Mycoses

Question 1

SUPERFICIAL
MYCOSES

Answer 1

localized along hair shafts and in superficial epidermal cells

Question 2

PITYRIASIS VERSICOLOR

Answer 2

a.k.a. tinea versicolor
chronic superficial infection of the stratum corneum
CA: Malassezia globosa, Malassezia furfur, Malassezia
sympodialis (dimorphic fungi)
◦ part of normal skin flora
◦ may also cause dandruff (seborrheic dermatitis)
◦ former genus: Pityrosporum
CF: discrete, serpentine, hyper-, or hypopigmented
maculae that develop on the skin, usually on the
chest, upper back, arms, or abdomen

Question 3

PITYRIASIS VERSICOLOR
Diagnosis:
Treatment:

Answer 3

◦ KOH mount: “spaghetti and meatballs” (short
unbranched, nonpigmented hyphae and round
spores)
◦ Wood lamp: yellowish-white or copper-orange

◦ selenium sulfide
◦ topical/oral azole

Question 4

TINEA NIGRA

Answer 4

a.k.a. tinea nigra palmaris
chronic and asymptomatic infection of the
stratum corneum
CA: Hortaea (Exophiala) werneckii
◦ a dematiaceous fungi
CF: dark (brown to black) discoloration,
often on the palm
Treatment: keratolytic solutions, salicylic
acid, azole antifungals

Question 5

BLACK PIEDRA

Answer 5

CA: Piedraia hortae
◦ a dematiaceous fungi
CF: nodular infection of the
hair shaft
Treatment: removal of the
infected hair, application of
a topical antifungal agent

Question 6

WHITE PIEDRA

Answer 6

CA: Trichosporon sp.
CF: larger, softer,
yellowish nodules on the
hair shaft
Treatment: removal of the
infected hair, application of
a topical antifungal agen

Question 7

CUTANEOUS
MYCOSES

Answer 7

keratinized tissues such as skin, hair, and nails
Transmission: direct contact

Question 8

DERMATOPHYTOSIS

Answer 8

was mistaken for ringworm or tinea
CA: dermatophytes such as Microsporum,
Trichophyton, Epidermophyton sp.
◦ Geophilic – soil, acute infections
◦ Zoophilic – animals, acute infections
◦ Anthropophilic – humans, chronic infections
CF: raised circular lesions
◦ restricted to nonviable skin because most are unable
to grow at 37°C or in the presence of serum

Question 9

DERMATOPHYTOSIS LOCATION

Answer 9

Tinea capitis Scalp hair
Tinea barbae Beard
Tinea faciei Face
Tinea manuum Hands
Tinea unguium (onychomycosis) Nails
Tinea corporis Trunk
Tinea imbricata Trunk and Limbs in concentric/annular pattern
Tinea cruris (jock itch) Groin
Tinea pedis (athlete’s foot) Feet

Question 10

DERMATOPHYTOSIS
Diagnosis:
Treatment:

Answer 10

◦ KOH mount: hyaline, septate, branching hyphae; chains of arthroconidia
(diagnostic)

◦ removal of infected and dead epithelial structures
◦ topical antifungal
◦ keeping areas dry
◦ avoiding sources of infection (infected pet or shared bathing facilities)

Question 11

CANDIDIASIS OF SKIN, MUCOSA, OR
NAILS

Answer 11

a.ka. moniliasis
occurs in broad-spectrum antibiotic overuse
Risk factors: AIDS, pregnancy, diabetes, young or old age, birth control pills, trauma
(burns, maceration of the skin
Pathogenesis: increase in the local census of Candida and damage to the skin or
epithelium that permits local invasion by the yeasts and pseudohyphae
CA: Candida albicans
Diagnostics:
◦ KOH mount: yeast and/or pseudohyphae

Question 12

Thrush

Answer 12

◦ white, adherent, painless, discrete or confluent patches
of whitish pseudomembranes on the tongue, lips,
gums, palate, esophagus
◦ can form an intractable biofilm
◦ should prompt investigation of underlying HIV
infection

Question 13

Vulvovaginitis

Answer 13

◦ irritation, pruritus, & vaginal discharge (usually thin but
may contain whitish “curds” if severe)
◦ not usually associated w/ HIV infection

