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Mycoses III Flashcards

1
Q

what causes most fungal lung infections?

A

Most are caused by dimorphic fungi that spreads via inhalation of airborne spores

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2
Q

what is the main outcome for most cases of fungal lung infections?

A

95% of cases are self-limiting meaning the immune system handles it and asymptomatic

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3
Q

what is the Innate Immunity response to inhaling conidia (fungal spores)?

A

Lectin-like receptors on immune cells recognize fungal components like mannoprotein and glucan which triggers the complement cascade and causes macrophages and neutrophils to ingest and destroy the spores through oxidative burst and free radicals

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4
Q

what is the Cell-Mediated Immunity response to inhaling conidia (fungal spores)?

A

T-helper 17 (Th17) cells produce IL-17
→ IL-17 helps recruit and activate neutrophils for fungal defense

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5
Q

what is the Humoral Immunity response to inhaling conidia (fungal spores)?

A

Antibodies coat the hyphae (opsonization)
→ This makes it easier for neutrophils to detect and destroy fungi

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6
Q

what is the Platelet response to inhaling conidia (fungal spores)?

A

Platelets can stick to fungal hyphae and become activated which can cause thrombosis (clotting) and hemorrhagic infarction (tissue death from bleeding or blocked blood flow)

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7
Q

what is the ideal diagnostic approach for Pulmonary Fungal Infections?

A

combination of clinical signs and laboratory confirmations through:
- symptoms, radiological findings and history
- Histopathological Examination, Fungal Isolation, Micromorphology etc

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8
Q

what is Histoplasmosis?

A

most common fungal lung infection in central and eastern states of the United States also called “Cave Disease”

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9
Q

what fungi causes Histoplasmosis (Cave Disease)?

A

dimorphic fungus apart of the Ascomycota group called Histoplasma capsulatum
- grows as mold in the environment (25°C) and converts to yeast in human tissues (37°C)

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10
Q

how do humans become infected with Histoplasmosis (Cave Disease)?

A

bird or bat droppings contain the mold that produces airborne spores (conidia) that are easily inhaled when exploring caves or demolishing/remodeling old buildings

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11
Q

how does Histoplasmosis (Cave Disease) progress once the mold is inhaled?

A

In the warm environment of the lungs, spores convert to yeast cells and evade the immune system by living inside alveolar macrophages and using metal ions to grow and replicate

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12
Q

what diseases can Histoplasmosis (Cave Disease) cause?

A

chronic pneumonia from multiplying yeast in the lungs that can then spread to other organs through the bloodstream like the brain and cause meningitis

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13
Q

what is the relapse potential for Histoplasmosis (Cave Disease)?

A

fungus can stay dormant in the body for months or years, then reactivate later

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14
Q

who is at risk for Histoplasmosis (Cave Disease)?

A

People with weakened cell-mediated immunity, especially those on corticosteroids or TNF inhibitors, infants and older adults (age 55+)

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15
Q

what is disseminated Histoplasmosis and what are the symptoms?

A

severe form of Histoplasmosis when infection spreads beyond the lungs and causes
- mouth ulcers
- red skin rashes
- photophobia
- nausea and vomitting
- meningitis (if infection reaches CNS)

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16
Q

how do you diagnosis Histoplasmosis?

A
  1. Chest X-rays or CT scans
  2. Microscopic Detection of budding yeast cells in fluid samples
  3. Isolation and Culture of body tissues, fluids or secretions
  4. Antigen or Antibody Detection in urine, serum or CSF
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17
Q

what causes Blastomycosis?

A

a dimorphic fungus called Blastomyces dermatitidis that exists as mold in the environment and yeast in human tissues

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18
Q

how does Blastomycosis infections manifest?

A

mainly as a cutaneous infection from lesions but can cause pulmonary infection through the inhalation of airborne spores (conidia)

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19
Q

what are the symptoms of Pulmonary Blastomycosis?

A

Often occurs without symptoms or is mild and self-limiting with symptoms of a fever, night sweats, cough fatigue and anorexia

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20
Q

what causes Coccidioidomycosis (Valley Fever)?

A

a fungus called Coccidioides immitis found in soil in the Southwestern United States

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21
Q

what is the mode of infection for Coccidioidomycosis (Valley Fever)?

A

inhalation of arthroconidia spores, from fungal hyphae that are disperse into the air and dust when soil is disturbed, deposit into the lungs and evolve into spherules

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22
Q

what is the primary infection that occurs with Coccidioidomycosis (Valley Fever)?

A

self-limiting respiratory infection that typically resolves itself within weeks to months in healthy individuals

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23
Q

what is Cryptococcosis?

