Microbiology 3 - Mycology

Front 1

4 Systemic Mycoses

Back 1

1) Histoplasmosis
2) Blastomycosis
3) Paracoccidiodomycosis
4) Coccidiomycosis

All cause Pneumonia

All are Dimorphic Fungi (ie. different in heat than cold)
Cold (20 deg. C) = Mold
Heat (40C) = Yeast
Exception is Coccoidomycosis = Spherule instead of a yeast

Front 2

Systemic Mycoses v. TB

Back 2

similar that they both cause granuloma formation BUT Mycoses can not be transmitted person-person

Front 3

Treatment for Mycoses

Back 3

Local = Fluconazole or Ketoconazole

Systemic = Amphotercin B

Front 4

MYCOLOGY
How are Coccidiomycosis and Histoplasmosis transmitted?

Back 4

Via inhalation of asexual spores (conidia)

Front 5

MYCOLOGY
Histplasmosis is endemic to which geographic region?

Back 5

Mississippi and Ohio river valleys

Front 6

MYCOLOGY
Blastomycosis is endemic to which geographic region?

Back 6

States east of Mississippi River and Central America

Front 7

MYCOLOGY
Coccidiomycosis is endemic to which geographic region?

Back 7

Southwestern United States, California, San Joaquin Valley/desert

Front 8

MYCOLOGY
Paracoccidioidomy is endemic to which geographic region?

Back 8

Rural Latin America

Front 9

MYCOLOGY
Describe the morphology of histoplasmosis.

Back 9

"Histo hides (within macrophages)"

Macrophage filled with Histoplasma

Front 10

MYCOLOGY
Describe the morphology of Blastmycosis

Back 10

"Blasto Buds"

Broad-base budding yeast

Front 11

MYCOLOGY
Describe the morphology of Coccidiomycosis

Back 11

Spherule filled with endospores

Front 12

MYCOLOGY
Describe the morphology of Paracoccidioidomy

Back 12

"Paracoccido w. the Captains Wheel all the way to Latin America"

Budding yeast with a "captain's wheel" formation

Front 13

MYCOLOGY
Histoplasmosis, Blastomycosis, Coccidiomycosis, and Paracoccidioidomy are all dimorphic fungi. Pray tell, what does that mean?

Back 13

They are mold in soil (low temperature) and yeast in tissue (high temperature) with the exception of Coccidio-spherule in tissue.

Front 14

MYCOLOGY
Describe the symptoms produced by histo/coccidio/blasto and paracoccidio

Back 14

Inhaled primary lung infection, can be asymptomatic/mild/severe or chronic lung infections.
Also see granulomas, calcification, cavitation, hematogenous dissemination

Front 15

MYCOLOGY
What is the treatment for histo, blasto, coccidio, and paracoccidioid...?

Back 15

Local infection: fluconazole or ketoconazole
Systemic: amphotericin B

Front 16

MYCOLOGY
Your patient presents with hyperpigmented patches that stay white in the sun while the surrounding skin tans. A KOH prep shows a "Spaghetti and meatball" appearance. What does he have and how are you going to treat it?

Back 16

He's got Tinea versicolor.

Tx: Topical miconazole, selenium sulfide

Front 17

Tinea Versicolor

Back 17

A cutaneous Mycoses
-Caused by malassezia furfur

lipids are degraded and produce acids that damage melanocytes + cause hyper or hypopigmented areas of the skin.

Front 18

MYCOLOGY
A four year old patient presents to clinic with a ring shaped rash with a raised red border. Her mom tells you she spends all of her time playing with the family's new kitten.

What does she have, how will it present on KOH prep + how do you tx?

Back 18

Tinea corporis (aka ringworm) caused by Dermatophytes (Microsporum, Trichophyton, Epidermophyton).

Also called Tinea pedis (foot), Cruris (groin), Capitis (Head)

KOH Prep: Mold Hyphae (not dimorphic)

Tx:Topical azoles.

Front 19

What type of Dermatophyte are pets a resevoir for?

Back 19

Microsporum

Front 20

MYCOLOGY
Your gyn patient presents with vaginal itching and a thick, copious discharge. She recently had a course of antibiotics for a UTI. On speculum examination you find an inflamed vaginal mucosa and a cottage-cheese discharge. What are you thinking she has, how will you treat?

Back 20

Candida albicans can cause vulvovaginitis in pts with a high pH, diabetes, use of antibiotics, and with oral contraceptives and during pregnancy.

Tx: Nystatin for superficial infxn
Amphotercin B for Serious Systemic Infxn

Front 21

Candida Albicans Microscopically

Back 21

Dimorphic yeast

at 20C = Pseudohyphae
at 37C= Germ Tubes (DIAGNOSTIC)

Front 22

Name the 6 different ways that Candida Albicans can present.

