Cause pneumonia Histoplamosis Blastomycosis Coccioidomycosis Paracoccidioidomycosis dimorphic fungi cold (20C)= mold heat (37)= yeast (except cocci= sperule) Tx: fluconazole or itraconazole for local infection amphotericin B for systemic infection

Dimorphic fungi ( cold= fungi, heat= yeast) Mississippi and Ohio river valley pneunomia bird or bat droppings \ Histo hides\

dimorphic fungi (cold= mold, heat= yeast) States east of Mississippi River and Central America Causes inflammatory lung disease can disseminate to skin and bones Forms granulomatous nodules Broad base budding \ Blasto buds Broadly\

dimorphic fungi ( cold = mold, heat=spherule) Southwestern US, Calfornia Causes pneumonia and meningitis can disseminated to bone and skin increase rate after earthquakes spherules are filled with endospores San Joaquin Valley Fever Desert bumps= erythema nodosum Desert rheumatism= arthralgias \ Coccidio Crowds\

Cutaneous mycoses Tinear Versicolor degradation of lipids produce acids that damage malanocytes and cause hypopigmentation and/or hyperpigmented patches "spaghetti and meatball" appearance occurs in hot, humid weather Tx: topical miconazole, selenium sulfide

opportunistic fungal infection systemic or superficial fungal infection Causes oral and esophageal thrush in immunocompromised (neonates, steroids, AIDS, diabetes), vulvovaginitis (diabetes, abx), diaper rash endocarditis in IVDU disseminanted candidiasis chronic mucocutaneous candidiasis Treatment topical azole for vaginal fluconazole or caspofungin for oral/esophageal fluconazole, amphotericin B or caspofungin for systemic

Opportunistic fungal infection Mucormycosis Disease mostly in ketoacidotic diabeteic and leukemia patients Fungi proliferate in blood veessle walls when there is excess ketones and glucose, penetrate cribiform plate and enter brain Rhinocerebral, frontal lobe abscesses Headache, facial pain, black necrotic eschar on face Tx: amphotericin B

Opportunistic fungal infection Sporotrichosis Dimorphic, cigar shaped budding yeast that lives on vegetation when spores are traumatically introduced into skin, (thorn, rose gardener's disease) causes a local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis) little systemic illness Tx: itraconazole or potassium iodide \ Plant a rose in a pot\

Protozoa: GI infection Giardiasis bloating, ftalulence, foul smelling, fatty diarrhea often seen in campers and hikers Transmission: cysts in water Dx: Trophozoites or cysts in stool Tx: metronidazole \ Fat rich Ghiaradelli chocolates for fatty stools of Giardia\

Protozoa: GI Severe diarrhea in AIDS mild disease (watery diarrhea) in immunocompromised Transmission: Oocytes in water Dx: Oocytes on acid-fast stain Tx: prevention: water filtration Nitazoxanide: immunocompetent hosts

Protozoa: CNS Brain abscess in HIV (ring enhancing lesions on CT) congenital toxoplasmosis chorioretinitis hydrocephalus intracranial calcification Transmission: Cysts in meat oocytes in cat feces Crosses placenta! ( pregnant women avoid cats) Dx: Serology, biopsy (tachyzoite) Tx: Sulfadiazine & pyrimethamine

Protozoa: CNS Rapidly fata meningoencephalitis Transmission: swimming in freshwater lakes enters cribiform plate dx: amoebas in spinal fluid Tx: Amphotericin B \ Nalgene bottle filled with fresh water containing Naegleria)\

Protozoa: CNS African sleeping sickness enlarged lymph nodes recurring fever ( antigenic variation) somnolence, coma Species rhodesiense gambiense Transmission: Tsetse fly, painful bite Dx: blood smear Tx: suramine: blood bourne disease melarsoprol: CNS penetration \ It sure is nice to go to sleep. Melatonin helps with sleep\

Microbiology: Mycoses, Parasites Flashcards by J C

Systemic Mycoses

Cause pneumonia
- Histoplamosis
- Blastomycosis
- Coccioidomycosis
- Paracoccidioidomycosis
dimorphic fungi
- cold (20C)= mold
- heat (37)= yeast (except cocci= sperule)
Tx:
- fluconazole or itraconazole for local infection
- amphotericin B for systemic infection

