Fungi Flashcards
Beta-D-Glucan notably misses:
cryptococcus
the zygomycetes (mucor, etc)
blastomyces
What are notable misses of amphotericin?
Aspergillus Terreus
Candida lusitanae (fluc/mica)
Candida auris (mica)
Scedosporium (vori)
+/-fusarium
What does vori miss?
MUCOR (needs ampho/cresemba/posa)
What does posa miss?
Nothing?
but break through can include:
- fusarium
- scedosporium (need vori or cresemba)
these are rhizoids
aseptate hyphae
mucor lacks these - so this is likely either rhizopus or rhizomucor (of the most common)
Aspergillus has 45⁰ angles (really only identifiable on path) and dandelion-head conidiophores VORI
Fusarium has oval shaped microconidia and canoe-shaped macroconidia AMPHO+VORI
Fusarium has oval shaped microconidia and canoe-shaped macroconidia AMPHO+VORI
Scedosporium has single conidia on long conidiophores VORICONAZOLE
Histoplasma looks like coronaviruses AMPHO/Itraconzazole
Blastomyces looks like Christmas lights
AMPHO/VORI
Sporothrix looks like grape clusters ITRA/AMPHO
Cryptococcus
AMPHO+FLUC
candida
barrel-shaped arthroconidia - coccioides
rosette shaped conidia
SPOROTHRIX
(also cigar-shaped yeast)
lollipop conidia and broad based budding yeast (blasto)
intracellular yeast - histoplasmosis
What is the differential for this lesion?
Crypto
Histo
Molluscum
Talaromyces (penicillium)
(Smallpox?)
64M from puerto rico p/w fevers, weight loss, dyspnea. Began two months ago and progressed. Now hypotensive, febrile and satting 88%.
SPlenomegally, hyponatremic, Pancytopenic, HIV+
PJP/TB on BAL negative
Dx?
Rx?
Disseminated Histoplasmosis
Can cause AI from infected adrenals
Start Amphotericin and Steroids(for AI)
mechanism of voriconazole
inhibits lanosterol 14-a demthylase, disrupting ergosterol synthesis
mechanism of amphotericin
binding ergosterol and altering membrane permeability
mechanism of echinocandins
inhibit 13BDG syntehsis
oval shaped yeast with a visible central septum
umbilicated lesions in HIV patient
(SE asia)
Talaromyces
*Histo/crypto clinically also could present with same syndrome, but would not have septum on microscopy
ampho/itra
82F on TPN presents with fevers/chills. Line looks fine, cultures negative.
Add olive oil to look for Malassezia!
lipophilic yeast that causes tinea versicolor but can cause CLABSI in TPN patients.
40M immunocomptetent man from michigan presents with fulminant pneumonia not responsive to standard therapy. Histo Ag positive. Verrucous Skin lesions.
Histo or Blasto?
Blasto - skin lesions more common in US, and blasto more commonly afflicts immunocompetent patients.
narrow based budding yeast
histo
Fungemia in cancer patient. Yeast is oval and budding, but crypto Ag is +
Trichosporon
pleomorphic budding yeast favors candida or trichosporon (crypto has no budding or psydohyae and is round)
Trichosporon can cause false crypto+ Ag
patient on TPN develops fevers/hypotension. no improvement with ABX and routine blood Cx negative.
Dx?
Rx?
Malssezia
enrich culture media with olive oil
Rx with ampho or azole (intrinsically resistant to echinocandins)
Histo
Cocci endospore spherule
Fontana Masson
Cryptococcus stain+
What is the most common invasive fungal infection associated with ibrutinib?
aspergillus
(ibrutinib inhibits B cells)
