Mycology

Front 1

Systemic mycoses

Back 1

1- All cause pneumonia and can be disseminated

2- Caused by dimorphic fungi

1- Cold (20•C)- Mold

2- Heat (37•C)- Yeast

3- Can form granulomas

4- Can not be transmitted person to person

4- Treatment fluconazole or itraconazole for local infection

Amphotericin B for systemic infection

5- Types 1- Histoplasmosis

2- Blastomycosis

3- Coccidiomycoais

4- Para- coccidiomycosis

Front 2

Histoplasmosis

Back 2

1- Mississippi and Ohio, River valleys

2- Macrophages filled with histoplasma (small than RBC)

3- Signs 1- Palatal/tongue ulcer

2- Splenomegaly

3- Pancytopenia

4- Associated with bird or bat droppings

5- Diagnose with urine/serum antigen

Front 3

Blastomycosis

Back 3

1- Eastern and Central US, Great Lakes

2- Broad based budding with Blastomyces (small size as RBC)

3- Signs 1- Inflammatory lung disease

2- Disseminated to bone/skin (mimmic SCC)

3- Formationnof granulomatous nodules

Front 4

Coccidiomycosis

Back 4

1- Southwestern US, California

2- Spherule filled with endoscopic coccidioides (larger than RBC)

3- Sign 1- Disseminated to bone/skin

2- Arthralgia(desert rheumatism)

3- Meningitis

4- Erythema nodisum or marginatum

4- Associated with dust exposure in endemic areas

Front 5

Paracoccidiomycosis

Back 5

1- Latin America

2- Budding yeast of paracoccidiodes in captains wheel formation (larger than RBC)

3- Signs (same as blastomycosis)

1- Inflammatory lung disease

2- Disseminated to bone/skin

3- Formation of granulomatous nodules

4- Male> female

Front 6

Tinea ( dermatophyte)

Back 6

1- Clinical name for dermatophyte (cutaneous fungal) infection

2- Branched septae hyphae visualized on KOH preparation with blue fungal stain

3- Three types 1- Microsporum

2- Trichophyton

3- Epidermophyton

4- Associated with Pruritus

Front 7

Tina capitis

Back 7

1- Occurs on head and scalp

2- Associated with 1- Alopecia

2- Lymphadenopathy

3- Scaling

Front 8

Tinea corporis

Back 8

1- Occurs in body (usually torso)

2- Characterised by enlarged erythematous scaly ring with central clearing (ring worm)

3- Can be acquired from contact with infected pets or farm animals

Front 9

Tinea Curis

Back 9

1- Occurs in inguinal area

2- Often does not show central clearing

Front 10

Tinea pedis

Back 10

1- 3 variants 1- Interdigital

2- Moccasin distrubution

3- Vesicular type

Front 11

Tinea unguium

Back 11

1- Occurs on nails

2- Onychomycosis

Front 12

Tinea (pityriasis) versivolor

Back 12

1- Cause by Malassezia spp (pityrosporum spp)

2- Yeast like fungus (not a dermatophyte)

3- Degradation of lipid into acid that inhibit tyrosinase (involved in melanin synthesis) - Hypopigmentation

4- Hyperpigmentation and pink patches can occur due to inflammatory response

5- Less Pruritus

6- Occurs anytime of year most common at summer (hot humid climate)

7- Spaghetti and meatball appearance on microscopy

8- Treatment - Selenium sulfide, toipical or oral antifungal

Front 13

Pneumocystis jirovecii

Back 13

1- Causes pneumocytis pneumonia a diffuse interstitial pneumonia

2- Yeast like fungus

3- Most infections are asymptomatic

4- Immunosuppression (eg HIV) predispose to disease

5- Diffuse bilateral ground glass opacity on chest imagining with pneumoceles

6- Diagnose with bronchoalveolar lovage or lung biopsy

7- Disc shape yeast with methenomine silver stain or fluorescent antibody

8- Treatment- 1- TMP-SMX

2- Pentamide

3- Dapsone (prophylaxis as single or combined agent)

4- Atorvaquone

9- Start prophylaxis if CD4 count < 200 in HIV patients

Front 14

Sporothrix schencki

Back 14

1- Causes sporotrichosis

2- Dimorphic fungus

3- Exist as cigar shaped yeast at 37•C in human body and Hyphae with spores in soil (conida)

4- Lives in vegetation

5- When spores are traumatically introduce in the skin, typically by thorn (rose gardener disease) cause local pustules or ulcers with nodules along draining lymphatics (ascending lymphongenitis )

6- Disseminated disease possible in immunocompromised host

7- Treatment 1- Itraconazole

2- Potassium iodide (only cutaneous/lymphocutaneous)

Front 15

Opportunistic fungal infections

Back 15

1- Candida albicans

2- Aspergillus fumigatus

3- Crytococcus neoformans

4- Mucor and Rhizopus spp

Front 16

Candida albican

Back 16

1- Alba- white

2- Dimorphic psuedohyphae and budding yeast at 20•C and germ tube at 37•

3- Systemic and superficial infection

4- Causes 1- oral and esophageal thrush in immunocompromised patients

2- Vulvovaginitis (diabetics, use of antibiotics)

3- Diaper rash

4- Endocarditis (IV drug users)

5- Disseminated candidiasis

6- Chronic Mucocutanous candidiasis

5- Treatment- oral fluconazole

Amphotericin B for systemic infection

Front 17

Aspergillus fumigatus

Back 17

1- Septae hyphae that branch at 45•

2- Some species of Aspergillus produces Aflatoxin (associated with HCC)

3- Cause 1- Invasive aspergillosis In immunocompromised

2- Neutrophil dysfunction (chronic granulomatous disease)

3- Aspergillomas in pre existing lung cavities especially TB

4- Treatment- Variconozole or echocondise

Front 18

Allergic bronchopulmonary aspergillosis (ABPA)

Back 18

1- Hypersensitivity response to Aspergillus in lung mucosa

2- Associated with asthma and cystic fibrosis

3- Can cause Bronchiectasis and esiniphilia

Front 19

Cryptococcus neoformans

Back 19

1- 5-10um with narrow budding

2- Not Dimorphic

3- Encapsulated

4- Found in soil and pigeon droppings

5- Causes 1- Cryptococcosis

2- Cryptococcal meningitis

3- Cryptococcal encephalitis (soap bubble lesions in brain)

6- Acquired by inhalation with hematogenous dissemination to meninges

7- Diagnosis 1- India ink (clear halo)

2- Mucicarmine (readiness capsule)

3- Latex agglutination test of polysaccharide capsule antigen

8- Treatment - Amphotericin B followed by fluconazole of meningitis

Front 20

Mucor and Rhizopus spp

Back 20

1- Irregular, broad non-septa at wide angles

2- Inhalation of spore - Fungi profligate in blood vessel wall- penetrate cribriform plate- enter brain

3- Cause 1- Mucosmycosis (mostly in ketoacidosis diabetic and/or neutropenia patient)

2- Rhinocerebral/ frontal lobe abscess

3- Cavernous sinus thrombosis

4- Headache

5- Facial pain

6- Black necrotic eschar on face

7- May have cranial nerve involvement

4- Treatment 1- Surgical debridement

2- Amphotericin B or isovuconazole