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Histoplasmosis

Dimorphic fungi ( cold= fungi, heat= yeast)
Mississippi and Ohio river valley
pneunomia
bird or bat droppings

*Histo hides*

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Blastomycosis

dimorphic fungi (cold= mold, heat= yeast)
States east of Mississippi River and Central America
Causes inflammatory lung disease
can disseminate to skin and bones
Forms granulomatous nodules
Broad base budding

*Blasto buds Broadly*

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Coccidioidomycosis

dimorphic fungi ( cold = mold, heat=spherule)
Southwestern US, Calfornia
Causes pneumonia and meningitis
can disseminated to bone and skin
increase rate after earthquakes
spherules are filled with endospores
San Joaquin Valley Fever
Desert bumps= erythema nodosum
Desert rheumatism= arthralgias

*Coccidio Crowds*

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Paracoccidioidomycosis

dimorphic fungi (cold= mold, heat= yeast)
Latin American
Budding yeast with ‘captain’s wheel’ formation

*Paracoccidio parasails with the captain’s wheel all the way to Latin America”

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Malassezia furfur

Cutaneous mycoses
Tinear Versicolor
degradation of lipids produce acids that damage malanocytes and cause hypopigmentation and/or hyperpigmented patches
“spaghetti and meatball” appearance
occurs in hot, humid weather
Tx: topical miconazole, selenium sulfide

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Dermatophytes:

Microsporum

Trichophyton

Epidermophyton

Pruritic lesions with central clearing resembling a ring
see mold hyphae in KOH prep
Includes
- tinea pedis (foot)
- tinea cruris (groin)
- tinea corporis (ringworm on body)
- tinea capitis (head, scalp)
- tinea unguinum (onychomycosis on fingernails)

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Candidia albicans

opportunistic fungal infection
systemic or superficial fungal infection

Causes

oral and esophageal thrush in immunocompromised (neonates, steroids, AIDS, diabetes),
vulvovaginitis (diabetes, abx),
diaper rash
endocarditis in IVDU
disseminanted candidiasis
chronic mucocutaneous candidiasis

Treatment

topical azole for vaginal
fluconazole or caspofungin for oral/esophageal
fluconazole, amphotericin B or caspofungin for systemic

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Aspergillus fumigatus

opportunistic fungal infection
invasive aspergillosis ( immunocompormised and chronic granulomatous disease)
Allergic bronchopulmonary aspergillosis (ABPA): associated with asthma and cystic fibrosis
- may cuase bronchietasis and eosinphilia
Aspergillomas in lung cavities, esp after TB infection
some species of Aspergillus produce aflotoxins ( associated with HCC)

*Acute Angles in Aspergillus. Not dimorphic*

(Hyphae at 45* angle)

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Cryptococcus neoformans

Opportunistic fungal infection
Cryptococcal meningitis, cryptococcosis
Heavily encapsulated yeast
Not dimorphic
found in soil, pigeon droppings
acquired through inhalation with hematogenous dissemination to meninges
Culture on Sabouraud agar
Stains with India Ink and mucicarmine
Latex agglutination test detects polysaccharide capsular antigen
“soap bubble” lesions in brain

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Mucor and Rhizopus

Opportunistic fungal infection
Mucormycosis
Disease mostly in ketoacidotic diabeteic and leukemia patients
Fungi proliferate in blood veessle walls when there is excess ketones and glucose, penetrate cribiform plate and enter brain
Rhinocerebral, frontal lobe abscesses
Headache, facial pain, black necrotic eschar on face
Tx: amphotericin B

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Pneumocystitis pneumonia (PCP)

opportunistic fungal infection
diffuse interstial pnumonia
Yeast
Inhaled
Diffue, b/l CXR appearance
Diagnosed by lung biopsy or lavage
Disc-shaped yeast forms on methenamine silver stain of lung tissue
Tx: TMP/SMX, pentamidine
Prophylaxis: dapsone, atorvaquone
- start when CD4 drops <200 in HIV pts

