Fungi

Question 1

Your patient comes to your clinic with a bad cough. He recently spent his weekend in the caves of Ohio, Mississippi and Indiana. He said that when he was in the cave, he noticed lots of bat and bird poop. He also raises chickens.

What tests would you like to do?
What do you plan to see under the microscope?

Answer 1

Urine Rapid Antigen Test,
Blood Rapid Antigen Test

This will help you determine if it is histoplasmosis.

When looking at it under the microscope, you expect to see the macrophage that engufled the histoplasmosis to be smaller than an RBC.

Question 2

You determined that your cave loving patient has histoplasmosis. You tell him that the reason why he contracted it was from inhaling _____.

Answer 2

bird or bat droppings.

Question 3

Histoplasmosis engulfed by a macrophage would be ___ than an RBC

Answer 3

smaller

Question 4

___ is acquired by inhalation of spores, esp. from bird or bat droppings. You can contract them from being in ___ or ___. No ___-to-___ transmission. It is a ___ disease which causes _____’s lung

Answer 4

Histoplasmosis is acquired by inhalation of spores, esp. from bird or bat droppings. You can contract them from being in caves or farms. No human-to-human transmission. It is a cave disease which causes spelunker’s lung

Question 5

Histoplasmosis, is mostly asymptomatic. Occasionally, however, it can progress to lung disease, similar to ____. This usually occurs in ____ patients.
Histoplasmosis may also spread systemically to form cutaneous lesions called ___ ____, infect joints and meninges. Severe infections can cause mediastinitis, lymphadenopathy, adrenal enlargement and _____ (a major feature, and also mentioned in sketchy). Lesions in the lung have a tendency to ____ as they heal. Another characteristic of histoplasmosis is __ __, a painful inflammatory lesion.

Answer 5

Histoplasmosis, is mostly asymptomatic. Occasionally, however, it can progress to lung disease, similar to TB. This usually occurs in immunocompromised patients.
Histoplasmosis may also spread systemically to form cutaneous lesions in ithe lungs, infect joints and meninges. Severe infections can cause mediastinitis, lymphadenopathy, adrenal enlargement and hepatosplenomegaly, (a major feature in immunocompromised, and also mentioned in sketchy). Lesions in the lung have a tendency to calcify as they heal. Another characteristic of histoplasmosis is erythema nodosa, a painful inflammatory lesion.

Question 6

TB and Histoplasmosis look almost the same. But a characteristic of TB is that there is ___ sputum.

Answer 6

Bloody

Question 7

Histoplasmosis is often diagnosed with ___ and ___ tests

Answer 7

Urine rapid antigen tests and blood rapid antigen tests.

Question 8

Histoplasmosis is often diagnosed with ___ and ___ tests

Answer 8

Urine rapid antigen tests and blood rapid antigen tests.

Question 9

If an immunocompromised individual contracts histoplasmosis, they will feel like A HAM. What symptoms show?

Answer 9

ARD (Acute resp. distress syndrome)
Heart problems
Adrenal insufficiency
Meningitis

Question 10

T/F: Histoplasmosis is a dimorphic fungi

Answer 10

True

Question 11

Histoplasmosis is a ___ fungi, which means it can spread to other parts of the body

Answer 11

Systemic

Question 12

An HIV patient contracts histoplasmosis. What symptoms do you expect to see?

Answer 12

Hepatosplenomegaly

Question 13

An immunocompromised patient who works for a construction company from the Ohio River Valley, comes to you with flu-like symptoms. What type of test would you do, and what would you expect to see under the microscope? What other symptoms might you expect to see?

Answer 13

You’d want to order a urine rapid antigen test. You’d probably expect to see blastomycosis. Under the microscope, you’d see BBB - broad based budding, and the same size as an RBC.

In the immunocompromised patient, you’d see patchy alveolar infiltrates on a CXR, Lesions may also be present. disease in skin and bones.

Question 14

Blastomycosis is the ____ size as an RBC

Answer 14

same

Question 15

T/F: Blastomycosis is dimorphic

Answer 15

True

Question 16

In the immunocompromised patient with Blastomycosis, you’d see ____ on a CXR. ____ may also be present and the patient may also develop disease in __ and ___.

Answer 16

In the immunocompromised patient, you’d see patchy alveolar infiltrates on a CXR. Lesions may also be present. They may also develop disease in skin and bones.

Question 17

After a big earthquake in Palm Dessert, a patient comes to you with cough, sweating, athralgia and erythema nodosum. What test would you like to do? What do you think it is, and what do you expect to see under the microscope?

Answer 17

You can do a KOH stain and you’d see a sphere full of endospores. This would be larger than an RBC.

Question 18

An HIV patient has developed Coccidiodomycosis. What types of symptoms might you expect to see?

Answer 18

Skin and lung infections, may disseminate to bone, can cause meningitis and a stiff neck.

Question 19

A Latin American patient comes to your clinic with cough, mucosal ulcers and cervical lymphadenopathy. Under the microscope, you’d expect to see what?

