chapter 17 Skin infections (diana's verison) Flashcards
1
Q
Bacterial infections
Hair follicle infections:
A
most commonly caused by staphylococcus aureus
most strains have several virulence factors
2
Q
what are the several virulence factors in bacterial infections
A
coagulase
protein A
hyaluronidase and collagenase
leukocidin
beta toxin
3
Q
this exoenzyme promotes fibrin clots
A
coagulase
4
Q
what does coagulase mean
A
this exoenzyme promotes fibrin clots
5
Q
binds to the Fc fragment of antibodies , inhibits opsonization
A
protein A
6
Q
what does protein A mean
A
binds to Fc fragment of antibodies, inhibits opsonization
7
Q
degrades hyaluronic acid and collagen
A
hyluronidase and collagenase
8
Q
what does hyaluronidase and collagenase mean
A
degrades hyaluronic acid and collagen
9
Q
kills leukocytes (especially nutrophils)
A
leukocidin
10
Q
what does leukocidin mean
A
kills leukocytes (especially neutrophils)
11
Q
destorys cells by poking holes in the membrane
A
beta toxin
12
Q
what is beta toxin
A
destroys cells by poking holes in the membrane
13
Q
clots blood (serves as a fort) , hide (immune system cannot find it)= it is protective
A
coagulase
14
Q
most abundant connective tissue, collagenese
A
cutting your collagen
15
Q
pokes holes in the membrane, it dies and everything is gonna leak out
A
beta toxin
16
Q
true or false. bacterial infections some strains possess additional virulence factors.
A
true
17
Q
this is an exotoxin that causes the separation of skin layers
A
exfoliatin
18
Q
describe the characteristics for exfoliatin
A
an exotoxin that cases the seperation of skin layers
causes scalded skin syndrome in newborns
transmitted by direct or indirect contact
-an issue in hospital nurseries
prevented using hexachlorophene
19
Q
what causes the toxic shock syndrome
A
toxic shock syndrome toxin
20
Q
where does toxic shock syndrome form from?
A
staphylococcus
21
Q
toxic shock syndrome toxin
A
causes toxin syndorme
results from a localized infection
toxin is released into the blood behaving as a superantigen
causes an extreme immune reaction
-fever, rash, vomitting., shock, organ failure, and ften death
an ex: would be tampon use
22
Q
toxins are produced in foods that are stored at rom temperature
A
enterotoxins
23
Q
this is commonly produced by streptococcus pyogenes can caused also be caused by staphylococcus aureus
A
impetigo
24
Q
usually requires a wound to penetrate the outer layers of the skin examples are cuts bites, scratches
A
impetigo
25
causes inflammation of epidermis and results in thin walled blister (breaks and oozes plasma) allows bacteria to spread to other areas of the skin
impetigo
26
this is transmitted by direct or indirect contact and treated with antibiotics
impetigo
27
this is an opening in the skin that lets them through , it hardens since its dehydrated.
Impetigo
28
Infectious fluid, can spread to other people can be harmful to someone who is not healthy
bacterial infections (impetigo)
29
Bacterial Infections: Acne Vulgaris is also known as a what?
inflammatory acne
30
what is acne vulgaris known caused by?
this is caused by Propionibacterium acenes ( a member of the normal microbiota)
31
where does acne vulgaris grow?
grows anaerobically in hair follicles
- eats sebum
-oil secreted production of sebum can block the follicle
-bacterial overgrowth leads to inflammation
32
how is acne vulgaris treated?
it is treated with antibiotics
benzyol peroxide
accutance (isoretinoin)
-reduces sebum production
-many side effects such as birth defects and depression
33
bacterial infections:
lyme disease how is this caused ?
this is cuased by borrelia burgdorferi
34
what is the morphology of lyme disease
spirochette
35
this commonly infects deer and mice and, they serve as a reservoirs and transmitted to humans by ticks and serve as a vectors
lyme disease
36
what are the symptoms for lyme disease?
1.Has a characteristics bullseye rash at the bite site
-followed by fever,muscle pain, and headache
-can last for two weeks
2.occurs weeks to months after initial infection
-characterized by arthritis, facial paralysis, irregular rhythms
3.occurs months to years later
- characterized by chronic arthritis, neurological changes including memory and mood changes and sleep disturbances.
