Week 1 - Day 4 Notes Contd Fungus

Front 1

Name the fungus infections on the superficial layer of skin? Appearence?

Back 1

1. Pityriasis versicolor- Malassezia furfur, multicolored (hypo or hyperpigmented)
2. Tinea nigra - Exophilala werneckii, black

Front 2

The common dermatophytes? What fungal infections do they cause?

Back 2

1.Microsporum, trichophyton, dermatophyton
2. Tinea corpris,T.capitis, T.Crusis (jock itch), T. pedis (athlete's foot)

Front 3

Superficial fungal infection caused by Exophialla werneckii. Now called Phaeoannellomyces werneckii

Back 3

Tinea nigra (not a true tinea)

Front 4

Pityriasis versicolor is also superficial and is caused by what organism?

Back 4

Malassezia furfur

Front 5

M. furfur appears in what pattern on KOH?

Back 5

spaghetti & meatballs

Front 6

Fluoresces bright green on wood's light (a dermatophyte) and is carried by animals.

Back 6

Microsporum.

Front 7

Copper-colored soil saprophytes cause this condition. Phialophora and Cladosporium
Hint: THe chromo man blasting mushrooms on skin

Back 7

Chromoblastomycosis

Front 8

Tx for sporotrichosis

Back 8

Oral KI or amphotericin B (if systemic)

Front 9

First line drugs for dermatophytoses

Back 9

topical imidazoles

Front 10

Used to treat tinea capits and tinea unguinum. Given orally

Back 10

griseofulvin

Front 11

Primary manifestation of Cryptococcus? Describe this fungal bug?
What population of patients are susceptible to Cryptococcus infections?

Back 11

1. meningoencephalitis
2. Polysaccharide encapsulated yeast (not dimorphic)
3. AIDS patients

Front 12

Stain to see capsules of cryptococcus

Back 12

india ink

Front 13

Treatment of cryptococcus (2 drugs)

Back 13

ampho B and flucytosine

Front 14

IF you suspect disseminated candidiasis, what part of the body must be checked for fluffy white candidal patches?

Back 14

retina with ophthalmoscope

Front 15

Two fungi like bacteria

Back 15

Nocardia/ actinomycetes

Front 16

Treatment for nocardia

Back 16

TMP/SMX (treatment of Nocardia/actinomycetes is a SNAP) SULFA FOR NOCARDIA. ACTINOMYCTES GIVE PENICILLIN

Front 17

Two antifungals given for more serious infections (one is orally administered. the other is not)

Back 17

ampho B (not oral. IV or intrathecal). & Itraconazole (oral)

Front 18

In addition to the azoles, ----- and ----- may be given for superficial fungal infections

Back 18

griseofulvin and nystatin

Front 19

T/F the azotemia caused by AmphoB is not reversible and will not subside when the drug is stopped.

Back 19

False. It is reversible!

Front 20

A common side effect after infusion of amphoB

Back 20

acute febrile reaction

Front 21

name two other side effects of ampho B

Back 21

anemia, phlebitis at IV site

Front 22

How does ampho B cause lysis of the fungal cell?

Back 22

binds to ergosterol and disrupts membrane

Front 23

Why is flucytosine rarely used alone?

Back 23

rapid development of resistance

Front 24

Flucytosine use is largely restricted to Tx of ---- ---- in conjunction with amphoB

Back 24

crypto meningitis

Front 25

Side effects of Flucytosine

Back 25

bone marrow suppression, nausea, diarrhea (like any other antimetabolite)

Front 26

Tx for chronic mucocutaneous candidiasis

Back 26

ketoconazole

Front 27

Why is there gynecomastia, and decreased sex drive on ketoconazole?

Back 27

P450 inhibition causes inhibition of testosterone synthesis

Front 28

Ketoconazole side effects other than inhibition of testosterone synthesis:

Back 28

hepatotoxicity, adrenal suppression, GI upset common

Front 29

The big picture of fluconazole is that it kills what organism very well? Think yeast infections. Only one dose of fluconazole is needed to Tx yeast infections.