Back 22

1. Oral or esophageal thrush in immunocomprimised patients
2. Vulvovaginitis
3. Diaper rash
4. Endocarditis in IV drug users
5. Disseminated candidiases (any organ)
6. Chronic mucocutaneous candidiasis

Front 23

Your TB patient returns to clinic with wheezing and coughing. His labs reveal eosinophilia. On chest x-ray you find....what???

Back 23

A MASSIVE ASPERGILLOMA!!!
Allergic Broncho-Pulmonary Aspergillosis where the fungi infects a preformed cavitary lesion

Front 24

Aspergillus Fumigatus presents Microscopically as...

Back 24

"Acute Angle Aspergillosis"

Mold w. Septate Hyphae that branch at acute angles ;45
degrees.

Rarely may see Fruiting Bodies

Front 25

Different Presentations of Aspergillosis + what is the most likely organ affected?

Back 25

Affects the Lungs (Esp. in Immunocompromised ppl w. Chronic Granulmatous Dz)

1) Allergic Bronchopulmonary Aspergillosis
2) Aspergilloma (Fungas Ball)
3) Invasive Aspergillosis

Front 26

Cryptococcus Neoformans

Back 26

Yeast with Wide Capsular Halo (Heavily Encapsulated) ; Not dimorphic

found in soil + pigeon Droppings

Soap Bubble Lesions seen in brain

Conditions= Cryptococcus Meningitis + Cryptococcosis

Front 27

How do you stain + grow Cryptococcus Neoformans??

Back 27

Stains with India Ink, grows on Sabourd's Agar

Latex agglutination test detects polysaccharide capsular antigen + is more Specific.

Front 28

MYCOLOGY
Your highly sexually active friend has stopped texting you in favor of using homing pigeons. He's got like 50 of them. His latest air-text reads: "Dude, I've got this massive headache and I can't touch my chin to my chest. Here's a sample of my CSF." You bust out your home-microscope and it's totally India Ink Positive and has latex agglutination for polysaccharide capsular antigens. What do you air-text back?

Back 28

"Bro, I think you have cryptococcus neoformans, it's this narrow based unequal budding yeast thing causing some meningioencephalitis. Also think you might have AIDS. Shoulda used a condom."

Front 29

Mucor + Rhizopus

Back 29

MOLD w. irregular nonseptate hyphae branching at WIDE angles

fungi proliferate in blood vessel walls, if excess ketone + glucose is present, they penetrate the cribiform plate + enter the brain.

Rhinocerebral, frontal lobe abscess

Symptoms: headache, facial pain, black necrotic eschar on face + cranial nerve involvement.

Front 30

MYCOLOGY
In which patients are you likely to find Mucor and Rhizopus proliferating in vessel walls and causing infarction and necrosis of distal tissue and rhinocerebral frontal lobe abscess?

Back 30

Mostly in ketoacidotic diabetic and leukemic patients

Front 31

Pneumocystis Jiroveci

Back 31

saucer shaped yeast forms

Seen in immunosuppressed ppl + causes Diffuse Interstitial Pneumonia

Test: Methanimaine silver stain of lung tissue

Front 32

MYCOLOGY
Your AIDS patient comes to clinic with shortness of breath. On CXR you see diffuse bilateral infiltration (interstitial pneumonia). you do a methenamine silver stain and identify squished ping-pong shaped fungi. What's the causitive organism, and how are you going to treat it?

Back 32

Pneumocystis jiroveci (formerly carinii, formerly a protozoan).

Tx: TMP-SMX, pentamidine,+ dapsone.

Prophylaxis when CD4 counts drop below 200 cells/mL

Front 33

Sporothrix Schenckii

Back 33

"Rose Gardener's Disease"-

Cigar Shaped Yeast Forms + Unequal budding


Traumatically introduced into skin (by thorn)-->Pustules or nodules along draining lymphatics

Front 34

Treatment for Sporothrix Schenckii

Back 34

"plant a ROSE in the POT"

Itraconazole or POTassium Iodide

Front 35

MYCOLOGY
Your patient was so sweet to bring you a bouquet of roses from her garden, where she spends a lot of time. She pricked herself on a thorn and has since developed a pustule with nodules draining along her lymphatics. What will you see on microscopic exam and how are you going to treat it?

Back 35

Cigar-shaped budding yeast confirms SPOROTHRIX SCHENCKII

Tx: Itraconazole or Potassium iodide.

Front 36

PARASITOLOGY
Despite your best efforts to dissuade your thirsty friend, she drank the pond water anyway. Now she's bloated, farting up a storm, and keep running in the bushes to produce a foul smelling diarrhea. How are you going to confirm her diagnosis of Giardia? What should she take to treat it?