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Sporothrix schenckii

Opportunistic fungal infection
Sporotrichosis
Dimorphic, cigar shaped budding yeast that lives on vegetation
when spores are traumatically introduced into skin, (thorn, “rose gardener’s disease”) causes a local pustule or ulcer with nodules along draining lymphatics (ascending lymphangitis)
little systemic illness
Tx: itraconazole or potassium iodide

* Plant a rose in a pot*

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Giardia lamblia

Protozoa: GI infection
Giardiasis
- bloating, ftalulence, foul smelling, fatty diarrhea
often seen in campers and hikers
Transmission: cysts in water
Dx: Trophozoites or cysts in stool
Tx: metronidazole

* Fat rich Ghiaradelli chocolates for fatty stools of Giardia*

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Entamoeba histolytica

Protozoa: GI
Amebiasis:
- bloody diarrhea (dysentary)
- liver abscess (anchovy paste exudate)
- RUQ pain
Histology: flask shaped ulcer if submucosal abscess of colon ruptures
Transmission: cysts in water
Dx:
- serology
- trophozoites (RBC in cytoplasm)
- cysts in stool
Tx:
- metronidazole
- Iodoquinol for asymptomatic cyst passes

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Cryptosporidium

Protozoa: GI
Severe diarrhea in AIDS
mild disease (watery diarrhea) in immunocompromised
Transmission: Oocytes in water
Dx: Oocytes on acid-fast stain
Tx:
- prevention: water filtration
- Nitazoxanide: immunocompetent hosts

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Toxoplasma gondii

Protozoa: CNS
Brain abscess in HIV (ring enhancing lesions on CT)
congenital toxoplasmosis
- chorioretinitis
- hydrocephalus
- intracranial calcification
Transmission:
- Cysts in meat
- oocytes in cat feces
Crosses placenta! ( pregnant women avoid cats)
Dx: Serology, biopsy (tachyzoite)
Tx: Sulfadiazine & pyrimethamine

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Naegleria fowleri

Protozoa: CNS
Rapidly fata meningoencephalitis
Transmission: swimming in freshwater lakes
- enters cribiform plate
dx: amoebas in spinal fluid
Tx: Amphotericin B

*Nalgene bottle filled with fresh water containing Naegleria)*

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Trypanosoma brucei

Protozoa: CNS
African sleeping sickness
- enlarged lymph nodes
- recurring fever ( antigenic variation)
- somnolence, coma
Species
- rhodesiense
- gambiense
Transmission: Tsetse fly, painful bite
Dx: blood smear
Tx:
- suramine: blood bourne disease
- melarsoprol: CNS penetration

* It sure is nice to go to sleep. Melatonin helps with sleep*

Plasmodium

P. vivax/ ovale
P. falciparum
P. malariae

Protozoa: Hematologic
Malaria: fever, headache, anemia, splenomegaly
Transmission: Mosquito (anopheles)
Dx: blood smear, trophozoite ring from in RBC, schizont containing merozoites
P. vivax/ovale
- 48 hr cycle
- includes fever on first day and third day
- dormant form in liver (hypnozoite)
P. falciparum
- severe, irregular fever pattern
- parasitized RBCs occlude capillaries in brain, kidneys, lung
P. malariae
- 72 hr cycle (quartan)
Tx
- Chloroquine: blocks plasmodium heme polymerase (mefloquine, atovaquone/proguanil)
- life treatening: IV quinidine ( test for G6PD deficiency)
- vivax/ovale: add primaquine for hypnozoite (test for G6PD deficiency)

Babesia

Protozoa: Hematologic
Babesiosis: fever, hemolytic anemia
predominantly in northeast US
asplenia increases risk for disease
Transmission: Ixodes tick ( same as Borrelia- Lyme dz)
Dx:
- blood smear: ring form, maltese cross
- PCR
Tx: atovaquone & azithromycin

Trypanosoma Cruzi

Protozoa
Chagas disease
- dilated cardiomyopathy
- megacolon
- megaesophagus
- predominantly in South America
Transmission: Reduviid bug (kissing bug) feces, deposited in a painless bite
Dx: blood smeal
Tx: Benznidazole or nifurtimox

Leishmania donovani

Protozoa
Visceral leishmaniasis
- spiking fevers
- hepatosplenomegaly
- pancytopenia
Transmission: Sandfly
Dx: macrophages containing amastigotes
Tx: amphotericin B, sodium stibogluconate

