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Opportunistic Fungi Flashcards

1
Q

are fungi motile?

A

no

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2
Q

fungi: prokaryotic or eukaryotic?

A

eukaryotic

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3
Q

why do antifungals have significant toxicity?

A

cross-reactivity with mammalian compounds/enzymes

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4
Q

what distinguishes fungi from prokaryotes?

A

membrane-bound nucleus and organelles

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5
Q

DNA morphology?

A

multiple linear chromosomes

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6
Q

fungi membranes not composed of cholesterol but instead…

A

ergosterol

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7
Q

drug that binds to ergosterol

A

amphotericin B

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8
Q

drug class that interferes with ergosterol biosynthesis

A

azoles

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9
Q

fungi cell wall components (not found in mammals)

A

chitin
B-glucan
mannoproteins

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10
Q

drugs that inhibit B-glucan synthase

A

echinocandins

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11
Q

two fungi recognized as part of the normal human microbiota

A

C. albicans

M. furfur

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12
Q

fungal energy source

A

heterotrophs –> organic material
NOT photosynthetic
absorptive, NOT phagotrophic

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13
Q

drugs that cross-react with P450 enzymes

A

azoles

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14
Q

fungi v. bacteria distinction: diaminopimelate, which one has it in their cell wall?

A

NO DAP in fungi

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15
Q

term for organism that lives on dead/decaying botanic matter

A

saprobe

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16
Q

a fungi that exists only as yeast

A

Cryptococcus neoformans

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17
Q

a DIMORPHIC fungus who’s yeast morphotype is the pathogenic, invasive form? mold?

A

Yeast: Histoplasma capsulatum
Mold: Candida albicans

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18
Q

which morphology grows by apical extension?

A

molds

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19
Q

unicellular oval structure that divides by budding or fission

A

yeast

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20
Q

a pathogenic fungus that exists only as a mold

A

Aspergillus

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21
Q

hyphae, mycelia

A

molds

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22
Q

both yeast/mold forms are invasive

A

candida

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23
Q

a form of yeast growth where cells remain attached and elongate

A

pseudohyphae

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24
Q

conversion to the host-adapted form is essential for pathogenesis in humans - especially systemic infections

A

dimorphism

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25
Q

dimorphic fungi (MSCHBC)

A 
Malassezia (superficial)
Sporothrix (subQ)
Candida (opportunisitc)
Histo (systemic)
Blasto (systemic)
Coccidio (systemic)
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26
Q

Yeast fungi ONLY (2C)

A 
Cryptococcus (opportunistic)
Candida glabrata (opportunistic)
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27
Q

Mold fungi ONLY (ADZ)

A

Aspergillus (opportunistic)
Dermatophytes (cutaneous)
Zygomycetes (subQ)

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28
Q

fusion of 2 gametangia –> zygote

A

zygomycetes

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29
Q

2 haploid nuclei fuse to form diploid –> meiosis in a sac “ASCUS” to form haploid

A

Ascomycetes

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30
Q

like asco but sac is called “BASIDIUM” –> haploid progeny mature on outer surface of sac (e.g.?)

A

Basidiomycetes

Cryptococcus

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31
Q

no sexual stage identified for these fungi

A

deuteromycetes

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32
Q

allergy

A

Type I, IgE-mediated
exposure via inhalation/ingestion/contact
re-exposure –enhanced rxn
morbidity via host response

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33
Q

major atmospheric fungi causing hypersensitivity (ACA)

A

Alternaria
Cladosporium
Aspergillus

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34
Q

cheese washer’s lung

A

Penicillium

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35
Q

paprika splitter’s lung

A

Mucor stolonifer

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36
Q

ingestion of seeds/nuts leading to hepatotoxicity (acute) and liver cancer (chronic)

A

aflatoxins from Aspergillus (most potent naturally occurring toxin)

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37
Q

ingestion of grains and breads leading to vasoconstriction, peripheral necrosis, gangrene

A

ergot alkaloids from Claviceps purpurea

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38
Q

grains and breads causing cytotoxic/systemic effects

A

trichothecenes from Fusarium

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39
Q

building materials (esp. damaged by water)

A

trichothecenes from Stachybotrys

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40
Q

superficial S.C. or cuticle infection e.g.