Back 36

Trophozoites or cysts in stool
Tx: metronidazole

"Think Giardia like fat rich Ghiradelli chocolate for fatty stools"

Front 37

Entamoeba Histolytica

Back 37

Blood Diarrhea (Dystentery) + Liver Abscess (Red/Brown)
Flask shaped Ulcer

from Cysts in Water

RBCs found in cytoplasm of Entaemoba

Tx. Metradiozole or Iodoquinol

Front 38

Cryptosporidium

Back 38

Acid Fast Cysts

severe diarrhea in AIDs , but mild dz in normal ppl

No Treatment

Front 39

Toxoplasma Gondii

Back 39

Cysts found in meat or cat feces

Can Cross Placenta

Congenital Toxoplasmosis Triad: 1) Chorioretinitis
2) Hydocephalus
3) Intracranial Calcification

Brain Abscess in HIV


Tx. Sulfadiazine + Pyrimethamine

Front 40

Naegleria Fowleri

Back 40

"Nalgene bottle with Freshwater"

Swim in fresh water + enter via Cribiform Plate

"Brain eating ameoba" +found in CSF
Rapidly Developing Meningitis

Tx: Amphotericin may help

Front 41

Your penpal from AFRICA writes of his family's affliction: they have SPORADIC FEVERs, SLEEP a lot, and have LARGE LYMPH NODES. He also describes a recent school outing where he and his classmates caught thousands of TSETSE flies. What is this and what does his family need to take?

Back 41

Organism = Trypanosoma Brucei or (T.Rambiense or T.Rhodesiense)



Tx: SURamin for bloodborne disease or MELArsoprol for CNS penetration

"SURe is nice to sleep, MELAtonin helps with sleep"

Front 42

PARASITOLOGY
Your patient, an immigrant from South America, has you stumped, They've got toxic megacolon, megaesophagus, and dilated cardiomyopathy (or maybe just one of those things). What should you look for? How should you treat it?

Back 42

Organism = TRYPPANOSOMA CRUZI

Chagas Dz = megacolon, megaesophagus, +Dilated Cardiomyopathy

C-shaped trypanosomes on blood smear

Spread via the Reduviid bug(kissing bug "painless bite")

Tx: Nifurtimox

Front 43

Your friend did a tour in Iraq and came back with SPIKING fevers, HEPATOSPLENOMEGALY, and PANCYTOPENIA. On microscopy, his macrophages have AMASTIGOTES. How do you treat his illness?

Back 43

Organism = Leishmania donovani (spread by sandfly)

Amastigotes = form w/o flagella

Tx. Sodium stibogluconate

Front 44

PARASITOLOGY
Which form of malaria is severe (cerebral)?

Back 44

Plasmodium. falciparum

daily cycles, parasitized RBCs may occlude capillaries in brain (Cerebral malaria), Kidneys +Lungs

Front 45

PARASITOLOGY
Which form of malaria is relapsing (dominant forms in the liver)?

Back 45

P. ovale and P. vivax

Cycles occur every other day
Dormant form in liver = Hypnozoite

Front 46

Microscopic Description of Plasmodium

Back 46

Trophozoite Ring form in RBCs

RBC schizont w. merozoites

Front 47

PARASITOLOGY
How do you treat malaria?

Back 47

Start w. CHLOROQUINE (to prevent relapse)
if resistant give MEFLOQUINE

For Vivax/Ovale - Add PRIMAQUINE for dormant forms in Liver(Hypnozoite)

Front 48

Babesia

Back 48

Maltese Cross + Ring Forms , No RBC pigment

Babesiosis = fever + hemolytic anemia (Found in Northeast US)

Tx. Quinidine + Clindamycin

Front 49

Trichomonas Vaginalis

Back 49

Vaginitis - foul smelling green discharge w. itching + burning

Transmitted: Sexually (cyst form cant exist outside body)

Lab = Trophozoites on wet mount

Tx. Metronidazole

Front 50

Trichomonas Vaginalis v. Bacterial Vaginosis

Back 50

Vaginitis - caused by Trichomonas Vaginalis (a parasite)

VS.
Bacterial vaginosis= Gardenella Vaginalis = caused by Gardenella Vaginalis (a Gram Neg. Bacteria)

Front 51

PARASITOLOGY
It's like your tenth date with this totally cute guy, and you're ready to put out....but you have this foul smelling greenish discharge and itching and burning...you know....down there. What should you do????

Back 51

1. Save it for "the one"
2. Take some metronidazole for your trchomonas.
3. Take a sample and check out some totally cool motile trophozoites on a wet mount! (there's a pun in there somewhere)

Front 52

No Notecards on Helminths/Worms (P 162)

Back 52

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