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Fungal Flashcards

1
Q

Inda Ink

GMS, PAS on histopath - narrow-based budding w/ large capsule

A

crypto

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2
Q

acellular, foamy, eosinophilic, intra-alveolar exudates on H&E

GMS/PAS stains on path = cysts (diff from alveolar proteinosis)

A

PJP

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3
Q

RF a/w chronic mucocutaneous candidiasis (disfiguring hyperkeratotic lesions, can have stricturing of esophagus)

A

Autoimmune regular (AIRE) gene mutation

STAT1 mutation

IL-7 receptor mutation

Dectin-1 deficiency

TLR-3 defect

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4
Q

chronic mucocutaneous candidasis

hypoPTH

adrenal insufficiency

A

autoimmune polyendocrinopathy-candidasis-ectodermal dystrophy/dyplasia (APECED)

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5
Q

Concerning/unique SEs of:

  • itra
  • vori
A
  • itra - heart failure, cardiomyopathy
  • vori - CNS and visual disturbances
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6
Q

Interpretation of histo Abs

A

H and M bands via immunodiffusion

M band: becomes + sooner. Seen with ANY exposure. persists for yrs

H band: only seen >20%. VERY spec for dissimen, chronic cavitary, severe acute pulm disease. Clears w/in 6mos

  • H+M = active histo
  • M alone = early/chronic disease
  • >1:32 = highly sensitive for active infection
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7
Q

FP results with histo Ag

A
  • blasto (commonly used to dx blasto)
  • cocci
  • talaromycosis
  • paracocci
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8
Q

FP results with CrAg

A

(esp w/ latex agglutination methods)

  • Trichosporon asahii
  • Rothia
  • Capnocytophaga
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9
Q

What are testing for with galactomannan?

What results in FP?

A

IAI

  • FP: fusarium, penicillium, histo
  • can have FP w/ zosyn or augmentin (though not in formulations after 2010)
  • also w/ IVIG
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10
Q

Fungi that will/may test + with beta-D-glucan

A
  • candida and invasive aspergillosis
  • may see with histo and PJP as well

**(will always test negative with crypto and zygomycetes)

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11
Q

Generally considered a positive beta-D-glucan test

A

>80 pg/mL

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12
Q

Ampho-R Fungi

A
  • C lusitaniae
  • some isolates of C auris
  • some fusarium spp (why empir AMB+VCZ)
  • aspergillus terreus
  • some scedosporium
  • all lemontospora prolificans
  • sporothrix
  • pseudallescharia boydii
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13
Q

fever + skin lesions (starting as cellulitis, sometimes around toenails)

pt in engraftment period post-HSCT

dx and tx

A

Fusarium

empiric AMB + vori (diff spp have varying susc)

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14
Q

S China

SE Asia

a/w AIDS and IC hosts

cultures w/ red diffusible pigment

Clin: dissemination, skin, CNS, bone

A

talaromyces

  • small oval non-budding yeast at 37C
  • smooth conidiophores w/ 4-5 terminal metulae at 25-30C (above pic)
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15
Q

S America (male, farmer predominance)

A

Paracocci

large round thick-walled yeast w/ budding = ship’s wheel appearance at 37C (body temp)

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16
Q

SW US

N Mexico

Central/South America

A

Cocci

  • round, thick-walled spherules containing endospores at 37C
  • (septated branched hyphae w/ thick-walled arthroconidia at 25-30C)
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17
Q

MS and OH River valleys

St Lawrence Seaway

Africa, Asia, S America

A

Blastomyces

broad-based buddying yeast (37C = body temp)

(septated branched hyphae at 25-30C)

The B’s: broad based budding, breath (PNA), bone, brain, body (skin)

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18
Q

MS, OH River valleys

A

Histo

small oval budding yeast at 37C = body temp (2-5um)

septated hyphae w/ round/pear shaped microconidia at 25-30C

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19
Q

BSI

(rarely causes disease except when a/w probiotic use)

A

Saccharomyces

unicellular, globose, ellipsoid-elongated blastoconidia

multipolar budding

*cases of misID. If not on MALDI, consider C auris

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20
Q
A
  • orange, red, “coral red” growth
  • unicellular blastoconidia, globose-elongated shape
  • no hyphae/pseudohyphae

Rhodotorula

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21
Q
A

Geotrichum

causes BSI, PNA in neutropenic pts

arthroconidia are unicellular/in chains/rectangle/barrel shaped

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22
Q
A

Trichosporon

  • septated hyphae/pseudohyphae
  • barrel-shaped arthroconidia (a sexual spore that is formed by breaking up of a hypha at point of septation
  • pleomorphic budding yeast
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23
Q
A
  • round budding yeast + capsule
  • NO hyphae/pseudohyphae
  • India ink, GMS/PAS

