Mycology Lecture 3 Flashcards
Which regional endemic fungi species has been isolated in eastern Washington state?
Coccidioides immitis
True or False: ALL regional endemic fungi are dimorphic.
True
True or False: All regional endemic fungi are systemic and primary pathogens.
False. Lobomycosis is sub-cutaneous. The part about all of them being primary pathogens is a true statement.
Name 5 common themes that the systemic endemic mycoses share.
- They are all ascomycetes
- Fungus grows in the environment as mold
- Causes primary pulmonary infection
- Risk depends on geographic exposure
- They are all lab hazards
Systemic endemic mycoses often present with no _____. However, patients that are symptomatic usually get better quickly. In _______ patients, the disease can be either _____, _______, or ________.
Symptoms, immunocompromised, severe, disseminated, reactivated
True or False: Sex and ethnicity may play a role in determining the severity of disease with patients suffering from systemic endemic mycoses.
True
________ present in culture is used to diagnose ___________.
Spherules, Coccidioides
Where is Coccidioides endemic to?
Southwest USA, Mexico, South and Central America
Where is Coccidioides hyperendemic to?
Central Valley of CA & Phoenix/Tuscon area of AZ
Name the characteristics of the early cases of Coccidioides
Progressive painful lesions on the face, leading to tissue destruction, and death several years later
Coccidioides was initially believed to be a _______, and also thought to have a high _______ ____.
Parasite, mortality rate
How many cases of Cocci are reported each year?
+ 150K cases per year in the USA
65% in AZ, 35% in CA
True or False: Spores from Cocci were inhaled from a micro plate by a med student in 1929.
True
Cocci _____ is found in Washington and California, while Cocci ______ is found in other areas, including Arizona.
immitis, posadasii
The infectious unit in soil are known as __________, and are generally asexual & produced by fungal hyphae.
Arthroconidia
___________ are released from ruptured _______ and propagate the infection in the host.
Endospores, spherules
Is this pathway regarding the Cocci life cycle correct?
Arthroconidia in lung -> Spherules -> Septated Spherule -> Segmented Spherule -> Formation of Endospores -> More Spherules
Yes
True or False: Most people who have Cocci are asymptomatic.
True (60%)
______ _____ fever is used to describe the flu-like illness, pneumonia, skin nodules, and arthritis that may accompany Cocci.
Acute Valley
Patients who have Cocci may get chronic ______ ____ disease, which looks like ________.
Cavitary lung, tuberculosis
Pneumonia as a result of Cocci may lead to further complications such as:
Skin lesions, bone lesions, or meningitis (rare)
Name some risk factors for severe/disseminated Cocci (5)
- HIV
- Transplant, chemo, or TNF-alpha blockers
- Filipino ancestry (?)
- Diabetes
- Pregnancy
True or False: Diabetes increases the risk of dissemination of Cocci.
False. Diabetes increases the risk of pulmonary complications, such as cavitation or chronic pneumonia.
Which trimester of pregnancy has the highest risk of severe/disseminated Cocci? Which class of antifungals is not recommended during pregnancy?
Third trimester (also post-partum), Azoles
The most common mode of diagnosis of Cocci is _______.
Serology
True or False: Cocci cannot be cultured.
False. Cocci can be grown in 3-5 days using routine media.
The spherule is referred to as being “________.”
Pathognomonic
Cocci can be cultured and it appears as a _____ when cultured at 25C.
Mould
During complement fixation, the patient’s sample is diluted and mixed in with ____ ______. If ________ are present, a ______ is formed, which depletes ______.
Cocci antigens, antibodies, complex, complement
A positive result at > _______ dilution is associated with Cocci dissemination.
1:16
List some disadvantages to using serology for diagnostic purposes (3)
- Antibodies such as IgM and IgG may not be present early in disease.
- People who are immunocompromised may not produce adequate antibodies.
- Cocci may be limited in a certain location and may not have escaped into the blood.
In immunocompromised patients who have a negative serology result, ______ ______ can be used.
Antigen testing
Name serums used for antigen testing with Cocci (3)
Blood, urine, CSF
True or False: Antigen testing is insensitive for pulmonary. The more severe/disseminated Cocci is, the higher yield with antigen testing.
True
True or False: People who are immunocompromised can have better luck with antigen testing due to a higher level of antigens present in their body.
True
Name one issue that comes with antigen testing for Cocci.
Cross reactivity with other endemic fungi
Treatment for Cocci includes ______ and _______ for immunocompromised patients with only pulmonary disease. If the disease is more disseminated/severe, add in __________.
Fluconazole, itraconazole, amphotericin
How long should antifungals be administered against Cocci?
3-12 months (depends on host)
Cocci ______ is very serious and hard to cure. It usually requires lifelong antifungals, and can be diagnosed by culture, or detection of antibodies in _____ ______.
Meningitis, spinal fluid
What’s the treatment for Cocci meningitis?
Fluconazole or Amphotericin (don’t inject Amphotericin directly into CSF)