DIT Mycology Flashcards by Jeff Rossow

Classic scenario of pancreatic cancer in head of pancreas?

50 year old man with painless jaundice

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Presentation of candidal esophagitis?

AIDS, leukemia, lyphoma

Painful swallowing with substernal chest pain and feeling of obstruction when swallowing

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Describe vulvovaginitis with candida

diabtic or after antibiotic

Severe itching, edema, discharge
ACIDIC pH

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Disseminated candidiasis can attack patients where?

Anywhere! it spreads and is dangerous. Endocarditis in IV drug users is possible but can really hit anything

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Dx and tx of candidiasis?

Blood culture: cells have germ tubes (also pseudohyphae)

Derm: topical azole or fluconazole

Oral: nystatin or fluconazole

Systemic: fluconazole if immune system works, amphotericin B if immunocompromised

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What is attacked by cryptococcus? Where is it from?

Cryptococcus is meningitis in AIDs patients

Found in pigeon shit and soil

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Cryptococcal diagnosis (buzzword city)

Soap bubble imaging in brain
Latex agglutination (b/c capsule)
muCiCaramine (CryptoCoCCus)
India Ink

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Tx cryptococcal meningitis?

Amphotericin B and flucytosine followed by fluconazole

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Stain for PCP?

Imaging?

Silver stain

Ground glass appearance of interstitial infiltrates

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Tx for PCP if sulfa allergy?

Pentamidine and clindamycine + primaquine (dapsone for prophylaxis if sulfa allergy)

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Aspergillus can cause what?

Allergic bronchopulmonary with asthma or CF

Aspergillomas in lung cavities

Aflatoxin for hepatoccelular carcionma

Invasive in immunocompromised or CHRONIC granulomatous disease

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Dx of aspergillus? know!

A for Acute Angles in Aspergillus. not dimorphic

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Who is affected by Mucor and Rhizopus?

Dx?

ketoacidotic diabetic and leukemic patients

Penetrate cribriform plate into brain

Wide angles (like 90 degrees) think upside down M in mucor for W in Wide angles

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Presentation of mucor?

Rhinocerebral. Facial pain and headache with large necrotic lesions (black escar)

CN deficits and blindness

Dx: tissue biopsy

Tx: debridement and amphotericin B

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What are the three primary causes of pruritic skin fungus?

Dx:

skin MET skin and spread it

Microsporum
Trichophyton
Epidermophyton

Mold hyphae in KOH prep

they can cause ringworm and onychomycosis

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Hypopigmented spots on shoulders andstuff (think on kids at pools) are caused by what?

Tx?

Tinea versicolor (changes skin COLOR). Malassezia furfur

Degrades lipids and stuff and makes skin hyper or hypo pigmented

Azoles or topical selenium sulfide

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What looks like spaghetti and meatball on KOH prep?

Tinea versicolor (malasssezia furfur). The hyperpigmented spots

Opportunistic fungal infections?

Candidiasis
Aspergillus
Cryptococcus
Mucor and Rhizopus

3 question warmup. Organism with following statements? (not fungus)

Cat scratch
Cat bite
Cat shit
Puppy shit
Animal urine

Cat scratch: bartonella
Cat bite: pastuerella m
Cat shit: toxoplasma
Puppy shit: yersinia enter..
Animal piss: leptospira or hantavirus if mouse pee

Localized mycoses tx?

Severe or disseminated or complicated infection tx?

Azoles for most localized or uncomplicated

Amphotericin B for severe

Granulomas seen with mycoses?

Non-caseating granulomas (one way to differentiate from TB)

What diseases are associated with birds?

HIsto
Cryptococcus (pigeon)
Chlamydophila psititaci
H5N1
West Nile

Patient was spelunking and has pulmonary infection. Disease? What does it look like? What region do you find it?

Histo is in bat dropping (So encountered bat shit)

Also in bird shit

Histoplasmosis HIDES in macrophages

Mississippi and Ohio River valleys

Fungi if it is cold (dimorphic)

Blasto affects what? What does it look like?

Enters by pulm route and is pulm infection, can disseminate to involve skin and bone

Broad Based Budding (it is same size as RBC)

dimorphic, btw so fungus if cold)

Where is blasto geographically?

Mississippi valley from central america to canada

What does coccidio look like? Where is it geographically?

Coccidio Crowds (spherules is where they divide and they get huge with a bunch of daughter cells until they burst) SW united states. San Joaquin Valley fever from spores in dust and gets thrown into air with earthquake (and sandstorms)

Coccidio symptoms?

usually asymptomatic or mild Can be severe pneumo Can disseminate to CNS bone and skin (skin most common dissemination)

What does paracoccidiomycosis look like? Where is it geographically? What symptoms can it cause?

Paracoccidiomycosis PARAsails with CAPTAINs week all the way to Latin America Captain wheel Severe pneumonia

What is sporothrix associated with? what does it look like? Symptoms?

Dimorphic fungus that looks like a cigar yeast Traumatic from rose thorn or sphagnum moss You get a local pustule or ulcer and can follow lymphatics but very little systemic illness They are painless

Tx of sporothrix? mnemonic

ITraconazole or potassium iodid plant a ROSE in a POTassium iodide

Amphotericin B mechanism? tox? (one is super important to know and how to limit it)

amphoTEARS holes in membrane Binds ergosterol in cell membrane to make pores that leak Binds cholesterol in human cells too a bit... oops. TamphoTERRIble for kidneys. Must hydrate, fever chills, hypotension, phlebitis and arrhythmia

Nystatin mechanism? Use? Tox

Binds ergosterol (like amphotericin) but too toxic to be used systemically Super toxic so only topical. Not bad if not injected. Not absorbed orally Topical things. Swish and swallow for oral candidiasis (not absorbed so its safe

Azoles mechanism?

inhibit ergosterol synth by blocking P450

Fluconazole use?

Crosses BBB. Cryptococcal meningitis prophylaxis in AIDs Also candidal

Side effects of azoles?

Block cyp450 (so hepatotoxicity AND... less testosterone production: Gynecomastia) Elevated liver enzymes

Mechanism of flucytosine? Use? Tox?

FLUcytosine converted to 5-FLUorouracil (disrupts DNA and RNA synthesis) Used in combo with ampho B for systemic candida and cryptococcus Bone marrow suppression makes sense

What are the echinocandins? Mechanism? Use Tox?

-fungin (that is what they kill, fungus) [cASPofungin] Inhibit cell wall by inhibiting synth of Beta glucan cASPofungin for invasive ASPergillosis Toxicity: GI upset and histamine release (flushing)

Terbinafine mechanism? Use? Tox?

Inhibits squalene epoxidase so can't make ergosterol Use: tinea pedis and corporis If taken orally: it is deposited in skin and nails, right where you want it Tox: HEPATOTOXIC (David told me!) and GI symptoms

Griseofulvin mechanism? Why it is useful? Tox?

Interferes with microtubule function. Disrupts mitosis. Good b/c deposits in keratin tissues, so superficial infection Tox: teratogenic, headache, confusion, CP450 inducer (Guiness...)

What is onchyomycosis treated with?

terbinafine that inhibits squalene epoxidase so can't't make ergosterol. It is toenail fungus