Chapter 162- Deep fungal infections Flashcards by Beatrice Maxine Chan

Sporadic diseases contracted in the tropics, subtropics caused by fungi that have been introduced directly into dermis or subcutaneous tissue

Subcutaneous mycoses

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Etiology of Sporotrichosis (5)

S. Schenkii
S. Brasiliensis
S. Globosa
S. Lurieie
S. Mexicana

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One impt characteristic of sporotrichosis

Scarcity of organisms in tissue

Asteroid body

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More common forms of sporotrichosis

Lymphangitic form

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Patients with AIDS who develop sporotrichosis often who have multiple cutaneous lesions with prominent lymphatic involvement.
True or False

False, without

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Molds should be confirmed to yeast phase on enriched media at 37 C

Brain heart infusion agar

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Sporotrichosis may resolve spontaneously but persist for more than ___ years

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Treatment for Sporotrichosis (2)

Itraconazole 200 mg daily
Terbinafine 250 mg daily
KI 4-6 ml TID for 3-4 weeks

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Infection of chest wall is most characteristic of

Nocardia infection

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Key to establishing diagnosis of mycetoma

Grains

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Black grains are always caused by ___; Red grains are always caused by ___

Fungi

Actinomycetes

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Matching type

Pale white to yellow grains
Yellow to brown grains
Red to pink grains

A. Streptomyces brasiliensis
B. Actinomadura pelletieri
C. Actinomadura madurae
D. Nocardia brasiliensis

C D
A
B

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Treatment for Eumycetoma

Itraconazole 200 mg
Ketoconazole 200mg
Voriconazole 200- 400 mg

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Actinomycetoma is treated with

Dapsone + Streptomycin

TMP-SMX + Rifampin / streptomycin

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Definitive treatment for mycetoma

Surgery

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Used in recalcitrant Nocardia infections

Amikacin
Moxifloxacin
Imipenem

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Chronic fungal infection caused by pigmented (dematiaceous) fungi implanted into dermis

Chromoblastomycosis

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In chromobalstomycosis, they form thick walled single cells or cell clusters termed as ___ with paeudoepitheliomatous hyperplasia

Sclerotic or muriform bodies

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Etiologic agent of chromoblastomycosis

Philaophora verrucosa
Fonsacea pedrosoi
Fonsacea compactm
Cladophialophora carrionii
Wangiella dermatitidis

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Treatment for chromoblastomycosis

Itraconazole 200 mg daily
Terbinafine 250mg daily
If extensive,
IV amphotericin B 1mkday

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Etiology for phaeohyohomycosis

Exophiala jeanselmei

Wangiella dermatitidis

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Appear in immunosuppressed patients as short, irregular pigmented hyphae

Phaeohyohomycosis

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Cystic lesions casued by nonpigmented hyphae

Hyalohyphomycotic cysts

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Etiologic agent by lobomycosis

Lacazia loboi

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Treatment for lobomycosis

Surgical removal

SubQ mucormycosis characterized by woody cellulitis at limb girdle sites is caused by

Basidiobolus ranarum

Subq mucormycosis present in the inferior turbinates of nose with painless swelling of central part of the face with severe deformity is caused by

Conidiobolus coronatus

Treatment for subQ mucormycosis

Ketoconazole 400 mg daily Itraconazole 100-200mg daily KI 4-6 drops TID

Development of polyps affecting mucous membranes esp nasal mucosa

Rhinosporidiosis

Rhinosporidiosis is characterized by development of polyps studded with white flecks called

Sporangia

2 main varietis of endemic mycoses

Opportunistic mycoses | Endemic respiratory mycoses

Erythema nodosum may be caused by

Endemic mycoses

Sexual state of Histoplasma capsulatum

Ajellomyces capsulatus

Matching type 1. Biologic therapy 2. DM 3. Heart valve surgery 4. Abdominal surgery A. Candidiasis B. Endemic mycosis C. Mucormycosis

B C A A

Neutropenic patients are predisposed to (3)