A

Malassezia

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41
Q

epidermis, finger/toe nails, hairs (dermatophytes) (TME)

A

Trichophyton
Microsporum
Epidermophyton

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42
Q

dermis, subQ, fascia, bone

A

fungi that cause sporotrichosis and zygomycosis

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43
Q

Fungal entry via resp tract –> hematogenous/lymph spread or direct extension (the big 3)

A

Systemic (deep)
Histo/Blasto/Coccidio
can cause disease in the immunocompetent

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44
Q

fungal entry via wounds/burns, or immunodeficiencies (CCAP)

A

Crypto
Candida
Aspergillus
Pneumocystis jiroveci

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45
Q

risk groups for immunodeficiency

A

cancer/AIDS/transplant
young/elderly
hospitalized
prolonged survival of the severely ill

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46
Q

Containment of fungi requires?

A

antigen-specific CD4 T-cells

activate MP’s via IFN-y stimulation

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47
Q

CMI or humoral, which is of primary importance in defending fungi?

A

CMI

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48
Q

for which fungi are neutrophils critical for defense?

A

Aspergillus

neutropenic pts, pts on chemo –> aspergillosis

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49
Q

this infection generally does not have sx, immune response, or physical discomfort

A

superficial mycoses

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50
Q

M. furfur

A

inhabits skin

lipophilic, dimorphic

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51
Q

disseminated disease in infants receiving TPN

A

M. furfur

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52
Q

dandruff, cradle cap, seborrheic dermatitis

A

M. furfur

can be early sign in HIV/AIDS pts

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53
Q

pathogenic form of M. furfur

A

HYPHAL (yeast is commensal)

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54
Q

asymptomatic disorder of host melanocytes

A

tinea versicolor

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55
Q

big 3 TME for cutaneous mycoses

A

Trichophyton
Microsporum
Epidermophyton

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56
Q

ectothrix/endothrix

A

growth w/in and outside hair shaft

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57
Q

paronychomycosis

A

fungal infection of nail beds
elderly
systemic abx

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58
Q

very contagious and transmittable infection

A

tinea

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59
Q

diagnostic methods for fungi

A

KOH –> lesion border
Wood’s lamp –> fluorescence of cell wall
Culture for DEFINITIVE DX (rarely used)

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60
Q

infection while working with potting soil, sphagnum moss, pricked by a rose thorn

A

sporotrichosis
sporothrix schenkii
“gardener’s disease”

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61
Q

Sporothrix schenkii

A

dimorphic
MOLD in env
yeast in tissues at 37C

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62
Q

small, hard, painless nodule that enlarges to a fluctuant mass that eventually ulcerates; may progress along lymphatics but rarely spreads beyond regional lymphatics

A

Lymphocutaneous sporotrichosis

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63
Q

inhalation of spores; may resemble TB

A

Pulmonary sporotrichosis

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64
Q

Zygomycosis fungi (RAM)

A 
Rhizopus
Absidia
Mucor
Rapidly invasive (2-7d)
All types of presentations (cut, subQ, dissem, etc.)
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65
Q

common initial sites of zygomycosis infection

A

lungs/nasal sinuses

burn/trauma pts also susceptible on skin

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66
Q

life-threatening, fulminant infection seen in ACIDOTIC individuals (poorly controlled DM) –> DKA
also in neutropenic pts or pts receiving IRON chelation therapy

A

Rhinocerebral zygomycosis

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67
Q

the 5 fungi of fragility (opportunism only)

A

Crypto
Candida albicans/other spp
Aspergillus
Pneumocystis j

68
Q

brudzinski’s / kerning’s signs indicate?

A

meningeal inflammation

69
Q

encapsulated budding yeasts on INDIA INK

A

Cryptococcus neo

70
Q

big immune defects (CMI and innate)

A

innate: neutrophils
CMI: CD4’s and MP’s

71
Q

airborne fungi settling on burn/wound

A

aspergillus

72
Q

soil introduced via trauma

A

Sporothrix schenkii

73
Q

on own skin

A

Candida albicans

74
Q

woman receives antibacterial treatment –> what fungal infection to worry about?

A

vaginal candidiasis

75
Q

defects in humoral immunity (complement, antibody) associated with susceptibility?

