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PBD II > Medically Relevant Fungi - SRS > Flashcards

Medically Relevant Fungi - SRS Flashcards

1
Q

What type of stain is being used on this sample of Cryptococcus?

What does it reveal?

A

India Ink Stain

Capsule

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2
Q

Cryptococcus infections of the lungs tend to be…

A

Self limited

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3
Q

Cryptococcus can fairly commonly cause meningitis in HIV patients. What is the treatment for this?

A

–Treatment is Ampho-B +/- flucytosine followed by fluconazole for a long time (6-12 months to life long)

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4
Q

After a sky diving accident your now quadriplegic patient presents with tinea veriscolor with hypopigmentation and seborrheic dermatitis.

You see the rash in the photo and obtain the sample of the organism shown below. What organism is this, and what is the classical description we can expect to see?

A

Malassezia furfur

•board question is “spaghetti and meatballs” in a patient getting longterm TPN.

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5
Q

What is the most common presentation of histoplasmosis infection?

A

Acute Pulmonary Illness

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6
Q

What are the other, less common presentations of histoplasmosis infections?

A
  • Rheumatologic syndromes 10%
  • Pericarditis 10%
  • Chronic Pulmonary Symptoms 10%
  • Disseminating disease 10%
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7
Q

Blastomycosis dermatididis is present in soils, and has a similar geography to histoplasmosis. What are the 5 most common presentations of blastomycosis?

A
  • Pulmonary with infiltrates 60-70%
  • Cutaneous 40-50%
  • Osteoarticular 10-15%
  • GU (prostate) 10%
  • CNS <10%
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8
Q

What are the yeast forms we covered?

A
  1. Candida
  2. Cryptococcus
  3. Malassezia
  4. Trichosporon
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9
Q

What are the mold forms we discussed?

A

Aspergillus

Zygomycetes

Mucor

Rhizo

Absidia

Fusarium

Pseudoallerscheria boydii/ scedosporium apiospermum

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10
Q

Name six dimorphs

A
  1. Histoplasma
  2. Blastomyces
  3. Coccidioides
  4. Paracoccidioides
  5. Penicillium
  6. Sporothrix
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11
Q

What component of the fungal cell membrane is unique and targeted by some antifungals?

A

Ergosterol

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12
Q

What is the only endogenous fungal organism?

A

Candida

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13
Q

Where is candida found?

A

GI and GU tracts

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14
Q

Your HIV positive patient presents with the attached physical findings.

What is this condition?

What organism is responsible for this?

A

This is an example of mucocutaneous candidiasis presenting as oropharyngeal/esophageal candidiasis. >90% of these will be caused by C. albicans.

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15
Q

Your patient presents with a yeast infection as shown, what is this condition called? What most likely lead to this?

A

Vulvovaginitis d/t candida.

Typically occurs after a course of antibiotics

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16
Q

This patient developed the rash shown after a course of antibiotics and steroid treatment. What would this fungal infection most likely be?

A

Cutaneous candidiasis

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17
Q

Systemic candidiasis - or candidemia (in the bloodstream) is the 4th most common nosocomial bloodstream infection. It has a 22-38% mortality even with tx.

Who do we see this in?

When do we typically see manifestations?

A

–Can be seen in severe immunocompromised (ie acute leukemia treatment or bone marrow xplant)
–Usually do not see manifestations until significant neutrophil recovery.

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18
Q

What are the 6 antifungals C. albicans is susceptible to?

A
  1. Fluconazole
  2. Itraconazole
  3. Voriconazole
  4. 5-FC
  5. Amphotericin B
  6. Echinocandins
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19
Q

Describe the sensitivity of C. glabrata to…

  1. Flucanazole
  2. Itraconazole
  3. Voriconazole
  4. 5-FC
  5. Ampho-B
  6. Enchinocandins
A
  1. Flucanazole: S-DD (dose dependent), Resistant
  2. Itraconazole: S-DD (dose dependent), Resistant
  3. Voriconazole: S-I (intermediate)
  4. 5-FC: Susceptible
  5. Ampho-B: S-I
  6. Enchinocandins: S
20
Q

Describe the sensitivity of C. parapsilosis to…

  1. Flucanazole
  2. Itraconazole
  3. Voriconazole
  4. 5-FC
  5. Ampho-B
  6. Enchinocandins
A
  1. Flucanazole: S
  2. Itraconazole: S
  3. Voriconazole: S
  4. 5-FC: S
  5. Ampho-B: S
  6. Enchinocandins: S-I
21
Q

Describe the sensitivity of C. krusei to…

  1. Flucanazole
  2. Itraconazole
  3. Voriconazole
  4. 5-FC
  5. Ampho-B
  6. Enchinocandins
A

Flucanazole: Resistant
Itraconazole: S-DD (dose dependent), Resistant
Voriconazole: S-I (intermediate)
5-FC: I-R
Ampho-B: I-R
Enchinocandins: S

22
Q

Describe the sensitivity of C. parapsilosis to…

  1. Flucanazole
  2. Itraconazole
  3. Voriconazole
  4. 5-FC
  5. Ampho-B
  6. Enchinocandins
A

Sensitive to all

23
Q

This CT scan was taken from a patient with longstanding neutropenia after their neutrophils bounced back. The patient presented with high fever and RUQ pain with nausea, vomiting and anorexia.

