killed

Front 30

where can we get histoplams from

Back 30

Mississippi!!! Ohio and Mississippi river valleys

NOT form other ppl, not comunicable

Foud in soil enriched with poo, found in bat intestines

Front 31

so I just got back from mississippi where i played on the river bank and watched bats at night, now I have a granuloma foci and miliary dissemination of CXR

Back 31

Histoplamsa

* on looking I have microscopic intracellular pathogens (inside of macro)

Front 32

whats the DOC for histoplasma

Back 32

itraconazole
amphotericin

**pretty much the same as candidia, candidia wanted fluconazole

Front 33

how can we prevent histoplasm

Back 33

dust protection
formaldehyde soil spraying

**dont inhale soil near mississippi orhi river valley that has poo in it. also stay away from bats

Front 34

A man who works for a tree service business in Ohio,
develops a prostrating flu-like illness, marked w/ fever,
malaise, & a persistent cough. Yeast cells, including
cells within macrophages, are visualized in the
microscopic exam of the sputum. The diagnosis is:

Candidiasis
2 Coccidioidomycosis
3 Histosplasmosis
4 Blastomycosis
5 Paracoccidioidomycosis

Back 34

histoplasmosis

Front 35

tell me about blastomyces dermatitidis

Back 35

also found in OH/Mississippi (same as histo)

causes simliar sx and is also foudn in soil BUT... blastomyces has a broad based yeast

Front 36

ok so the infective state of histo is microconidium, what is it for blastomyces

Back 36

microcondidium. SAME

Front 37

whats the opprotunistic infection that has a reall broad based bud

Back 37

blastomyces

**other than this morphology difference its pretty much the same as histo. can cause granulomas

Front 38

can blastomycosis dieeminate from the 1 lung infection? where is blastomycosis

Back 38

yep!

its in OH and mississippi but extends just a bit further east than histo

Front 39

what endemic mycoses will be the WRONG answer and has multiple buds and is treated for 2+ years

Back 39

paracoccidioides brasiliensis