A

generally not

76
Q

defect in the oxidative killing capacity of phagocytes

77
Q

lack of mature T and B lymphocytes; results in death <1 year

78
Q

inherited grab bag

A

C-type lectin (receptor pathway components)
Signaling components
Cytokines and receptors

79
Q

Inflam/autoimmune diseases leading to fungal susceptibility

A

RA, IBS, SLE, psoriasis

80
Q

Drugs that increase susceptibility

A

cyclophosphamide
radiation –> neutropenia
steroids –> supp antimicrobial phagocyte action
infliximab/etanercept (block TNFa)
calcineurin inhibitors (block T cell activation)
–> cyclosporin A, tacrolimus
Mycophenolate mofetil –> blocks T and B cell proliferation and fxn for transplant

81
Q

are ma’s antibodies protective against fungal infection?

82
Q

other viruses that increase fungal susceptibility

A

Herpes

CMV, EBV, HIV (CD4/MP’s)

83
Q

diabetes mellitus impact

A

hyperglycemia and acidosis

diminished phagocyte fxn

84
Q

monomorphic budding yeast w/capsule, worldwide found in soil, fruit, juice, milk, bagpipes, GUANO, pigeons, spelunking

A

Cryptococcus neo

can disseminate via blood or lymph

85
Q

disease distribution matching eucalyptus trees (reservoir) Australia, hawaii, california, BC, NW US

A

C. neo var. gattii (serotypes B and C)

more virulent can infect immunosufficient

86
Q

C. neo major form causing human disease

A

var. grubii (serotype A)

87
Q

aerosolization of unencapsulated yeasts w/no capsule inhaled to small airways; also sexual spores/condida

A

C. neoformans

respiratory/GI acquisition

88
Q

pulmonary presentations of C. neoformans

A

DIP, pleural effusion, ARDS

89
Q

disseminated presentations of C. neoformans

A

fungemia –>
meningitis (most serious; AIDS pts)
skin
prostate (reservoir)

90
Q

potential reservoir for C. neoformans

91
Q

leading cause of meningitis in AIDS pts? how to tx?

A

C. neoformans

lifelong fluconazole, antiretroviral therapy

92
Q

virulence determinants of C. neoformans

A

growth at 37C

capsule (GXM is Cn ANTIGEN)

93
Q

diagnostic criterion for cryptococcosis (hint: it’s a virulence determinant)

A

capsular antigen in SERUM or CSF

94
Q

how is C. neo capsule production regulated?

A

moisture, CO2, iron
small yeast –> dry soil low CO2 and iron (easily aerosolized)
moist env w/high CO2 and iron deprivation = SWELLING –> more effective inhibition of host defenses

95
Q

phenoloxidase activity as a virulence determinant of C. neo

A

CNS –> catecholamine-rich (phenoloxidase substrates) –> pigmented melanins –> free radical scavengers and thus resistance to oxidative stress
Melanin coat confers extreme resistance to other host stresses (drugs, pH, temperature, UV, phagocytes)

96
Q

diagnosis of C. neo

A

CSF LA test
also blood, serum, sputum, urine
DEFINITIVE: culture (slow and least-sensitive)
all tests are highly specific

97
Q

cryptococcal antigen (latex agglutination) test for C. neo

A

most SENSITIVE
CSF or serum for capsule
allows quantitative assessment of fungal burden

98
Q

India ink test for C. neo

A

CSF
“HALO” surrounding fungal cells
quick/easy but NOT sensitive

99
Q

Microscopic histology of tissue for C. neo

A

SOCCER BALL encapsulated yeasts (lung biopsy e.g.)

100
Q

tx of C. neoformans (severe, mild, prophylactic, subclinical)

A

severe: amphotericin B + 5-flucytosine
after improvement/less sever: fluconazole
prophylaxis: fluconazole (high-risk pts or persistent sub-clinical infection) low CD4 count? –> for life

101
Q

broad, ribbon-like, septate hyphae in tissue or necrotic debris

A

zygomycetes

102
Q

primary risk factors for zygomycosis

A

trauma, break in skin, inhalation
rapidly invasive/destructive
usually not assoc with immunocomp

103
Q

secondary risk factors for zygomycosis

A 
typically defects in innate immunity
neutropenia
immunosuppressive therapy
iron chelation
acidosis (b/c acidification causes iron to fall off transferrin)
DM, especially DKA
104
Q

cryptococcal antigen measured (tells us what)?

A

capsular polysacc

fungal load

105
Q

big cryptococcal disease

A

meningitis

106
Q

how to dx cryptococcal meningitis?

