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Mycology and Parasitology Flashcards

1
Q

Systemic mycoses characteristics

A

All can cause pneumonia and disseminate
- Dimorphic fungi: cold = mold (20C); heat = yeast (37C) –> except coccidioidomycosis is spherule not yeast

  • Tx:
  • Local infection - fluconazole/itraconazole
  • Systemic - amphotericin B

**Systemic can mimic TB, but no person-to-person transmission!

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2
Q

Types of systemic mycoses

A
  • Histoplasmosis
  • Blastomycosis
  • Coccidioidomycosis
  • Paracoccidioidomycosis
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3
Q

Histoplasmosis

A

Mississippi + Ohio River valleys –> pneumonia

  • Bird/bat droppings
  • Macrophage filled with histoplasma (smaller than RBC)
  • Histo Hides (in macrophages)*
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4
Q

Blastomycosis

A

Mississippi River/Central America

  • Inflamm lung disease, can disseminated to Bone/skin
  • Makes granulomatous nodules
  • Broad-based budding (same size as RBC)
  • Blasto Buds Broadly*
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5
Q

Coccidioidomycosis

A

Southwest US/California

  • Pneumonia/meningitis, can disseminate to bone/skin
  • Incr rate after earthquake bc spores in dust –> into air –> spherules in lung
  • Spherules (much larger than RBC) filled w/ endospores
  • (San Joaquin) Valley fever*
  • Desert bumps = erythema nodosum*
  • Desert rheumatism = arthralgias*
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6
Q

Paracoccidioidomycosis

A

Latin America
- Budding yeast with “captain’s wheel” formation (much larger than RBC)

Paracoccidio Parasails with the captain’s wheel all the way to Latin America

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7
Q

Cutaneous mycoses = tinea

A

Tinea versicolor
Other: Tinea pedis (foot), tinea cruris (groin), tinea corporis (ringworm), tinea capitis (head, scalp), tinea unguium (onychomycosis, fingernails)

*KOH prep - see mold hyphae

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8
Q

Tinea versicolor

A

Malassezia furfur

  • Degradation of lipids makes acids –> damage melanocytes –> hypo/hyperpigmented patches
  • Hot, humid weather
  • Dx - “spaghetti and meatball” appearance
  • Tx - topical miconazole, selenium sulfide (Selsun)

Leslie got rid of her furfur fungus w/ head + shoulders = selenium sulfide

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9
Q

Opportunistic fungal infections

A

1) Candida albicans
2) Aspergillus fumigatus
3) Cryptococus neoformas
4) Mucor and Rhizopus app.
5) Pneumocystic jirovecci
6) Sporothrix schenckii

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10
Q

Candida albicans

A
  • Systemic or superficial fungal infection
  • Oral/esoph thrush - immunocompromised
  • Vulvovaginitis - diabetes/abx use
  • Diaper rash
  • Endocarditis in IV drug users
  • Disseminated candidiasis
  • Tx:
  • Oral/esoph = fluconazole/caspofungin
  • Vaginal = topical azole
  • Systemic = fluconazole/caspofungin/amphotericin B

*alba = white (white pseudohyphae and budding yeasts) –> dimorphic (buds/yeast)

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11
Q

Aspergillus fumigatus

A
  • Invasive aspergillosis - immunocompromised and CGD
  • Allergic bronchopulmonary aspergillosis (ABPA) - asthma/CF –> bronchiectasis/eosinophilia
  • Aspergillomas - in lung cavities, esp after TB
  • HCC - some aspergillus make aflotoxin, assoc w/ HCC
  • Incr IgE eosinophilia
  • Septate hyphae that branch at 45degr (acute) angle [NOT DIMORPHIC]
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12
Q

Cryptococcus neoformans

A

Cryptococcal meningitis, cryptococcosis
- Soil/pigeon droppings –> inhale, then disseminates hematog to meninges

  • Sabouraud agar, India ink stain. Encapsulated yeast (halos), NOT DIMORPHIC
  • Latex agglutination test - detects polysaccharide capsule
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13
Q

Mucor and Rhizopus spp

A

Mucormycosis –> in DKA, leukemic pts

  • Fungi in blood vessel walls when excess ketones/glucose –> penetrates cribiform plate –> enters brain
  • Rhinocerebral/frontal lobe abscesses
  • HA, face pain, black necrotic face eschar, CN involvement

Tx = amphotericin B

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14
Q

Pneumocystis jirovecci

A

Pneumocystis pneumonia (PCP) = diffuse interstitial pneumonia

  • Yeast inhaled –> most asxs
  • Immunocompromised - predisporse
  • CXR - diffuse, bilateral
  • Dx - lung biopsy/lavage
Tx = TMP-SMX, pentamide
Ppx = dapsone, atovaquone; when CD4<200