Back 29

Candida albicans

Front 30

The azoles work by inhibiting ----- ------ which is necessary for ergosterol synthesis.

Back 30

P450 system

Front 31

Tx of oral, esophageal, and GI candidiasis. Not absorbed orally

Back 31

Nystatin, swish and swallow

Front 32

Like amphoB, nystatin binds to -----.

Back 32

ergosterol

Front 33

Griseofulvin is used to treat dermatophyte infections by what mechanism?

Back 33

prevents mitosis by preventing spindle formation

Front 34

KI is used to treat what fungal infection if it is not systemic?

Back 34

Sporotrichosis

Front 35

Drug that blocks fungal ergosterol synthesis by inhibiting formation of squalene epoxide from squalene.

Back 35

terbinafine

Front 36

Where does terbinafine accumulate?

Back 36

nails

Front 37

What the function of KOH -in the preparation of fungal specimen?

Back 37

To digest any non-fungal debri

Front 38

Name the essential sterol for fungal cell membrane?
Name drugs that bind to it?
Name drugs that inhibit this sterol's synthesis?

Back 38

1. Ergosterol
2. Amphotericin B and Nystatin
(they punch holes in the cell membrane)
3. Ketoconazole (inhibits the synthesis of ergosterol)

Front 39

Who are susceptible to Sporothrix Schenckii?
Tx?
(hint for both: Pot)
Location of infection and presentation?

Back 39

1.Gardeners
2.Potassium iodide
3.Due to trauma - gets to lymphatics
Track of nodules along the subQ lymp - that necrosis and propagate.

Front 40

1.Route of infection of Cryptococcus neoformans (not this is not coccidiodes)
2. Describe the presentation of the Cryptococcal meningitis?
3.Tx

Back 40

1. Pigeon droppings
2. Subacute to chronic meningitis. notably Cerebral edema--> brainstem compression.
3. Amphotericin B and Flucytosine

Front 41

Histoplasma capsulatum and Blastomyces dermatitidis are common in what region of the US? Coccidiodes immitis?
What kind of fungus are they?
Common clinical presentation?

Back 41

1. Histoplasma capsulatum (not capulated) and Blastomyces are endemic in regions around the Mississippi river.
2. Coccidiodes immitis - Southwestern
3. All present like TB (inhaled,mild-chronic infections, granulomas,can disseminate in blood, Skin like PPD)

Front 42

Histoplasma capsulatum, Blastomyces dermatitidis, Coccidiodes immitis
How do they differ from TB?

Back 42

1.No person to person transmission
2.Fungi are spores, not acid-fast bacteria

Front 43

Clinical presentation of Candida Albicans in Normal host? Immunocomprimised?

Back 43

1. Diaper rash- warm moist areas (skin folds too in adults)
2. Vaginitis - thick copious secretion
3. Oral thrush-difficult to scrape

A.Esophagitis
B.Disseminated - use Ampho B or oral imidazole= Fluconazole

Front 44

Asthmas is associated with this fungus?
Why?

Back 44

1.Aspergillus flavus
2.Aspergillus flavus stimulates IgE type I hypersensitivity reaction.

Front 45

Where are Aspergilloma usually formed in the lungs?
Name the Hypersensitivity rxn Aspergillus can cause?

Back 45

1.In cavities - made by TB or cancer
2. Aspergillomas
3. Type I and Type IV(cell mediated)

Front 46

Name two fungi like bacteria? what type of bacteria are they and describe them?
Tx

Back 46

1. Actinomycetes and Nocardia (both g+)
A. Actinomycetes- g+ anaerobic,normal flora,forms sulphur like granules (these are colonies not sulphur), can form abscesses in mouth.
Tx= penicillin
B. Norcardia-g+,aerobic, not nl flora, Acid-fast, lung abscess,
Tx: Sulpha (TMP-SMX)