Crypto

24
Q
A

Candida

  • round-oval yeast w/ pseudohyphea
  • clusters of blastoconidia at septa
25
important susc patterns in Candida spp: * glabrata * krusei * parapsilosis * lusitaniae
* R fluc, S ech * R fluc, S ech. ?dec AMB * Incr MIC ech, S to fluc. **Strong biofilm producer** * R AMB, S to fluc and ech
26
solitary lung cavity + eos meningitis
cocci
27
previously healthy adults w/ indolent ulcerative crusted skin lesions + asx pulmonary infiltrate
consider blasto
28
near drowning pt (or immunosuppressed)
**_scedosporiosis_** ## Footnote tx: vori **(\*\*AMB resistant)**
29
**GMS Stain** neutropenic pt w/ red, tender skin nodules --\> _rapidly_ spreads
Fusarium
30
**Reverse Halo Sign** consider mucor in right pt and presentation
31
broad, variable non-septated hyphae not well-vis here, but will have **right-angle branching** * dx * RF * tx
**_mucor_** * inhaled spores into lung/paranasal sinuses * RF: prolonged neutropenia, steroids, poorly controlled DM * TX: AMB \*\*can mimic cavernous sinus thrombosis following sinusitis
32
Neutropenic patient
ecthyma gangrenosa aspergillosis
33
long hyphae, few septations = **aspergillus**
34
Ddx
disseminated lesions w/ central ulceration * crypto * muluscum * talaormycosis
35
Thailand, S China bamboo rats skin lesions, LN, liver, spleen, bone dx and tx
**_Talaromycosis_** * dx: **methenamine silver** of skin/tissue, blood cx (1-2wks) * divide by **binary fission** (no budding) - seen in above pic * tx: AMB then itra
36
_children_: acute/subacute F, wt loss, LAD, HSM, often skin/mucosal lesions _adults_: farms of Latin America, indolent w/ skin/mucosal lesions + asx infiltrates on CXR
paracocci ## Footnote can be latent for decades
37
blasto
38
**thick-walled broad-based budding** moist earth near rivers, beaver dams acute PNA vs indolent progressive PNA that disseminates (skin, bone, **male GU tract - prostate, epididymitis**) MW, Great Lakes, Canada
blasto
39
chronic bone, CNS, or skin infection purulent eosinophilia
consider cocci in right geography
40
think cocci if right geography
41
**Cocci** 1. cocci arthrospore 2. cocci spherule on HE (big, no budding)
42
acute PNA +/- arthalgias or erythema nodosum _often_ residual nodule/**thin walled** pulm cavity persists _if disseminated_: bone, skin, chronic (eosinophilic) meningitis CA valley, AZ, NM, S Texas (Rio Grande), S America
think coccidiomycosis ## Footnote tx fluc if CNS (non-men = itra)
43
Manifestations of disseminated histo
* subacute fever, pancytopenia, hypoadrenalism, miliary lung lesions * IE * chronic meningitis * 1/4 causes have oral/mucosal lesions * tongue and penile lesions (can look like SCC)
44
pneumonitis +/- mediastinal or hilar LAD
consider acute pulmonary histo!
45
stains that detect histo
Wright's stain - blood GMS or PAS in tissue
46
Areas of disseminated blasto
* seen in 25-75% pts (\>\>\>histo or cocci) * skin = most common * single/mult, papular/pustular * chronic = ulcerative or verrucous * predilection for the face (esp nasolabial folds) * osteoarticular * chronic osteo - long bones, axial * septic arthritis * spinal (epidural, paravertebral, or psoas abscess) * GU - epididymoorchitis or chronic prostatitis (rare in women) * CNS (5-10% of disseminated cases)
47
stains for blasto
sputum/BAL - KOH or calcofluor white tissue - GMS, PAS **large (8-15um) yeast with broad-based budding**
48
fever, fatigue, cough, pelurisy, dyspnea high ESR and peripheral eos (10-15%)
consider cocci in right epi setting (acute pulmonary cocci)
49
Ddx for sporothrichoid lesion (nodular lymphangitis)
* sporotrichosis * nocardia * M marinum * leishmania
50
septate hyphae - nearly parallel to one another dichotomous branching at 45º angles
aspergillus
51
banana-shaped macroconidia typical of fusarium
52
ribbon-like hyphae of mucor irregular branching
53
near-drowning in dirty fresh water PNA + CNS
scedosporium
54
extensive pseudomembranous or ulcerative lesions in the tracheobronchial tree in liver tx pts
ulcerative aspergillus tracheobronchitis
55
toe cellulitis surrounding onychomycosis neutropenic patient
Fusariosis
56
refractory fever in neutropenic pt w/ metastatic skin lesions at different stages
consider fusarium

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