Mycology II

Question 1

Clinical manifestation of Cryptococcosis

Answer 1

• most patients will have meningoencephalitis at presentation
• present with headache, nausea, gait abnormalities, dementia, irritability, cranial nerve abnormalities and hydrocephalus
• deepening coma in untreated patients with eventual death

Question 2

Clinical manifestation of Cryptococcosis in lung and on skin

Answer 2

• pulmonary involvement with cough and chest pain, CXR will show one or more well localized infiltrates
• raised skin lesions resulting from dissemination of the yeast in IC patient

Question 3

How do you test for Cryptococcis?

Answer 3

• Look for encapsulated yeast in India ink
• Cryptococcal antigen Latex Agglutination
• Gram stain
• Methenamine silver (GMS)

Question 4

What are four dimorphic fungi?

Answer 4

• Histoplasma capsulatum
• Blastomyces dermatitidis
• Coccidioides immitis
• Sporothrix schenkii

Question 5

Where is the best place to find Histoplasma capsulatum?

Answer 5

-Ohio/Mississippi River Valleys

Question 6

Clinical Manifestations of Histoplasma capsulatum

Answer 6

• Asymptomatic
• Pulmonary infiltrates and mediastinal lymphadenopathy which may progress to cavitating lesion which has symptoms of fever, night sweat, and weight loss
• Disseminated has febrile illness with spread to CNS, skin, adrenal and enlarged liver and spleen

Question 7

Unique structural features of Histoplasma capsulatum

Answer 7

• at 25 degrees as mold
• Hyphae are septate and hyaline
• has both macro- and microconidia
• macroconidia has fingerlike projections

Question 8

Where can you find Blastomyces dermatitidis?

Answer 8

• Chicago Disease
• Central U.S.
• associated with soil and wood

Question 9

Pulmonary Clinical manifestation of Blastomyces dermatitidis

Answer 9

Fever, chest pain, cough with sputum

• Hilar lymphadenopathy, nodular lesion
• some patients have self-limited pneumonia while most have chronic pneumonia

Question 10

Clinical manifestation of Blastomyces dermatitidis on the skin and bone

Answer 10

skin lesions are common and may progress to large ulcers
-mucus membrane lesions are also common and may mimic CA(?)
Osteolytic lesions with draining sinuses are not infrequent

Question 11

Unique structure of Blastomyces dermatitidis

Answer 11

• Broad based budding yeast

- conidiophores that resemble lollipops

Question 12

Where would you find Coccidioides immitis?

Answer 12

• geographically limited to desert climate which is Southwest US
• San Joaquin Valley Fever
• Desert Rheumatism

Question 13

Unique characteristics of Coccidioides immitis

Answer 13

• In tissue it’s spherule filled with endospores

- In culture it’s mold with barrel shaped arthroconidia

Question 14

Clinical manifestations of Coccidioides immitis

Answer 14

Primary infection by fever, cough malaise, hypersensitivity. CXR shows infiltrate, hilar adenopathy, or pleural effusion.

• Most cases resolve spontaneously with complete recovery
• Dissemination is possible, occurs more frequently in minorities and IC patients

Question 15

Characteristics of Sporothrix schenckii

Answer 15

• Cigar shaped yeast at 37 C
• Mold with daisy-like conidiophore at 25 C
• Found in soil associated with rose thorns and moss

Question 16

Clinical Manifestations of Sporothrix schenckii

Answer 16

• Papular skin lesion enlarges and ulcerates
• Firm nodules form along lymphatics
• Multiple ulcers
• disseminates to bones, lungs, eyes, CNS

Question 17

What is chromoblastomycosis?

Answer 17

• post-traumatic chronic infection of subcutaneous tissue
• papules –> verrucuous cauliflower-like lesions on lower extremities
• systemic invasion is very rare