Answer 19

Captains wheel looking fungi. Patient came Latin America, which may clue you into thinking it is Paracoccidiodo

Question 20

T/F: Paracocci is dimorphic

Answer 20

True

Question 21

T/F: Paracocci is smaller than an RBC

Answer 21

False. It is much larger

Question 22

A Latin American patient comes to your clinic with ___, ___ ulcers and ____ lymphadenopathy. Under the microscope, you’d expect to see what?

Answer 22

A Latin American patient comes to your clinic with cough, mucosal ulcers and cervical lymphadenopathy. Under the microscope, you’d expect to see what? This is Paracocci

Question 23

A patient from the tropics comes to your clinic with pityriasis versicolor spots on her body and bad dandruff. You do a ___ stain and a ___ culture. What do you expect to see? You look at the skin under __ light and see ____.

Why are the spots discolored?

Answer 23

A patient from the tropics comes to your clinic with pityriasis versicolor spots on her body and bad dandruff. You grow it on Sab Agar and confirm it is fungi. You also do a PAS stain, and see a spaghetti and meatball look that are infrequently branched. You examine the skin under UV light and see fine, bran-like scales.

Fungi break down lipid and release acid –> acid causes apoptosis of melanocytes and causes discoloration.

Question 24

A baby shortly after birth is put on parenteral nutrition (lots of lipids) via catheter. The baby starts to develop decoloration on the skin. What does the baby have? How do you treat it?

Answer 24

Malassezia Furfur.

Selenium sulfate or selenium blue

Question 25

A patient comes to you with jock itch. How would you confirm that this is Tinea Cruris?

Answer 25

You can do a KOH prep and look for mycelia, the vegetative part of a fungus, consisting of a network of fine white filaments (hyphae). You can also use a woodslamp.

Question 26

A woman comes to your clinic and complains of having small, painless bump that developed 6 weeks after she was tending her garden. You notice that the bump is pink, or purple and appears on the finger, hand, and arm. You look at it under a microscope. What do you expect to see and what is this? What is the pattern of spread?
How can you treat it?

Answer 26

You expect to see cigar shaped yeast. This woman has sporotrichosis from sporotrix schenkii, a dimorphic yeast.
This can spread in an ascending pattern along the draining lymphatics.
You can treat it with potassium iodine.

Question 27

A 31 year old diabetic woman who is on birth control pills comes to your office complaining of “cottage cheese-like” discharge. What type of tests would you do, what does she have?

Answer 27

You should treat the sample with KOH and look for germ tubes in 37 degree. She probably has vaginal candidiasis.

Question 28

An HIV patient comes to your clinic white discharge in his esophagus. What does he have?

Answer 28

Candidiasis esophagitis

CD count < 100

Question 29

C. Albicans is catalase ___

Answer 29

posititve

Question 30

A young man who takes steroids through inhalation comes to your clinic with white cottage cheese-like substance in his mouth. What does he have?

Answer 30

Candida albicans

Question 31

A homeless HIV+ patient from New York City, comes with a bad cough, fever, headache, nausea and a stuff neck. What is your first step? What do you think it is?

Answer 31

You think it may be cryptococus meningitis. This can be contracted from inhalation of pigeon poop. It is an opportunistic fungi.

First, you can do a stain on india ink and look for halos. You can also get an MRI and look for soap bubble lesions.

Question 32

Cryptococcus neoformans is ___ and stains on ____ ink

Answer 32

encapsulated

india ink

Question 33

Cryptococcus neoformans is urease __

Answer 33

positive

Question 34

T/F: Cryptococcus is dimorphic

Answer 34

False

Question 35

What two stains can you do for crypococus neoformans?

Answer 35

India Ink

Mucocarmine - stains capsule red

Question 36

A patient comes to your clinic and complains of nausea, vomiting, headache, fever, and a stiff neck. You notice small soap bubble lesions on the MRI. What does he have?
How do you treat him?

Answer 36

Cryptococcus meningitis.

Ampho B + Flucytosine for 2 weeks, then switch to Flucanazole.

Question 37

Which fungi has a capsule?

Answer 37

Cryptococcus neoformans

Question 38

A HIV+ patient comes to your office complaining of pneumonia. You take a CT of the lungs and notice a ground glass appearance. What type of stain would you want to do after this to confirm? What would the year look like? What do you diagnose?

Answer 38

Ground glass lungs are typical of pneumocystis jiroveci. You should follow up with a silver stain. If the patient has pneumocystis jiroveci, then you will see the yeast that look like discs.

Question 39

A diabetic patient who is HIV+ comes to your clinic complaining of fever, pain, lethargy, confusion. Her breath smells like nail polish remover. Under a microscope, what do you expect to see?

Answer 39

You’d expect to see wide non-septate hyphae at 90 degree angles (in contrast to aspergillus).
–> Mucormycosis infection

Question 40

Which two fungi are catalase positive? Which fungi is urease positive?

Answer 40

The two catalase positive fungi are aspergillus and c. albicans.
The urease posititve fungi is cryptococcus neoformans

Question 41

Dimorphic Fungi:

Answer 41

BHCS
Body Heat Changes Shape
Blasto, Histo, Cocci, Sporothrix