A

india ink

culture and slide agglutination

107
Q

tx cryptococcal meningitis in AIDS pt

A

acute amphotericin B
fluconazole prophylaxis
now ART to maintain CD4 levels

108
Q

which C. neoformans variant is common in Europe?

A

neoformans (serotype D)

109
Q

leading cause of meningitis in pts with AIDS

110
Q

ABCD serotyping of Cn based on?

111
Q

cryptococcal capsule (or shed antigens) pathogenic mechanisms

A

antiphagocytic
depletion of complement
down-modulation of immune responses

112
Q

the hyphal (mold) form invades tissue, the yeast form is commensal on the body surface

A

candida albicans

113
Q

all filamentous forms: hyphae, pseudohyphae, germ tubes are considered?

114
Q

oropharynx, GI, vagina, intertriginous, perioral, perianal colonization
not found on dry areas

115
Q

albicans pathogenic action

A

skin, nail, mucosal in immunocompetent

invasive/disseminated in immunocompromised

116
Q

RF’s for candidiasis

A 
Abx/age
chemo/neutropenia
gastric acid suppression
abd surgery
CVC's, TPN, genetics
117
Q

dermatitis, onychomycosis, paronycho, OE

118
Q

vulvovaginal, orophar (thrush), esoph, perianal

119
Q

extensive, chronic, tx-resistant superficial infection w/o dissemination accompanied by T-lymphocyte/MP defects but NORMAL HUMORAL responses

A

chronic mucocutaneous candidiasis

120
Q

fungemia –> sepsis, endocarditis, UTI, meningitis, pneumonia, endophthalmitis

121
Q

infects virtually all individuals with AIDS

A

candida albicans

122
Q

4th leading cause of nosocomial bloodstream infection

123
Q

approach to candida infection

A

culture –> determine spp –> susceptibility testing

124
Q

candida virulence factors

A

morphogenesis
adhesins (mimic CR3/CR4 on host phagocytes)
BIOFILMS
hydrolytic enzymes

125
Q

vulvar erythema, pruritis, thick CHEESY vaginal discharge, EXTERNAL dysuria

A

Vulvovaginal candidiasis (yeast infection)

126
Q

Dx VVC

A

pelvic speculum exam –> WHITE plaques
vaginal fluid results: pH 4-4.5 (higher if bacterial)
calorimetric metabolic profiling

127
Q

microscopic exam of KOH prep VVC shows?

A

filamentous hyphae, pseudo, germ tubes

glabrata –> only budding yeasts (no filamentous form)

128
Q

Culture for VVC shows?

A

germ-tube test: + if albicans (differentiates from other candida spp)

129
Q

adherent white plaques on tongue, buccal mucosa, or corner of mouth (angular shelties), asymptomatic or painful, can lead to esophagitis (in severe immunocompromised)

A

oropharyngeal candidiasis
dx based on clinical presentation
confirm via micro exam of KOH prep via skin scraping

130
Q

a candida syndrome occurring in pts with CMI compromise (AIDS, premies), GI leakage, foreign body

A

disseminated candidiasis (bloodstream infection)

131
Q

dx disseminated (bloodstream) candidiasis

A

culture blood, CSF, peritoneal fluid
definitive, significant, limited sensitivity
also Beta-D-glucan in blood/fluids via LIMULUS horseshoe crab assay (cell wall component marker for invasive)
also detection of antigen/metabolites/enzymes/PCR:rDNA

132
Q

tx candida (mild/moderate/severe)

A

mild: topical antifungals/oral azoles
moderate: IV azoles or echinocandins
serious: IV echinocandins or amphotericin B (bloodstream)
probiotics also an option??
mucosal/cutaneous infection in immunocompetent pt (or baby/or pt with mono) may not receive tx

133
Q

tx AIDS pt w/oropharyngeal candidiasis
tx AIDS pt w/candida esophagitis
nosocomial candidemia?

