Mycology

Question 1

Systemic mycoses

Answer 1

• Histoplasmosis
• Blastomycosis
• Coccidioidomycosis
• Paracoccidioidomycosis

Question 2

Histoplasmosis location

Answer 2

Mississippi & Ohio River Valleys

Question 3

Blastomycosis location

Answer 3

Mississippi River

Central America

Question 4

Coccidioidomycosis location

Answer 4

Southwestern US

California

Question 5

Paracoccidioidomycosis location

Answer 5

Latin America

Question 6

clinical presentation of histoplasmosis

Answer 6

pneumonia

Question 7

clinical presentation of Blastomycosis

Answer 7

inflammatory lung disease

disseminates to skin & bone

Question 8

clinical presentation of Coccidioidomycosis

Answer 8

• pneumonia
• meningitis
• disseminates to bone & skin

Question 9

cases increase after earthquakes

Answer 9

Coccidioidomycosis

Question 10

histoplasmosis histology

Answer 10

MΦ filled w/ histoplasma

smaller than RBC

Question 11

blastomycosis histology

Answer 11

broad based budding

same size as RBC

Question 12

coccidioidomycosis histology

Answer 12

spherule filled w/ endospores

much larger than RBC

Question 13

paracoccidioidomycosis histology

Answer 13

budding yeast w/ “captain’s wheel” formation

much larger than RBC

Question 14

*Malassezia furfur *

Answer 14

Tinea versicolor

Question 15

**Tinea versicolor **

pathology

clinical presentation

Answer 15

• occurs in hot/humid weather
• degradation of lipids
• acids damage melanocytes
• hypo/hyper-pigmented patches

Question 16

tinea versicolor treatment

Answer 16

topical Miconazole

selenium sulfide

Question 17

“spaghetti & meatball appearance”

Answer 17

tinea versicolor

Question 18

Definitions

• tinea pedis
• tinea cruris
• tinea corporis
• tinea capitis
• tinea unguium

Answer 18

• tinea pedis = foot
• tinea cruris = groin
• tinea corporis = ringworm (on body)
• tinea capitis = head, scalp
• tinea unguium = onychomycosis (fingernails)

Question 19

dermatophytes

Answer 19

• microsporum
• trichophyton
• epidermophyton

Question 20

how do the other tinae clinically present?

Answer 20

pruritic lesions w/ central clearing (ring)

mold hyphae on KOH

Question 21

candida albicans clinical presentation

Answer 21

• oral & esophageal thrush (immunocompromised)
• vulvovaginitis
• diaper rash
• endocarditis in IV drug users
• disseminated candidiasis
• chronic mucocutaneous candidiasis

Question 22

candida albicans treatment

• vaginal
• oral/esophageal
• systemic

Answer 22

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

Question 23

clinical diseases of Aspergillus fumigatus

Answer 23

• invasive aspergillosis
• allergic bronchopulmonary aspergillosis (ABPA)
• aspergilloma

Question 24

who tends to get infected w/ invasive aspergillosis

Answer 24

• immunocompromised
• chronic granulomatous disease

Question 25

allergic bronchopulmonary aspergillosis

Answer 25

* asthma & cystic fibrosis * bronchiectasis & eosinophilia

Question 26

aspergillomas infect the __________ post ______ infection.

Answer 26

lung cavities TB

Question 27

Aspergillus fumigatus aflatoxins

Answer 27

hepatocellular carcinoma

Question 28

aspergillus branches at a _____ degree angle

Answer 28

45

Question 29

"soap bubble" lesions in brain

Answer 29

Cryptococcus neoformans

Question 30

**Cryptococcus neoformans** morphology spread/dissemination

Answer 30

* heavily encapsulated yeast (NOT dimorphic) * soil, pigeon droppings * inhalation --\> hematogenous dissemination to meninges

Question 31

Mucormycosis

Answer 31

Mucor & Rhizopus spp.

Question 32

Mucormycosis patient population

Answer 32

ketoacidotic diabetic & leukemic patients

Question 33

mucormycosis spread

Answer 33

* excess ketone & glucose * fungi proliferate in BV walls * penetrate cribriform plate * enter brain

Question 34

Mucormycosis clinical presentation

Answer 34

* Rhinocerebral, frontal lobe abscesses * headache, facial pain, black necrotic eschar on face * maybe CN involvement

Question 35

Mucormycosis treatment

Answer 35

amphotericin B

Question 36

inhaled yeast diffuse bilateral CXR appearance

Answer 36

Pneumocystis jirovecii

Question 37

when do you start PCP prophylaxis?

Answer 37

* CD4 **\<200 cells/mm³** in HIV patients * dapsone, atovaquone * TMP-SMX, pentamidine

Question 38

diffuse interstitial pneumonia

Answer 38

Pneumocystis jirovecii (PCP)

Question 39

dimorphic, cigar-shaped budding yeast

Answer 39

Sporothrix schenckii

Question 40

How is sporothrix schenckii spread?

Answer 40

* vegetation --\> thorn --\> spores * local pustule or ulcer w/ nodules along draining lymphatics * ascending lymphangitis

Question 41

Sporothrix schenckii treatment

Answer 41

itraconazole, potassium iodide