37
what is the treatment for lyme disease? and when are they given?
antibiotics,the first stage
38
Treatment of lyme disease:
Arthritis and neurological changes are most likely due to ________
autoimmunity
39
Will antibiotics still be effective in second or third stage of lyme disease?
no, it is no longer effective
40
Viral infections are still in the _____
skin
41
this spread virus back and forth and have the capacity by going in the respiratory droplet
varicella
42
what is a varicella?
chickenpox caused by the Varicella-Zoster Virus
human herpes virus 3
43
What is known as a highly contagious viral infection and transmitted by respiratory droplet?
varicella
44
what is varicella characteristics? as being a varicella
patients develop a characteristics rash
raised itchy lessions all over the body
45
what is the incubation period with varicella
incubation period varies from 10-21 days
46
when the virus is done- does not leave
sleep in one neuron (falls asleep) and. never wake up
but some can-people who are immunocompromise
varicella can lead into shingles
47
what is varicella treated with?
it is treated with an antiviral (acyclvoir)
48
what is also used as a herpes medication? descreases the replication of the virus, you just have less, but it is still there, and the severity of the infection is lower (can tolerate better)
acyclovir
49
how could you prevent varicella
attenuated whole agent vaccine administered as a part of the MMRV engine
50
True or false. Rubeola is spread a respiratory spread and easy spread and seen as contagious
true
51
this is also known as a measles virus
rubeola
52
what is rubeola incubation period?
incubation period lasts 10-12 days
53
what are the signs and symptoms for rubeola
cold like symptoms, koplik spots, and a macular rash
54
what could be the possible complications of rubeola
virla pneumonia, encephalitis,brain damage, SSPE
55
what are the treatments available for viral infections (rubeola)
no treatment available
56
what is the prevention for rubeola
attenuated vaccine administered as a aprt of the MMRV vaccine
57
Beofre vaccination measles caused _____ million deaths per year
2.6
58
true or false. Huamns are the only reservoir, eradication is possible .immunocompormise people does not need to get vaccinated, pregnant women etc.
true
59
True or false. Anytime a human is only reservoir, you do not have to minimize exposure or vaccinate all the animals
true
60
post-vaccination- _____ deaths occur per year
200,000 deaths
61
Viral infections : (Rubella)
german measles caused by _____ virus
rubella
62
this causes a milder disease than measles (faint pink rash)
rbella
63
true or false. Rubella cause serious complications if infection occurs during pregnancy
true
64
fetus can develop ___ rubella syndrome
congenital
65
birth defects in rubella include :
eye cataracts ,deafness, heart defects, mental retardation and still birth
66
what is the treatment for rubella
none , there is NONE
67
what could be a way of " prevention " for rubella
attenuated vaccine administered as a part of the MMRV regime
68
characteristics for rubella:
Viral Infections
German measles caused by Rubella virus
causes a milder diseases than measles
- faint like pink rash
may cause serious complications if infection occurs during pregnancy
fetus can develop congenital rubella syndrome
birth defects include: eye cataracts, deafness, heart defects, mental retardation, and still birth
no treatment is possible
prevention:
attenuated vaccine administered as a part of the MMRV regime
69
Viral infections : ( Warts ) is a skin to skin contact. True or false?
true
70
what can be caused by human papillomavirus.
warts
71
what is seen as a small tumours on the skin and mucous membranes
warts can be seen as these
72
Can warts be transmitted by direct or indirect contact
both
73
specific viral types infect different types of skin and membranes , and what are the examples.
cause different types of warts
ex) plantar warts, genital warts, dermal warts
74
true or false. Warts : only some viral strains are considered oncogenic, what are the examples
true.
cervical cancer, mouth cancer, and throat cancers
75
how do you remove warts ?
by removing virally infected cells
- freezing with liquid nitrogen
-salicylic acid (compound W)
-surgical removal
76
what is the prevention (can be given to boys and girls) for warts?