What is the name of this condition?

A

Hepatosplenic (chronic disseminated) candidiasis

24
Q

You perform a fundoscopic exam on a patient with candidemia and see the attached image. What is this condition?

A

Endophthalmitis

25
Q

Known as “valley fever”. Infections with Coccidioidomycosis immitis are asymptomatic in 60% of cases. What happens in the other 40% of cases?

A

can progress to pneumonia, nodules, cavities

also can disseminate to skin, bones, tendons, CNS

26
Q

What fungal infection is associated with the lesion shown in the image?

What is the typical vector of infection?

What are the common sequelae of this infection if symptomatic?

A

This Captains wheel shape is characteristic of Paracoccidioides brasillensis

Inhalation

  • bone marrow, organomegaly and Lymphadenopathy common. also intra-abdominal issues
  • CNS 10-25%
27
Q

While tending to his scarlet carson garden, “V” gets pricked by one of the rose bushes. Trusting your capacity for secrecy he comes to you with the skin lesions shown here. You take a sample and visualize the other image microscopically.

What organism is causing this presentation?

A

Sporothrix schenckii

28
Q

Sporothrix schenckii has a 1-10 week incubation period after infection, what are the four categories that this organism can present as?

A

–lymphocutaneous; 75%
–fixed cutaneous
–disseminated
–extracutaneous

29
Q

What is the function of the black/brown molds?

A

To return organic material from whence it came

30
Q

Your 45 y/o male patient with cavitary lung disease. Scans of the patient are attached. A sample of the organism revealed a 45 degree angle branching fungus. What is the organism? What are the structures visible in the scans?

A

Aspergillus

Aspergilloma

31
Q

Who do we worry about severe reactions to aspergillus in?

A

Immunocompromised and neutropenics

32
Q

Your 43 y/o female patient presents with sudden onset of asthma. Lab tests show IGE levels over 500, and eosinophilia.

What do you suspect is the problem here?

A

Acute Bronchopulmonary Aspergillosis

(ABPA) AKA farmer’s lung

33
Q

Microscopy reveals fungi with right angle (90 degree) branching hyphae. What is the organism?

What does the typical patient profile look like?

A

Zygomycosis

•Typical patient is an uncontrolled DM with sudden onset rhinocerebral necrotizing disease

34
Q

Characterize the mortality and growth rate of zygomycosis.

A

Very fast growing

High mortality

35
Q

What is the best treatment for a zygomycosis infection?

A

Surgical excision, plus antifungals

36
Q

In normal host we see this organism in fungal keratitis as well as some other superficial infections. What is this organism?]

What do we see commonly in severely neutropenic hosts?

A

Fusarium

In neutropenic hosts:

  • 60-80% death

–disseminated/fungemia*
–skin*, pneumonia including hemoptysis

37
Q

Scedosporium apiospermum/Pseudoallersheria boydii can be encountered in soil and contaminated water. What happens to the immunocompromised host?

What are some other presentations?

A

•immunocompromised hosts tend to get CNS infection and if not aggressively treated upfront, has 75% mortality

other
•Respiratory, keratitis/endophthalmitis and skin/bone infections can be seen.
•also been implicated in sinusitis and lymphadenitis

38
Q

What are the Scedo and Pseudo forms of Scedosporium apiospermum/Pseudoallersheria boydii?

A

•Scedo is asexual (perfect) form and Pseudo is sexual (imperfect) form.

39
Q

Dermatophytes like keratin, so think of nails, hair and skin areas. What are the primary organisms associated with this?

A

Tinea

–Tinea capitis
–Tinea pedis
–Tinea corporis
–Tinea cruris
–Tinea rubrum
–Tinea unguium

Trychophyton

40
Q

What would you call this?

A

Tinea Pedis

41
Q

What is this?

A

Tinea corporis

42
Q

What is this?

A

Tinea capitis

43
Q

What is this?

A

Tinea Cruris

44
Q

What is this? What causes it?

A

majocchi granuloma

Tinea Rubrum

45
Q

What is this?

A

Tinea Unguium - nails (onychomycosis)

46
Q

Who do we see pneumocystic jiroveci (carinii) in?

A

HIV and other immunocompromised patients

47
Q

Your patient presents with three weeks of non-productive cough, progressive shortness of breath to the point where they have to rest while ascending stairs in their home. Xray and histology images are attached.

What does this person have that is causing their symptoms?

What else do they likely have?

What would be the treatment?

A

Pneumocystis

Often diagnostic of HIV/AIDS

Treatment is with antibiotics, not antifungals

PBD II (18 decks)

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