Aspergillosis Candidiasis (Oropharyngeal, Systemic) Mucormycosis

Patients with CD4 lymphopenia (3)

Candidiasis (oropharyngeal) Cryptococcosis Endemic respiratory mycoses

This type of histoplasmosis is more common in HIV positive patients with widespread dissemination to liver, spleen, lymphoreticular system, and bone marrow

Acute progressive disseminated histoplasmosis

The most common presentation of chronic progressive disseminated histoplasmosis are (3)

Oral or pharyngeal ulceration Hepatosplenomegaly Adrenal insufficiency

T. Marneffei is differentiated from Histoplasma by its

Septum formation

Intradermal histoplasmin skin test is not useful as disseminated histoplasmosis is often negative. True or False

True

Rising complement fixation antibodies in histoplasmosis indicates

Dissemination

Precipitins by immunodiffusion are valuable due to presence of (2) antibodies

H- active infection | M- recent infection

MC involved sites of African Histoplasmosis

Skin, bone >> lymph nodes

African Histoplasmosis is caused by

Histoplasma capsulatum var. duboisii

Disseminated or localized histoplasmosis is treated with

Itraconazole 200-400mg daily

Blastomyces is a chronic mycosis caused by the dimorphic pathogen of

Blastomyces dermatitidis

Chief site of involvement of blastomycosis are

Lungs

Common presenting feature of disseminated blastomycosis

Skin manifestations | Hyperkeratotic, symmetric, affects face and extremities

Exposed to a cave, and presented with cough, chest pain, fever with accompanying joint pains and rash - toxic erythema, EN, or EM

Acute Pulmonary Histoplasmosis

Precipitating antibodies are present in the sera of infected patients, and a characteritic precipitin line

E band

Aside from Itraconazole, treatment for blastomycosis

Voriconazole for 6 months

Characteristic of coccidioidomycosis is a large spore containing structures in infected tissue in coccidioidomycosis

Spherules

Matching type 1. Nodule or indurated ulcer 2. Chancre 3. Indurated nodule 4. Acneiform pustules 5. Echthyma Gangrenosum 6. Target like lesions ``` A. Blastomycosis B. Coccidiodomycosis C. Histoplasmosis D. Aspergillosis E. Cryptococcosis F. Fusarium ```

``` C A B E D ```

Most common clinical type of coccidiodomycosis

Primary pulmonary form

Precipitins develop in approximately 90% within ___ in coccidiodomycosis

2-6 weeks

Characteristic of more severe infections and increases to a maximum in 6 months

Complement fixing antibodies

Types of coccidioidomycosis with better prognosis

Skin and joint

Dimorphic fungus with respiratory tract infection with tendency to disseminate to mucous membranes and lymph nodes

Para coccidioidomycosis

Para coccidioidomycosis mainly affects males due to presence of ___ on the fungus wherein ___ suppresses concersion of mycelium to yeast

Cytoplasmic estrogen receptor | Estradiol

Numbers of round yeasts with a characteristic form of multiple budding

Para coccidioidomycosis

(2) antibodies are highly specific for this infection in immunoblotting

Pb27 | 87kDa

Natural infections are known to occur in ___

Cannonys bamboo rats

T. Marneffei is a green or grayish mold that produces typical ___

Conidiophores

The most common clinical manifestation of cryptococcosis

Meningoencephalitis

Cryptococcosis are observed by direct microscopy of ___

India ink | Nigrosin

The most frequently used drug regimen in the nonAIDS patients

IV Amphotericin B + Flucytosine

In systemic candidiasis, skin lesions can occur in (2)

Neutropenic patients | IV drug users

Cause disease in patients with poorly controlled DM, neutropenia, or renal disease

Mucormycosis

Mucormycosis in close apposition of skin with contaminated dressings is caused by

Rhizopus rhizopodiformis

Mucormycosis in wooden tongue depressors

Rhizopus microsporus

Aspergillosis can be detected by using

Galactomannan assays