The HPV vaccine protects against 4 different viral strains 2 of which are most commonly found in cervical cancer cases
77
this virus gets shed if the person touch the surface (skin to skin): it is domino effects and highly contagious , can be direct or indirect
warts
78
most of them is not a big deal, but if its in the cervic can lead into cervic cancer
warts (HPV)
79
Fungal Infections:
Cutaneous mycoses
fungi grows on hair ,nails, and outer layers of the skin
- use keratin protein as a nutrient source
example : ringworm
ring shaped fungal rash
- often occurs in moist areas of the body (athlete's foot, jock itch)
80
how is cutaneous mycoses tretaed?
it is treated with topical creams containing azoles on the skin
oral griseofulvin for hair and nail infections
81
you have to keep it localized as you can
you do not pop a pill, you spread it through a topical cream
it has circular pattern ( looped around ) right onto the skin surface
fungal infections (cutaneous mycoses)
82
Fungal Infections:
candidiasis
caused by the yeast candida albicans
- causes thrush and vaginitis
an opportunistic pathogen
- infects when the normal microbiota is eliminated secondary to antibiotic use
83
how is candidiasis treated?
it is treated with topical azoles or mouthwash containing nystatin
84
these will not be killed (antibiotics)- more space and more food and overgrow that way you have to treat it to restore balance
candidiasis
85
this is common in babies (since they do not have a lot of antibodies )
candidiasis
86
bacterial diseases:
streptococcal pharyngitis
strep throat
streptoccus pyogenes
- Group A streptococci
87
what does the symptoms include in streptococcal pharyngitis
sore throat, pus, red spots, fever
88
what are the virulence factors for sterptoccoal pharyngitis?
streptolysins
streptokinase
capsule
M proteins
89
exoenzymes that lyse red and white blood cells
streptolysins
90
define streptolysins
exoenzyme that lyse red and white blood cells
91
A fibrinolysin
streptokinase
92
define streptokinase
a fibrinolyisn
93
prevents phagocytosis
capsule
94
define capsule
prevents phagocytosis
95
surface antigens that interfere with complement
M proteins
96
Define M proteins
surface antigens that interfere with complement
97
what is the treatment for streptococcal pharyngitis
penincillin
98
name the term for these describing:
comes outside of the cell finds these cells and rupture them (immune system less protective)
for sticking (you can replicate) allows you to be resistant to phagocytosis
this is also for attachment however it looks so much like heart cardiac muscle, it targets them instead
streptolysins
capsule
M protein
99
True or false. Some group A Strep have additional virulence factors ?
true
100
Bacterial diseases:
Group A Strep have additional virulence factors:
Scarlet Fever
Erythrogenic toxin
- reddening toxin
Symptoms include:
- severe high fever, scarlet red tongue, sandpaper like red rash
101
bacterial diseases (Group A Strep have additional virulence factors):
Necrotizing Fasciitis:
Pyrogenic exototoxin A
-super antigen
- causes a massive immune response, high fever, inflammation and shock
102
bacterial diseases (Group A Strep have additional virulence factors):
Necrotizing Fasciitis: Pyrogenic exotoxin B
exoenzyme
- degrades protein, causing tissue death and breakdown
infects tissue faster than the surgeon can cut
103
describe the following circumstances:
to produce the color red (it's a colouring toxin)
this is a flesh eating disease
scarlett fever
necrotizing fasciitis
104
this is an enzyme (joints are held together by proteins, if you have a chemical that degrades (crumbling sand losing)
pyrogenic exotoxin B
105
this is an enzyme (joints are held together by proteins, if you have a chemical that degrades (crumbling sand losing)
pyrogenic exotoxin B
106
Bacterial Diseases :
Post Streptococcal sequelae:
is described as what?
complications that can develop after recovery from strep throat
107
Bacterial Diseases: Post Streptococcal Sequelae
Rheumatic Fever:
Antibodies against M proteins damage heart tissue and valves
symptoms include:
fever, joint pain, nodules in the joints
108
Bacteria disease: Post streptococcal Sequelae
Carditis
inflammation of the heart
long term damage to the heart valves
leads to heart failure, death
109
this has become rare in north american
- prompt treamtnet of strep throat
carditis
110
random mutations in the gene encoding the M protein
carditis
111
it goes back and forth , the turbulence will murmur
carditis
112
true or false. Bacteria are little and simple (can change) organism like is cannot change, it's complicated and highly conserved
True
113
Bacterial diseases:
this is caused by corynebacterium diptheriae
diptheria
114
what does the symptoms include in dipetheria:
mild sore throat, extreme fatigue, and malaise
produces diptheria toxin
- cytotoxin
-destroys cells in the respiratory tract
-pseudomembrane forms on the tonsils and throat
can cause suffocation
-toxin can be released into the blood causing heart and kidney failure
115
what are the treatments for diphtheria
antibiotics work to stop the infection- cannot destroy the txin
anti toxin antibody can be adminsitered
116
what is the prevention for diptheria?
