Fungi

Question 1

Aspergillus: M, E, C, T

Answer 1

M: mold, septate hyphae at 45 degreees
E: everely immunocompromised, from soil or rotting vegetation, mulch
C: many things, in lungs often well-circumscribed lesions or nodules; on skin can look like ecthyma gangrenosa
T: voriconazole

Question 2

Blastmoycosis: M, E, C, T

Answer 2

M: dimorphic fungus, broad based budding
E: mainly SE and south central US and all the way up the Mississippi to Wisconsin (most cases usually), associated with moist soil by riverbanks
C: lots of things depending on immune status, pulmonary most common
T: amphotericin then itraconazole

Question 3

Coccidioides: M, E, C, T

Answer 3

M: dimorphic fungus, spherules
E: immunocompromised, black, Filipino; SW USA
C: lung, skin, bone, CNS, disseminated
T: fluconazole (can use itraconazole if no meningitis), can use amphotericin B if can’t use fluconazole or combination if needed for salvage

Question 4

Fusarium: M, E, C, T

Answer 4

M: mold, septate hyphae at 45 degrees
E: severely immunocompromised
C: key are red, tender skin nodules
T: vori

Question 5

Histoplasmosis: M, E, C, T

Answer 5

M: dimorphic fungus
E: all over but most in US are around Mississippi and Ohio River Valleys, in moist rich soil, associated with birds and bats
C: lots of things depending on immune status; 1/4 of disseminated cases have oral lesions; adrenal invasion is possible
T: amphotericin then itraconazole

Question 6

Malassezia furfur: M, C

Answer 6

M: budding yeast, spaghetti and meat balls, needs olive oil to grow
C: catheter-associated sepsis especially with TPN

Question 7

Zygomyces: M, E, C, T

Answer 7

M: mold, aseptate hyphae at 90 degrees
E: immunocompromised, diabetes
C: most common form is invasive sinusitis (look for eschars in nose or pharynx); also lung disease and others
T: ampho then posa (surgery!)

Question 8

Penicillium marneffei: M, E, C, D, T

Answer 8

M: dimorphic fungus
E: SE Asia (including southern China), more common if immunosuppressed
C: fever, anemia, weight loss, skin lesions (71%, more common than Histo, umbilicated), LAD, HSM
D: methamine silver stain, blood culture
T: amphotericin B and then itraconazole

Question 9

Phaeohyphomycosis: M, C, T

Answer 9

M: septated molds, hyphae contain melanin (unlike Aspergillus, Scedosporium), dark colonies
–Species: Cladophialophora, Ochroconis, Ramichloridium, Exophiala, Bipolaris
C: brain abscesses, sinusitis, lung granulomas, bone and soft tissue granulomas
T: resection + (itraconazole OR posaconazole OR voriconazole)