Question 14

Paronychia

Answer 14

◦ painful swelling at the nail–skin interface

Question 15

Onychomycosis

Answer 15

◦ painful, erythematous swelling of the nail fold that may
destroy the nail

Question 16

Intertrigo

Answer 16

◦ erythematous irritation w/ redness & pustules in skin
folds

Question 17

Balanitis

Answer 17

◦ erythematous-pustular infection of the glans penis

Question 18

Erosio interdigitalis blastomycetica

Answer 18

◦ infection between the digits of the hands or toes

Question 19

Diaper Rash

Answer 19

◦ common erythematous, pustular perineal infection in
infants

Question 20

CANDIDIASIS OF SKIN, MUCOSA, OR
NAILS
Treatment:

Answer 20

◦ topical nystatin
◦ oral ketoconazole or fluconazole

Question 21

CHRONIC MUCOCUTANEOUS
CANDIDIASIS (CMC)

Answer 21

formation of granulomatous candidal lesions on any or all cutaneous (hair, nails, skin)
and/or mucosal surfaces
persists despite intermittent antifungal therapy
associated with:
◦ immunologic dysfunction – failure of Th17 lymphocytes to secrete type-17 cytokines in response
to Candida antigens
◦ autoimmunity
◦ hypoparathyroidism
usually comes in infancy or within the first two decades of life
CF:
◦ chronic, raised, and crusty highly disfiguring keratitic lesions on the skin, oral mucosa, and scalp
◦ exophytic outgrowths on the skin

Question 22

SUBCUTANEOUS
MYCOSES

Answer 22

tissues beneath the skin
Transmission: direct implantation of spores or mycelial fragments into a
puncture wound in the skin
fungi normal reside in soil or vegetation

Question 23

SPOROTRICHOSIS

Answer 23

a.k.a. rose gardener’s disease
chronic granulomatous infection typically followed by 2° spread
with involvement of the draining lymphatics and lymph nodes
caused by trauma associated with plants
CA: Sporothrix schenckii (dimorphic fungi)
CF:
◦ Lymphocutaneous – granulomatous nodule that may
progress to a necrotic or ulcerative lesion; draining lymphatics
become thickened and cord-like
◦ Primary pulmonary sporotrichosis – mimics chronic cavitary
tuberculosis when inhaled by those with impaired cellular
immunity

Question 24

SPOROTRICHOSIS
Diagnosis:
Treatment:

Answer 24

◦ Histologic examination: cigar-shaped yeast,
often with surrounding asteroid body

◦ KISS
◦ oral or systemic antifungal

Question 25

CHROMOBLASTOMYCOSIS

Answer 25

a.k.a. chromomycosis
subcutaneous mycotic infection caused by traumatic
inoculation of fungi, which reside in soil and vegetation
CA: Phialophora verrucosa, Fonsecaea pedrosoi,
Fonsecaea compacta, Rhinocladiella aquaspersa,
Cladophialophora carrionii
◦ dematiaceous fungi
Diagnosis:
◦ KOH mount: sclerotic bodies (pathognomonic; dark brown,
thick-walled, septate fungal forms that resemble large
yeasts)

CF:
◦ slow development of progressive granulomatous lesions that
induce hyperplasia of the epidermal tissue
◦ verrucous and wart-like with extension along the draining
lymphatics
◦ cauliflower-like nodules with crusting abscesses
◦ small ulcerations or“black dots” of hemopurulent material
◦ rarely, elephantiasis
Treatment:
◦ surgical excision
◦ local heat
◦ oral or systemic antifungal

Question 26

PHAEOHYPHOMYCOSIS

Answer 26

presence of darkly pigmented
septate hyphae in tissue
CA: Exophiala jeanselmei,
Phialophora richardsiae,
Bipolaris spicifera, Wangiella
dermatitidis
CF:
◦ SC: solitary encapsulated cyst
◦ Systemic: sinusitis, brain
abscess (fatal)

Question 27

PHAEOHYPHOMYCOSIS
Diagnosis:
Treatment:

Answer 27

◦ Histologic examination: large hyphae w/
accompanying yeast cells; melanin in cell wall

◦ oral or systemic antifungal

Question 28

MYCETOMA

Answer 28

chronic subcutaneous infection induced by traumatic
inoculation with fungi (eumycetoma) or actinomycetous
bacteria (actinomycetoma, more severe)
CA: Pseudallescheria boydii, Madurella mycetomatis,
Madurella grisea, Exophial jeanselmei, Acremonium
falciforme
◦ dematiaceous molds
CF:
◦ local swelling of the infected tissue with suppuration,
abscesses, granulomata and interconnecting, often
draining, sinuses or fistulae containing granules
◦ may spread to muscle and bone