toxoid vaccine given as a part of the DTaP regime
117
we vaccinate against the toxin and not the bug, is this true in terms of diptheria?
yes this is true
118
Bacterial Diseases:
Pertusis is caused by
bortadella pertusis
Whooping cough
119
what is the first and second stage of pertusis
first stage: cold like symptoms
Second stage : bacterium produces a cytotoxin and kills ciliated cells in the airway
prevents the movement of mucuous
results in violent coughs
120
what are the treatment for pertusis?
antibiotics are only effective against the bacterium
during the first stage before damage has occurred
121
how could YOU prevent pertusis ?
effective vaccination as a aprt of DTap
Required booster every 10 years
122
babies with whooping cough will/
die of exhaustion
123
pertusis destroys?
destroys respiratory cells
124
Pinkeye, earaches, and sinus infections can be caused by
bacteria or viruses
125
Define the characteristics for conjuctivits
infection of the surface of the eye
symptoms include redness, itching of the eye
pus and swelling are present when bacteria are responsible
126
what is the treatment for conjuctitivis?
antibiotics
127
otitis media define the charcatertisitcs
infection of the middle of the ear
causes severe earache
most common in young children
antibiotics are rarely effective
128
Define the following:
inflammation around the eye
not infectious they are....
over the top surface of the the eye becomes inflammed
this is meant to indicate infection of the middle ear
pink eye
earaches
conjunctivitis
otitis media
129
describe what sinusitis mean
infection of sinuses
facial pain and pressure
thick green nasal discharge
treatment: antibiotics
130
this is the hollowing-out of the face and the bone and the outcome a lot of pressure and pain
dark limey very characteristics and different from what you expect from a respiratory infection
sinusitis
131
this is a lung infection and can be caused by many different bacteria
(immune system is not functioning properly)---> can cause a very serious infection
bacterial pneumonias
132
Pneumococcal pneumonia
is a streptoccous pneumoniae (a gram positive bacterium)
symptoms include high fever, difficulty breathing, chest pain, coughing, prostration
often requires hospitilization
treated with antibiotics
133
how do we prevent pneumococcal pneumonia
subinit vaccine
capsular polysaccharde
given to risk groups such as smokers , alcoholics and smokers
conjugate vaccine
effective in babies as young as 2 months old
134
describe the following:
this is where you take a bit of capsule
you combine it with diphtheria toxoid and the point is you ultimately give effects to inside of two antigen at once
subunit vaccine (capsular polysaccharide)
conjugate vaccine
135
Klebsiella Pneumonia is caused by
klebsiella pneumoniae a gram negative bacterium
symptoms include high fever, difficulty breathing, chest pain, coughing, prostration
136
how is kelvsiella pneumonia treated?
it is treated with broad spectrium antibiotics
problems with resistance
KPC: Klebsiella pneumoniae carbapenemase (B lactamase)
- frequent cause of nocosomial infections
137
what is the prevention for klebsiella pneumonia
infection control measures
138
this is a different bacterium than pneumonical, same species name but different genus and its a gram negative
klebsiella pneumonia
139
the different organism and a different gram stain, it will create the same symptoms
gives you coverage, incase there's another spectrum the ling is protective you don't want a infection in broad spectrum = gives you better coverage
bacterial disease (klebsiella pneumonia)
140
True or false. The purpose of the prevention of klebsiella pneumonia--> minimizing exposure, making sure you are not taking it from one infected person to another, making sure people are not suffering from consequences
true
141
Bacterial Disease:
Other bacteria that cause pneumonia include
haemophilus influenzae
Pseudomonas aerugonisa
Mycoplasma pneumoniae
142
describe the haemophilus influenzae
Pseudomonas aerugonisa
Mycoplasma pneumoniae
once the major cause of pneumonia in young children
major cause of pneumonia in cystic fibrosis patient
'walking pneumonia' generally more mild pneumonia that rarely requires hospitalization
143
produces an aqua color on a petri dish
this targets the weakest people and the outcome is severe consequences (resistant to disinfectants and antibiotics )
pseudomonas aeruginosa
144
does not have a cell wall (that's weird cannot use penincillin to target it peptidoglycan)
people who are not confided to bed and state of health in general
mycoplasma pneumoniae
145
this is caused by mycobacterium tuberculosis
tuberculosis
146
how is tuberculosis trasmitted?
