Endemic mycoses

Question 1

Histoplasma

Answer 1

Capsulatum

Cave dweller

Question 2

Histoplasma morphology

Answer 2

Thermally dimorphic

Mold at ambient temperatures–macro- and microconidia

Question 3

Histoplasma epidemiology

Answer 3

High nitrogen areas–bird or bat poop; caves, decaying buildings, etc

Question 4

Histoplasma presentation

Answer 4

Most asymptomatic or flu-like illness
Rare–disseminated disease
Super rare–chronic pulmonary disease

Question 5

Histoplasma diagnosis

Answer 5

Exclusionary

Easy test–histoplasmin in serum or urine

Question 6

Histoplasma treatment

Answer 6

Oral azoles and amphotericin B

Question 7

Blastomyces

Answer 7

Dermatitidis

Question 8

Blastomyces morphology

Answer 8

Thermally dimorphic
White to tan mold at ambient temperature
Nonencapsulated yeast at body temp

Question 9

Blastomyces epidemiology

Answer 9

Mold in decaying organic matter
Dogs can be infected
Non-contagious–spores must be inhaled

Question 10

Blastomyces presentation

Answer 10

Pulmonary–can resemble TB or cancer

Skin–resembles squamous cell carcinoma

Question 11

Blastomyces diagnosis

Answer 11

Look for broad-based budding yeast in tissue

Question 12

Blastomyces treatment

Answer 12

Amphotericin B for life-threatening or meningeal disease

Question 13

Coccidiodes

Answer 13

Immitis

Aka San Joaquin Valley Fever

Question 14

Coccidiodes morphology

Answer 14

Dimorphic

Question 15

Coccidiodes epidemiology

Answer 15

Endemic to desert
Found in soil, enhanced growth in bat guano
Arthroconidia inhaled when dry soil is disturbed

Question 16

Coccidiodes presentation

Answer 16

Primary infection–asymptomatic pulmonary disease/self-limited flu-like illness
Secondary infection–symptomatic after 6 weeks; disseminates throughout the body

Question 17

Coccidiodes risk factors

Answer 17

HIV+ men of Filipino, AA, NA, or Hispanic origin

90% mortality without treatment

Question 18

Coccidiodes diagnosis

Answer 18

Endosporulating spherules in sputum, exudates, or tissue

DO NOT CULTURE–highly infectious!

Question 19

Coccidiodes treatment

Answer 19

Amphotericin B + azole