*Disc shaped yeast on silver stain

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15
Q

Sporothrix schenckii

A

Sporotrichosis

  • Spores enter traumatically through skin (thorn prick) –> pustule/ulcer with nodules along lymphatics
  • Little systemic illness

Tx = itraconazole/POTassium iodide

*Dimorphic, cigar shaped budding yeast, lives on vegetation

“Plat a ROSE in the POT”

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16
Q

Types of parasites

A
  • Protozoa
  • Nematode (roundworms)
  • Cestodes (tapeworms)
  • Trematodes (flukes)
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17
Q

Protozoa

A

GI infections - giardia, entamoeba histolytica, cryptosporidium

CNS infections - toxoplasma, naegleria fowleri, trypanosoma brucei

Heme infections - plasmodium, babesia

Visceral - trypanosoma cruzi, leishmania donovani

STDs - trichomonas vaginalis

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18
Q

GI infections from protozoa

A
  • Giardia
  • Entamoeba
  • Histolytica
  • Cryptosporidium

Gut Entered High Cut

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19
Q

Giardia lamblia

A

Giardiasis - bloating, flatulence, foul-smelling + fatty diarrhea

  • Transmission cysts in water (campers/hikers)
  • Dx - trophozoites or cysts in stool
  • Tx - metronidazole

fat-rich Ghiradelli –> fatty stools

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20
Q

Entamoeba histolytica

A

Amebiasis - bloody diarrhea (dysentery), liver abscess (“anchovy paste” exudate)

  • Sx - RUQ pain (flask-shaped ulcer if colon submucosal ulcer ruptures)
  • Transmission - cysts in water
  • Dx - trophozoites (w/ RBC in cytoplasm) or cysts in tool
  • Tx - metronidazole; iodoquinol if asx cyst passers
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21
Q

Cryptosporidium

A

Severe diarrhea in AIDS

  • Immunocompetent = mild watery diarrhea
  • Transmit - oocytes in water
  • Dx - oocytes on acid-fast stain
  • Tx - prevent by filtering city water; nitazoxanide in immunocompetent
22
Q

CNS infections from protozoa

A
  • Toxoplasma gondii
  • Naegleria fowleri
  • Trypanosoma brucei
23
Q

Toxoplasma gondii

A

Brain abscesses in HIV (ring-enhancing lesions on CT/MR)

  • Congenital = classic triad of chorioretinitis, hydrocephalus, intracranial calcif
  • Transmit - cysts in meat/oocytes in cat feces (crosses placenta!)
  • Dx - serology, biopsy (tachyzoite)
  • Tx = sulfadiazine + pyrimethamine
24
Q

Naegleri fowleri

A

Rapidly fatal meningoencephalitis

  • Swimming in freshwater –> enters cribiform plate
  • Dx - amoebas in CSF
  • Tx = amphotericin B (few survive)