transmitted via coughing: airborne
remains viable in dried droplets/ sputum
147
this is something you "cough out"
this is sputum
148
People with tuberculosis and infected develop what? which leads into what after?
they develop a latent infection: no symptoms, can lead into chronic disease later in life
149
what does the symptoms for tuberculosis?
progressive weight loss, chronic coughing, calcified lessions in the lung (tubercules), and eventual death
150
slow growing , and you need a cocktail therapy - sometimes more than a year , the resistance chance is very high and at the end of the day this is a respiratory disease
tuberculosis
151
True or false. Tuberculosis becomes active can be life long creates a scenario spreading a part of their body , this can be systemic and may result in a sinister outcome
tuberculosis
152
Bacterial Disease:
Diagnosis of TB
(Tuberculin skin test) (Mantoux test)
purified protein is injected into skin and reacts with memory T cells
- Type IV hypersensitivity
may indicate
- active infection
-previous infection
-previous vaccination
153
true or false.
In terms of diagnosis :
they take purified cell wall of mycobacterium species (doesn't matter)- it has myolic acid in the cell wall
inject it underneath following with another cytotoxic shot. If a person has memory T cells activate- cytotoxic T cell response causing it to repair
this is false. Cytotoxic is not given as a "shot", and it does not repair, it damages your tissues instead
154
What happens if you inject foreign material underneath the skin?
you will have a respond
155
True or false.
You want to measure and tell a difference of foreign material or memory T cells , the diameter will be really important (a positive is not the same )--> people who does not have a good immune system).
true
156
what is the treatment for tuberculosis?
6 month regimen of 3-4 antibiotics including rifampin, isoniazid , streptomycin
157
is resistance a big problem in TB?
yes it is a big problem, MDR TB
158
what are the vaccine that can be given to tuberculosis?
live attenuated vaccine composed of closely related species
can cause disease in immunocompromised patients
does not always confer effective immunity
159
there are certain strains to already resistant drugs to tb what is it?
MDR-TB
160
True or false. The vaccine that can be seen used for TB is actually very good, and less risk are given.
False, it is the opposite
161
Live attenuated is composed related species myobacterium ____ not myobacterium tuberculosis. (same genus but different species).
polvis
162
Legionnaire's disease is caused by
legionella pneumophilia
163
this survives and multiples inside of macrophages
legionella's disease
164
it's not just any free bacteria, this is inside of the cell (he is protective from immune system)
legionnaire's disease
165
what does symptoms include in legionnaire's disease?
dry cough, fever, shaking chills, confusion, and possibly death
166
how is legionnaire's disease transmitted?
through aerosolized water droplets
ex: large central air conditioning systems
cannot be transmitted from person to person
167
how are legionnare's disease treated?
they are treatment with antibiotics that exhibit good tissue penetration
168
Describe these following and name the term for it:
is is non productive : no mucuous, and blood pressure is not overcome/controlled which leads to death.
this must not only enter your tissue extracellular but also the macrophage
legionnaire's disease
169
what does transmitted through aerosolized water droplets mean?
it basically means not purified water
170
wha is the prevention for legionnaire's disease?
no vaccine exists but you could proper disinfect to minimize infectious aerosols
171
true or false.