Question 29

MYCETOMA
Diagnosis:
Treatment:

Answer 29

◦ Histologic examination: granules (microcolonies of the agent embedded in
tissue material)

◦ surgical debridement or excision
◦ long-term topical, oral, or systemic antifungal

Question 30

PRIMARY SYSTEMIC
MYCOSES

Answer 30

many organs deep within the body
Transmission: inhalation

a.k.a. endemic mycoses
caused by dimorphic fungi

Question 31

COCCIDIOIDOMYCOSIS

Answer 31

a.k.a. San Joaquin Valley fever, desert rheumatism
CA: Coccidioides posadasii, Coccidioidesimmitis
CF:
◦ 60%: asymptomatic
◦ 40%: self-limited influenza-like illness with fever, malaise,
cough, arthralgia, and headache
◦ 15%: hypersensitivity reactions, e.g. rash, erythema
nodosum, erythema multiforme
◦ pulmonary infiltrates, pneumonia, pleural effusions, or
nodules
◦ <1%: secondary or disseminated coccidioidomycosis (CNS,
bone)

Question 32

COCCIDIOIDOMYCOSIS
Diagnosis:
Treatment:

Answer 32

◦ Histologic examination:
spherules (arthroconidia
that enlarge, become
rounded, and develop
internal septations, and
contain endospores)

◦ oral or systemic antifungal

Question 33

HISTOPLASMOSIS

Answer 33

a.k.a. spelunker’s disease (transmitted from
bird and bat guano)
the most prevalent pulmonary fungal
infection in humans and animals
CA: Histoplasma capsulatum
◦ facultative intracellular parasite
◦ able to replicate within alveolar macrophages
Diagnosis:
◦ Histologic examination: yeast with narrow-based
budding; intracellular yeasts
CF:
◦ Acute
◦ self-limited flulike syndrome with fever, chills, myalgias, headaches, and nonproductive cough
◦ CXR: hilar lymphadenopathy and pulmonary infiltrates or nodules (heal with calcification)
◦ Chronic
◦ reactivation
◦ progressive inflammation, tissue necrosis, and fibrosis mimicking cavitary tuberculosis
◦ precipitated by structural lung disease (e.g., emphysema)
◦ Progressive disseminated histoplasmosis (PDH) in immunosuppressed
Treatment:
◦ oral or systemic antifungal

Question 34

BLASTOMYCOSIS

Answer 34

a.k.a. North American blastomycosis,
Gilchrist disease
a chronic infection with granulomatous and
suppurative lesions that is initiated in the
lungs, but dissemination may occur to any
organ but preferentially to the skin and
bones
CA: Blastomyces dermatitidis
Diagnostic Test:
◦ Histologic examination: yeast with broad-based
budding
CF:
◦ Acute LRTI (fever, malaise, night sweats, cough, and myalgias)
◦ Chronic pneumonia – pyogranulomatous reaction with neutrophils and
noncaseating granulomas
◦ Disseminated blastomycosis (skin, bone, CNS, larynx, GUT)
Treatment: oral or systemic antifungal

Question 35

PARACOCCIDIOIDOMYCOSIS

Answer 35

a.k.a. SouthAmerican blastomycosis
CA: Paracoccidioides brasiliensis
Diagnostic Test:
◦ KOH mount: yeasts with budding in
steering-wheel pattern
CF:
◦ Acute/Juvenile Form:
◦ uncommon, usually <30 years old
◦ disseminated infection of the reticuloendothelial system
◦ Chronic/Adult Form:
◦ ~90%, usually in older men
◦ progressive pulmonary disease, in the lower lobes, with fibrosis
◦ ulcerative and nodular mucocutaneous lesions in mucous membranes of the upper respiratory
tract
Treatment:
◦ oral or systemic antifungal

Question 36

SYSTEMIC CANDIDIASIS

Answer 36

the most prevalent systemic mycosis
associated with corticosteroids or other immunosuppressive agents; with hematologic
diseases such as leukemia, lymphoma, and aplastic anemia; or with chronic
granulomatous disease
due to candidemia caused by indwelling catheters, surgery, IV drug abuse, aspiration,
or damage to the skin orGIT
CA: C. albicans, C. parapsilosis, C. glabrata, C. tropicalis, C. guilliermondii, C. dubliniensis
◦ an endogenous opportunist (normal flora of the skin, mucous membranes, andGIT)
◦ C. albicans – dimorphic unlike other species
may develop occult lesions anywhere, esp. the kidney, skin, eye, heart, and meninges
CF:
◦ Endocarditis
◦ Kidney infections
◦ Macronodular skin lesions
◦ Endophthalmitis
Treatment:
◦ oral and systemic antifungal