A

an opportunistic infection (AIDS defining illness) caused by two saprophytes Cryptococcus neoformans and/or Cryptococcus gattii

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24
Q

how is Cryptococcosis transmitted to humans?

A

Spores become airborne from disturbed bird droppings or tree hollows and inhalation of spores → entry into lungs where spores transform into yeast form that may localize or disseminate, especially to the central nervous system (CNS).

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25
what are the differences between Cryptococcus neoformans and Cryptococcus gattii in Cryptococcosis?
- Neoformans: found in soil of urban environments and grows in droppings of birds that can effect immunocompromised patients or (pigeon handlers) - Gattii: Found in soil around eucalyptus, pine, and douglas fir trees and affects mostly immunocompetent patients
26
what are the ways Cryptococcus neoformans avoid the immune system?
1. Capsule (Outer Covering): prevents it from being eaten (phagocytosed) 2. Form Titan Cells 3. Survival Inside Macrophages: lives, multiplies and grows faster 4. Melanin Pigments: fungus make melanin that neutralizes free radicals
27
Lung Cryptococcosis
inhaled spores can remain hidden inside macrophages and granulomas until a person becomes immunocompromised, where fungi reactivate, spread and cause pneumonia
28
Disseminated Cryptococcosis
fungus spreads through macrophages into the central nervous system and causes cryptococcal meningitis with symptoms of: - Headaches - Ocular or facial palsies - cerebral edema
29
Skin Cryptococcosis
Purple (violaceous) nodules with granulomatous are seen in 10–15% of C. neoformans infected immunocompetent patients
30
Oral Cryptococcosis
Rare, C. neoformans infection seen in AIDS patients and can affect: - Gums (gingiva) - Palate (soft and hard) - Oral mucosa - Tooth socket post-extraction
31
Bone Cryptococcosis
Affects 5–10% of patients causing Osteolytic lesions (bone destruction), that may be mistaken for bone tumors (neoplastic lesions) or tuberculosis of the bone
32
how is Cryptococcosis diagnosed?
1. Isolation & Culture of the Fungus 2. Biochemical Identification
33
how is isolation & culture used in the diagnosis of Cryptococcosis?
a sample of CSF is collected and inoculated on blood agar, chocolate agar and Sabouraud’s agar and allowed to grow at 25°C or 37°C to show: - Mucoid colonies - Budding yeast cells - No pseudohyphae - Capsule (visible using India ink stain)
34
how are biochemical tests used in the diagnosis of Cryptococcosis?
- Urease Test: Positive if organism hydrolyzes urea, turning the medium pink - Sugar Metabolism: negative for fermentation, but positive for sugar assimilation - Nitrate Assimilation: negative
35
what is Candidiasis?
most common yeast infection worldwide caused by Candida albicans that are found on skin, GI tract, mouth, genital tract, and mucous membranes
36
when does Candidiasis cause infection?
opportunistic conditions like: - Antibiotic use (most common trigger) - Immunosuppression - Invasive medical devices (catheters) - Chronic mucocutaneous candidiasis (T-cell deficiency) ***Diabetes patients are predisposed
37
what are Candida albicans?
Oval, budding yeast cells that form pseudohyphae in favorable conditions that produce Blastospores and Chlamydospores
38
how do Candida albicans lead to infection?
at 37°C (body temperature), the yeast form transforms into pseudohyphae that are resistant to phagocytosis, adhere to epithelial and ECM and excrete enzymes for tissue invasion
39
Cutaneous Candidiasis
called Diaper rash in infants and presenets as redness (erythema) and white patches or scaling, in moist skin folds
40
Mucocutaneous Candidiasis
- Oral Candidiasis (Thrush): thick, white, curd-like coating on tongue, inner cheeks, and throat - Vaginal Candidiasis ("Yeast Infection") that causes white vaginal discharge, itching, irritation
41
Disseminated (Invasive) Candidiasis
main systemic disease that causes bloodstream infections and infects organs also known as Candidemia or Candida septicemia and effects the lungs, CNS, GI tract and heart
42
what are the ways Candidiasis is diagnosed?
1. Microscopic Observation: KOH Mount and Gram Stain 2. Culture on Sabouraud's Dextrose Agar (SDA): Budding yeast, Pseudohyphae Blastoconidia can be seen 3. Germ Tube Test: + = Candida albicans 4. Chlamydospore Formation: seen at 25°C 5. Sugar Fermentation & Assimilation Tests: Uni-yeast
43
why would a positive test not always mean active infection of Candida albicans?
Many individuals especially those on broad-spectrum antibiotics may show Candida albicans overgrowth causing positive result
44
what is Candida auris?