Trichomonas vaginalis

Protozoa
Vaginitis
- foul smelling, greenish discharge
- itching and burning
Sexual transmission
Dx:
- Trophozoites (motile) on wet mount
- strawberry cervix
Tx: metronidazole for pt and partner (prophylaxis)

NOT Gardnerella vaginalis (bacterial vaginosis)

Enterobius vermicularis

* Nematode (pinworm) * Tranmission: fecal oral * Intestinal infection causing anal pruritus * Dx: scotch tape test * Tx: **Bendazole** or pyrantel pamoate \* worms are **bend**y\*

Ascaris lumbricoides

* Nematode (giant roundworm) * Transmission: fecal-oral (eggs visible in feces under microscope) * Intestinal infetion * Tx: bendazole or pyrantel pamoate

Strongyloides stercoralis

* Nematode * Transmission: larvae in soil penetrate the skin * Disease: intestinal infection causing vomiting, diarrhea, epigastric pain (may be peptic ulcer like) * Tx: Ivermectin or albendazole

Ancylostoma duodenale Necator americanus

* Nematode (hookworms) * Transmission: larvae penetrate skin * Intestinal infection causing anemia by sucking blood from intestinal wall * Tx: Bendazole or pyrantel pamoate

Onchocerca Volvulus

* Nematode * Transmission: female **black**fly bite * Hyperpigmented skin and **river blindness** * allergic reaction to microfilaria possible * Tx: **Iver**mectin \* **Black** flies, **black skin** nodules, **black sight**\* \***Iver**mectin for **river** blindness\*

Loa Loa

* Nematode * Transmission: deer fly, horse fly, mango fly * Swelling skin, worm in conjunctiva * Tx: Diethylcarbamazine

Wuchereria bancrofti

* Nematode (roundworm) * Transmission: Female mosquito * Blocks lymphatic vessels, elephantitiasis * takes 9 mo to 1 year after bite to become symptomatic * Tx: Albendazole or mebendazole

Toxocara canis

* Nematode * Transmission: fecal oral * visceral larval migrans * Tx: albendazole or mebendazole

Nematodes Routes of infection: Ingested Cutaneous Bites

* Ingested: **E**nterobius, **A**scaris, **T**oxocara * you'll get sick if you **EAT** these! * Cutaneous: **S**trongyloides, **A**ncylostoma, **N**ecator * These get in your feet in the **SAN**d * Bites: **L**oa loa, **O**nchocerca, **W**uchereria bancrofti * lay **LOW** to avoid getting bitten

Taenia solium

* Cestode * Transmission: ingestion of larvae encysted in undercooked pork or Ingestion of eggs * Intestinal infection * Cysticercosis, neurocysticercosis * Tx: Praziqunatel (albendazole for neurocysticercosis)

Diphyllobothrium latum

* Cestode * Transmission: Ingestion of larvae from raw freshwater fish * Vitamin B12 deficiency leads to anemia * Tx: Praziquantel

Echinococcus granulosus

* Cestode * Transmission: Ingestion of eggs from dog feces * Hydatid cysts in liver, causing anaphylaxis if antigens released * Tx: Albendazole

Schistosoma

* Trematode * Transmission: Snails are host * cercariae penetrate skin of humans * Liver and spleen granulomas, fibrosis and inflammation * Chronic infection with S. haematobium can lead to squamous cell carcinoma of the bladder ( painless hematuria) * Tx: Praziquantel

Clonorchis sinensis

* Trematode * Transmission: undercooked fish * biliary tract inflammation leading to pigmented gallstones * associated with cholangiocarcinoma * Tx: Praziquantel

Parasite association: ## Footnote Biliary tract disease cholangiocarcinoma

Clonorchis sinensis

Parasite association: ## Footnote Brain cysts seizures

Taenia solium

Parasite association: Liver (hydatid) cysts

Echinococcus granulosus

Parasite association: Microcytic anemia

Ancylostoma, Necator

Parasite association: perianal pruritis

Enterobius

Parasite association: Portal HTN

Schistosoma mansonii Schistosoma japonicum

Parasite association: Vitamin B12 deficiency

Diphyllobothrium latum