Nalgine of fresh water full of Naegleri

25
Trypanosoma brucei
African sleeping sickness | - Enlarged LN, recurrent fever (antigenic variation), somnolence, coma
26
Heme infections from protozoa
- Plasmodium (P vivax/ovale, falciparum, malariae) | - Babesia
27
Plasmodium
Malaria - fever, HA, anemia, splenomegaly - P. vivax/ovale - 48 hr cycle of fevers; dormant form (hypnozoite) in liver - P. falciparum - severe, irreg fever pattern, RBCs with parasites occlude capillaries in brain, kidneys, lungs - P. malariae - 72 hr cycle, milder - Transmit: mosquito - Dx - blood smear, trophozoite rink w/in RBC, schizont containing merozoites
28
Tx of plasmodium
Chloroquine - blocks plasmodium in heme [mefloquine, atovoquone, proguinal if resistant] P.vivax/ovale - use primiquine to kill hyponozoite (dormant hepatic infection) Life threatening - use IV quinidine *Test for G6PD defic
29
Babesia
Babesiosis - fever, hemolytic anemia - NE US, high risk if asplenic - Transmit - ixodes tick (same as in Lyme; can coinfect!) - Dx - ring form, "Maltese cross" - Tx - atovaquone + azithro
30
Visceral infections from protozoa
- Trypanosoma cruzi (chagas) | - Leishmania donovani
31
Trypanosoma cruzi
Chagas disease --> dilated CM, megacolon, megaesophagus - South America - Transmit - Reduviid bug ("kissing bug") feces, deposited in painless bite - Dx - blood smear - Tx - benznidazole or nifurtimox
32
Leishmania donovani
Visceral leishmaniasis - Spike fevers, hepatosplenomegaly, pancytopenia - Transmit - sandfly - Macrophages containing amastigotes - Tx - amphotericin B, sodium stibogluconate
33
Trichomonas vaginalis
Vaginitis - foul-smelling, greenish discharge, itching, burning - NOT Gardnerella vaginalis (Gram neg, bacterial vaginosis)
34
Nematodes
Roundworms - Ingested = Enterobius, Ascaris, Toxocara "You'll get sick if you EAT these!" - Cutaneous = Strongyloides, Ancylostoma, Necator "These get in your feet from the SANd" - Bites- Loa loa, Onchocerca volvulus, Wuchereria bancrofti "Lay LOW to avoid getting bitten" (Bendazoles for worms bc worms = bendy)
35
Intestinal nematodes
EAAS - Enterobius vermicularis - Ascaris lumbricoides - Ancylostoma duodenalse, Necator americanus - Strongyloides stercoralis
36
Enterobius vermicularis
Pinworm, fecal-oral - Intestinal infection causing anal puritis (Scotch Tape test) - Tx - bendazoles/pyrantel pamoate
37
Ascaris lumbricoides
Giant roundworm, fecal-oral, see eggs in feces w/ microscope - Intestinal infection - Tx - bendazoles/pyrantel pamoate
38
Ancylostoma duodenale, Necator americanus
Hookworms, larvae penetrate skin - Intestinal infection - anemia by sucking blood from intestinal walls - Tx - bendazoles/pyrantel pamoate
39
Strongyloides stercoralis
Larvae in soil penetrate skin - Intestinal skin with vomiting, diarrhea, epigastric pain (like peptic ulcer) - Tx = ivermectin/albendazole
40
Tissue nematodes
WOLT - Wuchereria bancrofti - Onchocerca volvulus - Loa loa - Toxocarna canis
41
Wuchereria bancrofti
Female mosquito - Blocks lymphatics, elephantiasis (9mo-1yr after bite) - Tx = diethylcarbamazine *di = ethyl-carbs- amazing; double elephant size via carbs amazing; for elephantitis*
42
Onchocerca volvulus
Female blackfly bite - Hyperpigmented skin + river blindness; can get allergic rxn to microfilaria - Tx = IVERmectin (for rIVER) *Black fly, black skin nodules, black sight*
43
Loa loa
Fly; (Deer fly, horse fly, mango fly) - Swelling in skin, worm in conjunctiva - Tx = diethylcarbamazine
44
Toxocara canis
Fecal-oral - Visceral larva migrans - Tx = albendazole/mebendazole (like other fecal-oral ones)
45
Cestodes
Tapeworms - Taenia solium - Diphyllobothrium latum - Echinococcus granulosus *Cestode tx = praziquantel +/- albendazole (echino/neurocysticercosis)*
46
Taenia solium
Intestinal infection --> larvae cysts in undercooked pork - Tx = praziquantel Cysticercosis, neurocysticercosis --> ingested eggs - Tx = praziquantel; albendazole for neurocisticercosis
47
Diphyllobothrium latum
Ingestion of larvae from raw freshwater fish - B12 defic (tapeworm competes for B12 in intestine) --> anemia - Tx = praziquantel
48
Echinococcus granulosus
Ingestion of eggs from dog feces - Hydatid cysts in liver --> if antigens released = anaphylaxis * Surgeon - inject cyst with ethanol to kill cysts before remove - Tx = albendazole
49
Trematodes
Flukes - Schistosoma - Clonorchis sinensis *Fluke tx = praziquantel*
50
Schistosoma
Snails are host; cercariae penetrate skin of humans - Liver + spleen granulomas, fibrosis and inflammation = MANSONI/JAPONICUM - Chronic S. haematobium = squamous cell ca of bladder (painless hematuria) - Tx = praziquantel
51
Clonorchis sinensis
Undercooked fish - Biliary tract inflammation + pigmented gallstones - Associated with cholangiocarcinoma - Tx = praziquantel
52
Parasite hints (associations)
- Biliary tract disease, cholangiocarcinoma = clonorchis sinensis - Brain cysts/sz = taenia (cysticercosis) - Hematuria, bladder cancer = schistosoma haematobium - Liver (hydatid) cyst = echinococcus granulosus - Microcytic anemia = ancylostoma/necator - Perianal pruritis = enterobius - Portal HTN = schistosoma mansoni/japonicum - VitB12 deficiency = diphyllobothrium latum

Microbiology (7 decks)

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