There are no cure for anti-viral diseases
true
172
Viral diseases:
The common cold
nasopharyngitis
- inflammation of the nose and throat
symptoms include sneezing and nasal congestion
self limiting in 1 week
- there is not treatment or vaccine available-treat symptoms
173
The common cold: Exposure results in long immunity but:
there are at least 8 groups including rhinoviruses ,coronaviruses and other viruses
each group has serverla types
ex: at leadt 113 rhinoviruses
over 200 different cold are possible
174
what is this describing? Creates discomfort
(you have a lot of fluid)
breathing isn't so easy, this is a virus and there are no treatment, you can treat symptoms , drink water , if you are doing those things you are supporting therapy
The common cold
175
this is referred to as the flu, and symptoms include fever, malaise, body aches, chest cough
infleunza
176
True or false. Influenza is a cold like symptoms appear as the fever subsides (an enveloped, segmented RNA virus--> 8 segments)
True
177
What are the two types of spikes in influenza: (surface antigens)
hemagglutinin (h antigen): used for attachment
Neurominidase: (N antigen): used to promote release of virus from host cell
- target neuraminidase inhibitors tamiflu and relenza
178
sometimes people get misconception that cause to gastrointestinal illness as a flu but in general ____ is a respiratory flu
influenza
179
used to peeling off the cell , already been infected
neuraminidase inhibitors
180
Virus is named for these two antigens:
H1N1
H1N5
swine flue
bird blue
181
True or false. The type of variant you are going to encounter , is the type of immune respond what you're gonna need
true
182
Viral diseases:
what are the two type of genetic change that can happen in infleunza
antigenic drift and antigenic shift
183
true or false. Antigenic drift is minor mutations in H antigen or N antigen, and can result in minor annual flu variations
true
184
Antigenic drift: Is it false, that number designation does not change ,and results in vaccine or immunity becoming less effective.
NO this is true
185
name the characteristics for antigenic drift
antigenic drift is minor mutations in H antigen or N antigen
can result in minor annual variations
- number designation does not change
results in vaccine or immunity becoming less effective
186
name what this is describing:
kinda looks the same but if you look to the right, there is a slight change= this is called a minor change (this is gentle)
No change in the term if it's h1 it's still called H1
antigenic drift
187
name what this is describing: (this is a big change)
this is aggressive , any anybodies you wold've produced would no longer work in the second one genetic rearrangment
antigenic shift
188
this is when two viruses infect the same individual they an exchange segments a
antigenic shift
189
describe the characteristics of antigenic shift
when two viruses infect the same individual they can exchange segments
-genetic rearrangment
-allows evasion of almost all previously developed immunity
can result in pandemics
190
Influenza vaccine: True or false directed at three antigens strains expected to be prevalent in the coming year
true
191
Influenza vaccine: describe the characteristics
made each year
directed at three antigenic strains expected to be most prevalent in the coming year
192
name what this is describing:
H7N3
H1N6
= the pig gets co infected
** The fact it's co infected** means two infections at the same time- both influenza infections, same cells can be infected= rearrangment creates a novel infection
because RNA is segmented, you just mix and match pieces when assembling new virus which can result in pandemic and spread across the world
antigenic shift
193
RSV is the what?
this is the leading cause of lower respiratory tract infections in young children
194
RSV causes cells to form
synctia
195
what are the symptoms for RSV
runny nose, wheezing, and difficulty breathing
196
what is the most common characteristic for RSV :
loud, high pitched cough called croup (barking cough)
197
what are effective treatments or vaccination available for RSV?
none, it can ONLY treat the symptoms but not the actual infection
198
Hantavirus pulmonary syndrome caused by
hantavirus
199
how is hantavirus pulmonary syndrome transmitted?
transmitted through the inhalation of dried urine, and feces from infected rodents for example : deer mouse of manitoba
200
what are the symptoms of hantavirus pulmonary syndrome
fever, muscle aches, nausea, vomiting, and diarrhead
201
true or false. Hantavirus pulmonary syndrome : lungs fill with fluid causing difficulty breathing : followed by shock and death in 50% infected individuals
true
202
what is the treatment for hantavirus pulmonary syndrome
no treatment available
- you just treat the symptoms
203
what is the prevention for hantavirus pulmonary syndrome?
no vaccine , avoid contact with urine and feces
204
true or false. to treat the symptoms in hanatvirus pulmonary syndrome, fluid restoration , is more likely to maintain a blood pressure , more likely keeping your organ from failing
true
205
this can lead into hypovolemic shock , losing a lot of volume multiple organ failure
hantavirus pulmonary syndrome
206
Fungal diseases:
North American Blastomycosis is caused by
Blastomyces dematitidis
207
North American Blastomycosis is transmitted by the
inhalation of yeast like spores found in acidic soils
208
this begins as a lung infection) pneumonia like symptoms
North American Blastomycosis
209
this becomes systemic (usually diagnosed based on skin or tissue ulcers)
north american blastomycosis
210
How is north american blastomycosis treated
treated with amphotericin B
211
once it goes in thats where the spores are and that's where they germinate, they become vegetative because systematic - it has a terrible selective toxicity
North American Blastomycosis
