Fungal Infections Flashcards by Kajal Khatri

organism causing histoplasmosis

histoplasma capsulatum

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geographic predilection of histoplasmosis

endemic to ohio and mississippi river valleys

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transmission of histoplasmosis

spores in bird or bat droppings

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histoplasmosis mimics what disease

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clinical features of acute histoplasmosis

flu-like illness

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clinical features of chronic histoplasmosis

cavitary pulmonary lesions

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disseminated histoplasmosis effects what population

elderly, debilitated, or immunocompromised

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oral clinical features of histoplasmosis

localized disease secondary to implantation over previously traumatized mucosa

associated with disseminated disease

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clinically, histoplasmosis may be identical to

malignancy

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special stains to detect fungal organisms in tissue

silver stain (GMS) or PAS

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treatment of chronic or disseminated histoplasmosis

amphotericin B

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treatment of mild or maintenance therapy of histoplasmosis

ketoconazole or itraconazole

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cause of blastomycosis

blastomyces dermatitis

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geographic predilection of blastomycosis

extends into Wisconsin, Minnesota, and Canada

sporadic cases in other parts of world

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when disseminated, affected sites of blastomycosis include

skin
bone
prostate
meninges
oropharyngeal mucosa
visceral organs

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acute blastomycosis

pneumonia like symptoms

high fever, chest pain, productive cough, night sweats

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chronic blastomycosis

TB like symptoms

night sweats, low grade fever, wieght loss, cough, hilar, masses on x-ray

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skin and oral mucosa lesions of blastomycosis

enlarging erythematous nodules that ulcerate
varying degrees of pain
oral lesions resemble squamous carcinoma

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identification of yeasts of blastomyces dermatitidis

identification of characteristic yeasts (8-20. microns) in histologic sections stained with methenamine silver or PAS technique

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treatment of blastomycosis

systemic amphotericin B

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etiology of coccidioidomcyosis

coccidioides immitis

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geographic localization of coccidioidomycosis

endemic to desert southwest US

valley fever

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clinical features of coccidioidomycosis

inhalation of spores
flu-like illness in 40% of infected patients
dissemination in <1%
skin of central face may be affected; oral lesions are rarely described

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histopathology of coccidiodomycosis

large (20-60micron) spherules that contain endospores
variable host response, ranging from acute to granulomatous inflammation
diagnosis can be made by culture or biopsy

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treatment of coccidioidomycosis

amphotericin B for disseminated cases

cause of cryptococcosis

cryptococcus neoformans

how humans contract cryptococcosis

organisms live in pigeon droppings transmitted by air borne spores

predisposing illnesses for crytococcosis

affects immunosuppressed patients exclusively

presenting features of cryptococcosis

1. flu like symptoms with initial pulmonary infection 2. disseminates to meninges 3. cutaneous lesions may develop in 10-20% 4. oral lesions are rare

histopathology of cryptococcosis

4-6 micron yeasts with clear halo

treatment of cryptococcosis

severe cases treated with amphotericin B and flucytosine fluconazole for less severe cases

prognosis for cryptococcosis

poor because most patients are immunocompromised

cuase of aspergillosis

severeal species of aspergillus genus

different types of infections from aspergillosis

allergy localized infection invasive aspergillosis

spores of fungus aspergillosis commonly found in

spores in soil, water, decaying organic debris

clinical features of infection with aspergillosis

-allergy may trigger asthma -tissue damage post extraction -aspergilloma

histology of aspergillus flavus

branching septate hyphae occlusion of small vessels by hypahae

vasoinvastion and vaso-occlusion is seen in what two diseases

aspergillus and zygomycetes

treatment of aspergillosis

amphotericin B (with or without debridgement)

prognosis of aspergillosis

good prognosis if normal immune status poor prognosis if immunocompromised

zygomycosis and diabetes

affects severe diabetic or immunocompromised patients

features of rhino cerebral form of zygomycosis

1. form in oral region 2. nassal obstruction + blood nasal discharge 3. black necrotic lesions 4. progression superiorly, visual disturbances and blindness 5. seizures and death

histopathological appearance of zygomycosis

large branching nonseptate hyphae with extensive tissue necrosis

treatment of zygomycosis

radical surgical debridement IV amphotericin B

prognosis of zygomycosis

poor (death within hours - days)

yeast / spore form of candida

commensal

hyphal form of candida

pathogen disease causing form

germ tube

ability of yeasts to undergo transofmraiton to hyphal form under appropriate conditions, producing germinative or germ tubes

mycelia

colony of hyphae with / without spores

predisposing factors of candida

host immune status oral mucosal environment virulence of candida strain

white candida lesions

acute pseudomembranous candidiasis hyperplastic candidiasis

red candida lesions

acute atrophic candidiasis central papillary atrophy of tongue chronic atrophic candidiasis

other forms of candida

angular cheilitis

acute pseudomembraneous candidiasis

-thrush -white curdled milk or cottage cheese like -pseudomembranous (CAN BE WIPED OFF) -asymptomatic

hyperplastic candidiasis

-candidal leukoplakia -white patch that cannot be rubbed off -anterior buccal mucosa -should resolve with antifungal therapy -SHOULD BIOPSY

acute atrophic candidiasis

-redness -tongue common site -diffuse atrophy of dorsal tongue papillae, particularly after broad spectrum antibiotics

central papillary atorphy of tongue

referred to as median rhomboid glossitis -most due to chronic candidiasis -well defined area of redness

chronic atrophic candidiasis

-denture sore mouth -denture is contaminated with candida organism, no invasion of mucosa is seen -erythema of palatla denture bearing area

angular chelitis

candidiasis, but ay have cutaneous bacteria mixed -redness at corners of mouth

diganosis of candidiasis

clinical signs and symptoms are sufficient

preferred treatment of oral candidiasis

nystatin (mycostatin)

not absorbed systemically, msut be in contact with organism to be effective

clotrimazole (mycelex)

pleasant tasting lozenges must be taken 5x per day