Question 37

CRYPTOCOCCOSIS

Answer 37

more common in patients with
HIV/AIDS
CA: Cryptococcus neoformans,
Cryptococcus gattii
◦ have polysaccharide capsule
◦ present in pigeon droppings
Diagnostic test:
◦ Microscopic examination: encapsulated
yeast w/ India ink
CF:
◦ pulmonary infection –
asymptomatic or influenza-like
respiratory infection
◦ osteomyelitis
◦ chronic meningitis (most common)
Treatment:
◦ combination systemic antifungals

Question 38

ASPERGILLOSIS

Answer 38

CA: Aspergillus fumigatus
DiagnosticTest:
◦ acute-angle septate hyphae, uniform
in width

Allergic Forms
• Allergic Bronchopulmonary Aspergillosis – asthma, recurrent chest
infiltrates, eosinophilia; both type I and type III skin test
hypersensitivity
• Extrinsic Allergic Alveolitis
Aspergilloma and Extrapulmonary Colonization
• Fungus Ball – cough, dyspnea, weight loss, fatigue, and hemoptysis
• increased risk in previous cavitary disease
• a late manifestation of chronic cavitary pulmonary aspergillosis
• infection of nasal sinuses, the ear canal, the cornea, or the nails
Invasive Aspergillosis
• associated with lymphocytic or myelogenous leukemia and
lymphoma, stem cell transplant recipients, individuals taking
corticosteroids, and AIDS
• fever, cough, dyspnea, and hemoptysis
• thrombosis, infarction, and necrosis due to presence in

TREATMENT
combination systemic antifungals
antiretroviral therapy in AIDS
Immune Reconstitution Inflammatory Syndrome (IRIS)
◦ occurs in 1/3 of ART-treatedAIDS patients
◦ a paradoxical worsening of preexisting, untreated, or partially treated opportunistic
infection

Question 39

MUCORMYCOSIS
(ZYGOMYCOSIS)

Answer 39

associated with acidotic patients (esp.
in DM), leukemias, lymphoma,
corticosteroid treatment, severe burns,
immunodeficiencies, dialysis with
deferoxamine
CA: Rhizopus oryzae (most common),
Rhizomucor, Lichtheimia,
Cunninghamella, Mucor sp.
Diagnostics:
◦ Histologic examination: ribbon-like aseptate
hyphae
CM:
◦ Rhinocerebral Mucormycosis (most common)
◦ invasion of the sinuses, eyes, and brain
◦ edema of the involved facial area, a bloody nasal exudate, and orbital cellulitis
◦ Thoracic Mucormycosis
Tx:
◦ surgical debridement
◦ systemic antifungal

Question 40

PNEUMOCYSTIS PNEUMONIA

Answer 40

CA: Pneumocystis jiroveci (carinii)
◦ formerly thought of as a protozoan
◦ 2 forms: trophozoite and cyst
associated with AIDS
CF:
◦ Acute or Subacute Pneumonia
◦ initially characterized by a vague sense of dyspnea alone that subsequently manifests as fever and nonproductive cough with
progressive SOB
◦ may progress to respiratory failure and death
◦ Extrapulmonary Manifestations
◦ rare
◦ can include involvement of almost any organ, most notably the lymph nodes, spleen, and liver
Treatment:
◦ cotrimoxazole
◦ ART in AIDS

Question 41

TALAROMYCOSIS (PENICILLIOSIS)

Answer 41

associated w/ HIV/AIDS, tuberculosis,
corticosteroid treatment,
lymphoproliferative diseases
CA: Talaromyces (Penicillium)
marneffei (dimorphic fungi)
Diagnostic Test:
◦ Histologic exam: oval or elliptical yeast-
like organisms with transverse central
septation

CF:
◦ fungemia, skin lesions, and systemic
involvement of multiple organs, esp. the
RES
◦ mimic disseminated histoplasmosis
◦ cough, fever, fatigue, weight loss, and
lymphadenopathy; cutaneous or
subcutaneous papules, pustules, or rashes
◦ mortality rate >90% if untreated
Treatment:
◦ systemic antifungal