type of yeast (fungus) that lives on the skin and other body parts without causing symptoms, can contaminate surfaces and medical equipment and spreads easily in healthcare settings, especially among very sick patients
45
Why is Candida auris dangerous?
Many strains are resistant to common antifungal medicines including the standard treatment Echinocandins
46
what is Pneumocystis jirovecii Pneumonia (PJP)?
fungal pneumonia caused by inhalation of airborne droplets from Pneumocystis jirovecii (16S RNA) that resides in lungs silently until the immune system is weakened
47
who is affected by Pneumocystis jirovecii Pneumonia (PJP)?
mainly immunosuppressed individuals like AIDS patients with CD4 < 200 cells/mm³ and elderly patients on high-dose steroids and also premature or malnourished infants
48
what clinical symptoms occur with Pneumocystis jirovecii Pneumonia (PJP)?
mild fever cough shortness of breathe asphyxia
49
how is PJP diagnosed?
- Collect Bronchoalveolar lavage (BAL) fluid - Use Methenamine silver stain or DFA for visual confirmation - Check Chest X-ray or CT scan for ground-glass infiltrates - Confirm diagnosis with PCR, especially in immunocompromised or HIV-positive patients.
50
what is Aspergillosis?
group of fungal infections affecting mainly people with weakened immune systems or lung diseases caused by species of the mold Aspergillus, most commonly Aspergillus fumigatus
51
how do Aspergillus fumigatus infect and spread within an individual?
asexually reproduce quickly, releasing thousands of tiny airborne spores (conidia) from each conidial head that are easily inhaled—especially in dusty environments—and can reach deep into the lung alveoli, causing infection
52
what diseases are caused by repeated exposure to conidia (without mycelial colonization)?
- Allergic Aspergillus sinusitis - Allergic bronchopulmonary aspergillosis (ABPA)
53
Allergic Aspergillus sinusitis
Inflammation in the sinuses causing symptom like stuffy nose, headache, runny nose, and loss of smell
54
Allergic bronchopulmonary aspergillosis (ABPA)
Inflammation in the lungs seen in people with asthma or cystic fibrosis that causes symptoms like wheezing, cough, shortness of breath, sometimes fever
55
what diseases are caused by mycelial growth in the body (requires treatment)?
- Chronic pulmonary aspergillosis - Invasive aspergillosis
56
Chronic pulmonary aspergillosis
occurs in people with preexisting pulmonary diseases where fungus grows in lung cavities, forming a fungus ball (aspergilloma) causing symptoms like cough, hemoptysis from disruption of blood vessels (coughing blood) and weight loss
57
Invasive aspergillosis
infection spreading beyond the lungs that affects those with weakened immune systems especially cancer patients (leading cause of death) where fever is common
58
Cutaneous aspergillosis
Enters through breaks in skin, usually occurs in immunocompromised individuals but can also spread from lungs to skin
59
Oral aspergillosis
Affects immunocompromised individuals (neutropenic, AIDS patients) at the gingival margin and can advance to painful necrosis that cause black or yellow ulcers with facial swelling and usually treated with antifungal therapy, rarely, surgical resection
60
how is Aspergillosis diagnosed?
1. Imaging Tests: Chest X-ray or CT scans 2. Histopathology (Microscopy): Septate hyphae with acute angle branching
61
What is Mucormycosis?
serious fungal infection caused mainly by fungi in the Rhizopus genus (Zygomycota phylum) is aggressive and often fatal, especially in people with: - Uncontrolled diabetes - Immune disorders - Malnutrition - Severe burns
62
How does Mucormycosis grow and spread?
Rhizopus grow using three types of hyphae: stolons, rhizoids, and sporangiophores and reproduces asexually via sporangiospores or sexually forming zygospores
63
who is most at risk for Mucormycosis?
People with uncontrolled diabetes especially ketoacidosis because it weakens immune cells (↓ phagocytosis), promotes fungal growth due to high iron levels and fungi invade blood vessels leading to thrombosis, necrosis and ischemia
64
Rhinocerebral mucormycosis (most common & deadly)
Starts in sinuses, spreads to brain and face and causes facial pain, fever, swelling, black eschar (dead tissue), loss of vision * EXTREMELY RAPID PROGRESSION
65
Pulmonary mucormycosis
Affects lungs and often linked to patients who used voriconazole (antifungal) for a long time
66
Disseminated mucormycosis
Spreads through bloodstream, seen after major vascular events (heart attack, GI bleeding)
67
Cutaneous mucormycosis
Enters through broken skin (surgery, trauma), causes painful, necrotic skin ulcers and often resistant to regular antibiotics

Inflamm Final (13 decks)

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