A

topical antifungal
topical antifungal + oral azoles
IV antibiotics (amphoB)

134
Q

candida spp (2) resistant to fluconazole

A

glabrata/krusei

albicans susceptible

135
Q

exists as mold only, airborne –> inhalation –> hypersensitivity w/germination to form invasive hyphae

A

aspergillus spp

136
Q

Aspergillus syndromes (infection w/viable fungi not necessary)

A

allergy/hypersensitivity pneumonitis/ABPA
mycotoxicosis –> aflatoxins (seeds, nuts, corn; india/africa)
cavitary colonization –> aspergillomas –> hemoptysis
invasive pulmonary aspergillosis –> hemoptysis
dissemination

137
Q

risk factors and tx of aspergillomas

A 
TB, emphysema, smoking, a-1-antitrypsin def
surgical excision (cavity action)
138
Q

RF’s for invasive/disseminated aspergillosis

A

neutropenia
transplant
AID/CGD
chemo/steroids

139
Q

colonization via aspergillus assoc w?

A

cavitary lesions

140
Q

corticosteroids impair function of WAT?

A

macrophages –> high risk for IPA and disseminated aspergillosis

141
Q

aspergillus virulence factors

A

allergens
toxins
hydrolytic enzymes

142
Q

aspergillus dx

A

best: microscopic histology or beta-D-glucan marker for invasiveness; or aspergillis galactomannan assay
also culture of tissue/fluid to look for BRANCHING SEPTATE HYPHAE, but variable and low sensitivity

143
Q

branching septate hyphae

A

aspergillus

144
Q

xray or CT of IPA shows?

A

halo sign (early: represents HEMORRHAGE)
air-crescent sign (late: rim of cavitation as NP’s recover)
highly suggestive but not diagnostic
pts with IPA aren’t nec coming in coughing up a bunch of sputum, bc they don’t have full innate defenses

145
Q

tx of aspergillosis (DOC?)

A

DOC: voriconazole
high-dose Ampho-B
transplant: vori + echinocandin

146
Q

drug for aspergillus prophylaxis in immunocompromised pts?

A

Posaconazole

147
Q

2 morphologic forms of Pj

A

trophozoites –> nonrefractive, active, motile (predominant)

cysts –> refractive, non-motile, thick-walled

148
Q 
no ergosterol, yes cholesterol
not susceptible to amphoB
susceptible to anti-parasitic agents (TMP-SMX)
life-cycle similar to parasites
fragile cell wall
no in vitro culturable form
A

Pj attributs atypical for a fungus

149
Q

evidence for Pj is a fungus

A

chitin and B-glucans in cell wall
sensitive to echinocandins
genes/arrangements
rDNA –> gold std

150
Q

room air, apple orchard

A

pneumocystis j

151
Q

ID’d from the lungs of infected people/animals but CANNOT be cultured in vitro

152
Q

most common disease of Pj? route of infection?

A

pneumonia
common env exposure (very early in life)
respiratory

153
Q

other Pj facts

A

don’t know a lot about this guy
host specificity suggests a non-human reservoir is unlikely
don’t know infectious form

154
Q

trophozoites damage pneumocytes and cause loss of cells lining alveoli –> FOAMY eosinophilic exudate fill alveoli –> HONEYCOMB –> gas exchange compromised –> pO2 descends

A

diffuse interstitial pneumonia

can also disseminate

155
Q

70-80% of AIDS pts infected; COD in 15-20%

A

P. jiroveci (extreme opportunist)

156
Q

dx P. jiroveci

A

gold std: histo via biopsy/BAL/sputum
Beta-D-glucan in blood/fluids (nonspecific)
NO CULTURE (can’t)/SEROLOGY (everyone is seropositive)

157
Q

tx P. jiroveci

A

acute: TMP-SMX
high-risk prophylaxis: TMP-SMX
also dapsone (and anti-parasite drugs)
STEROIDS to dampen host inflammatory response; along with antimicrobials, ESPECIALLY w/fluid accum in lungs!

158
Q

candida infection typically exogenous/endogenous?

A

endogenous

159
Q

germ tube induction in serum diagnostic for?

A

candida albicans

160
Q

sporothrix form at 37 deg?

A

yeast
mold at room temp
thermoregulated morphogenesis
unlike candida, which can be present in all forms

161
Q

if you see only yeast on histo it’s probably…

A

candida glabrata

162
Q

cutaneous candidiasis sx

A

redness, pain, pruritis

163
Q

most common dissemination site for candida

164
Q

PICU (neonates) candidiasis?

elderly?

A

C. parapsilosis

C. glabrata

165
Q

fluorescence on wood’s lamp via?

166
Q

what bacteria can cause disease similar to the subcutaneous mycoses?

A

mycobacteria

Bugs & Drugs (15 decks)

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