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- All can cause pneumonia and can disseminate:
- All are dimorphic fungi:
- -Cold (20°C) = mold
- -Heat (37°C) = yeast
is a spherule (not yeast) in tissue.
- -fluconazole or ketoconazole for local infection
- -amphotericin B for systemic infection
Systemic mycosis can mimic TB (granuloma formation), except (unlike TB) have no person-person transmission
Endemic location: Mississippi and Ohio river valley
Pathology: Macrophage filled with Histoplasma (smaller than RBC)
Histo Hides (within macrophages). Bird or bat droppings
Endemic location: east of Mississippi River and Central America
Disease: inflammatory lung disease that can disseminate to skin and bone. Forms granulomatous nodules
Pathology: Broad-base budding (same size as RBC)
Blasto Buds (Broadly)
Endemic location: Southwestern US, California
Disease: pneumonia and meningitis; can disseminate to bone and skin
Spores in dirt; increased rate after earthquakes
Pathology: Spherule filled with endospores (much larger than RBC)
Coccidio Crowds. San Joaquin Valley (or Imperial Valley) or desert "valley fever"
- Endemic location:Latin America
- -Rare, but most severe
Budding yeast with "captain's wheel" formation (much larger than RBC)
Captain wheel appearance. P
arasails with the captain's wheel
all the way to Latin America
- 1. Tinea versicolor
- - Caused by Malassezia furfur. Degradation of lipids produces acids that damage melanocytes and cause hypopigmented and/or hyperpigmented patches
- -Occurs in hot, humid weather
Topical miconazole, selenium sulfide (Selsun)
Spaghetti and meatball
appearance on KOH prep
- 2. Other tineae
- -tinea pedis (foot), tinea cruris (groin), tinea corporis (ringworm, on body), tinea capitis (head, scalp)
- -Pruritic lesions with central clearing resembling a ring, caused by dermatophytes (Microsporum, Trichophyton, and Epidermophyton)
See mold hyphae in KOH prep, not dimorphic
Opportunistic fungal infections
- Candida albicans
- Aspergillus fumigatus
- Cryptococcus neoformans
- Mucor and Rhizopus spp.
- Pneumocystis jiroveci
- Sporothrix schenckii
Systemic or superficial fungal infection
- -oral and esophageal thrush in immunocompromised (neonates, steroids, diabetes, AIDS),
- -vulvovaginitis (diabetes, use of antibiotics),
- -diaper rash,
- -endocarditis in IV drug users,
- -disseminated candidiasis (to any organ),
- -chronic mucocutaneous candidiasis
topical azole for vaginal; fluconazole or caspofungin for oral/esophageal; amphotericin B, fluconazole, or caspofungin for systemic
(alba = white)
Invasive aspergillosis - especially in immunocompromised and those with chronic granulomatous disease
- 1. Allergic bronchopulmonary aspergillosis: with asthma or CF
- 2. Aspergillomas in lung cavities especially after TB infection
- 3. Some species of Aspergillus produce aflatoxins, which are associated with hepatocellular carcinoma
- 4. Invasive and/or disseminated disease in immunocompromised patients, especially in lungs.
ngles in A
Cryptococcal meningitis, cryptococcosis
-Heavily encapsulated yeast
. Not dimorphic
- -Found in soil, pigeon droppings
- -Acquired through inhalation with hematogenous dissemination
-Culture on Sabouraud's agar. Stains with India ink. Latex agglutination test detects polysaccharide capsular antigen and is more specific.
"Soap bubble" lesions in brain
and Rhizopus spp.
Disease mostly in ketoacidotic diabetic and leukemic patients
Fungi proliferate in blood vessel walls
when there is excess ketone and glucose, penetrate cribiform plate, and enter brain.
Rhinocerebral, frontal lobe abscesses
Headache, facial pain, black necrotic eschar on face; may have cranial nerve involvement
Causes diffuse interstitial pneumonia
- -most infections are asymptomatic
- -Immunosuppression predisposes to disease
- -Diffuse, bilateral CXR appearance
Dx: lung biopsy or lavage
- Disk-shaped yeast forms on methenamine silver stain of lung tissue
- Tx: TMP-SMX, pentamidine, dapsone.
- -Start prophylaxis when CD4 drops <200 cells/mL in HIV patients
- Dimorphic, cigar-shaped budding yeast that lives on vegetation
- -When traumatically introduced into the skin, typically by a thorn ("rose gardener's" disease), causes local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis).
- -Little systemic illness
itraconazole or pot
assium iodide. ("Plant a rose
in the pot
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