Mucosal, Cutaenous, Opportunistic and Pathogenic Mycoces Flashcards
Tinea Versicolor: Bug, Pathogenesis and Morphology
Bug: M Furfur
Pathogenesis: feeds on keratin but does not elicit inflammatory response
Morphology: Spaghetti and Meatballs (yeast and hyphae)
Treatment for Tinea Versicolor
Itraconazol; Selsin Shampoo
Common Dermatophytes causing species
Microsporum, Epidermophyton, Floccosum, Trichophyton
Microsporum: Morphology, and common anatomical sites of infection
Morphology: Septated Hyphae with characteristic Dolphin Beak
Sites: All but nail bed
Epidermophyton: Common anatomical sites of infection
Tinea Cruris
Trichophyton: Morphology & Common Sites of infection
Morphology: Propagating spores; much smaller than microsporum
Common Sites: capitus, barbae, corporis, cruris
Tinea Capitus:
Treatment
Systemic: Terbinafine, Itraconazole
Topical: Selsin, Ketonazole
Sterilize fomites
Ectothrix:
Causal organisms
Manifestations
M. Canus;
Eating of hair shat with keratinase
Alopecia
Endothrix
Causal Organisms
Manifestations
T. Tonsurans
Eating of hair shaft from the bulb.
Irreversible alopecia
Tinea Pedis:
Causal Organism
Treatment
Bug: T Rubrum
Treatment:
First line - Topical Miconazole, Clotrimizale
Secondary (if extensive): Oral Itraconazole, fluconazole
Tinea Corporis, Barbae, Cruris, manuum:
Treatment:
Treatment:
first line - topicals (miconazole, clotrimazole)
Second line: Oral (itraconazole, fluconazole, terbinafine)
Tinea Unguium: 3 Classifications + Causal organisms
PSO - T rubrum (proximal)
DSP - T rubrum, T tonsurans (most common; Distal)
WSO - T mentagrophytes (least common; dorsal surface)
Often seen in HIV and other immunocompromised patients
Tinea Unguium
Oral: Terbinafine, itraconazole, fluconazole
Opportunistic Mycoces: 2 Divisions of Immuno-Compromise
1) Altered T Cell function – eg HIV
2) Altered Phagocytic Function - eg neutropenia
Opportunistic Mycoces: Disease of altered T cell function
Mucocutaneous Candidiasis (thrush)
Cryptococcosis
Pneumocystosis
Mucocutaneous Candidiasis (thrush):
Causal Bug
Characteristic Morophology
Virulence
Bug: C. Albicans
Morphology: Budding yeast, pseudohyphae, true hyphae
(+ germ tube)
Virulence: surface receptors, cell wall, enzymes; chitin at end of germ tube
MucoQ Candidiasis: Treatment
Topical: Clotrimazole, Miconazole, Nystatin
IV: Fluconazole, echinocandins (in severe cases)
Cryptococcosi:
Causal Bug
Virulence
Treatment
Cryptococcus Neoformans
Virulence: Encapsulated (only one). Can cross the BBB; block drainage of CSF
Meningitis
Treatment:
Induction - Ampho B + 5fc
Maintain - Fluconazole
Pneumocystosis Pneumonia (PCP Pneumonia):
Treatment
First line: Trimethroprim-Sulfamethoxazole (TMP-SMX = Bactrium);
Second line: Pentamidine, Clindamycin
Opportunistic Mycoces: Disease of altered phagocytic function
Candidemia
Aspergillosis
Zygomycoces
Aspergillosis : Characterisitic Morphology Distinct Radiological Finding Distinct Pathogenesis Treat
Morphology: Angular, Dichotomously (Y shaped) branching, septated hyphae
Radiology: Halo Sign (infarction); followed by Crescent sign (clearing of infarct)
Pathogenesis: Angio-Invasion
Treat:
Voraconazole (if liver healthy)
Ampho B (If kidneys healthy)
Candidemia:
Diagnostic Test
Treatment
Deeply Invasive Candiasis:
Positive C. albicans in the blood
Treat:
- echinocandins
- followed by Fluconazole
Zygomycosis (mucromycosis) Common Bug Morphological Characteristics Distinct Pathogenesis Treatment
Common Bug: Z. Rhizupus
Morphology:
- lab: sporangiophores
- Broad ribbon Hyphae; little branching; sparse septa
Pathogenesis: Angio-Invasion
Parasinal –> Orbit –> Brain
Can kill very quickly
Treatment: From “A to Z”
- AmphoB with surgical reduction
Pathogenic Mycoces: 3 bugs and their endemic regions
Histoplasmosis: OH/MS River Valley
Coccidioidomycosis – Desert of SW USA/Mexico
Blastomycoces – North Central and SE USA
Histoplasmosis:
Distinct Morphology -
Pathogenesis
Treatment
Morphology: Intracellular, 3 micron budding structures within monocytes and macrophages
Pathogensis: Granuloma Formation
Attacks Reticulo-Endothelail Systems
Treat:
- Itraconazole
- Ampho B for more severe cases
Coccidioidomycosis
- Morphology
- Pathogenesis
- Treatment
- Morphology: Spherules filled with endospores
- Path: Can cross into CNS; meningitis
formulation of granulomas - Treat: Itraconazole
Blastomycosis:
- Morphology
- Pathogenesis
- Treat
Morpho: Thick double wall with broad based budding
Path: Granulomas
Treat: Itraconazole
Name the Two Angio-invasive mycoces
- Aspergillus
- Zygomycetes
