OPPORTUNISTIC SYSTEMIC MYCOSES Flashcards
1
Q
Common Opportunistic Fungi causing systemic
mycosis
A
- Pneumocystis carinii
- Aspergillus spp
- Cryptococcus neoformans
- Candida albicans
- Rhizopus specie
- Mucor/Rhizopus spp
2
Q
mold found in environment causing disease particularly to those with lung disease or undergoing immunosuppressive therapy
A
Aspergillosis
3
Q
- Etiologic agents of aspergillus
A
- Aspergillus fumigatus
- Aspergilllus flavus
- Aspergillus niger
- Aspergillus terreus
- Aspergillus nidulans
- Aspergillus clavatus
- Aspergillus restrictus
- Aspergillus amsteloidami
4
Q
Responsible for the “ moldy” description of
the earth
A
Aspergillus
5
Q
Produce large quantities of spores which are
easily dispersed by the wind
A
Aspergillus
6
Q
They are found in soil, agricultural and
industrial products
A
Aspergillus
7
Q
Inhibited by cycloheximide
A
Aspergillus fumigatus is inhibited by
8
Q
90% of all infections caused by opportunistic systemic myscosis is due to
A
aspergillus fumigatus causes about how many percentage of diseases
9
Q
produced by aspergillus fumigatus
A
- Usually produces asexualspores
- Rarely infective
10
Q
is aspergilus fumigatus infective?
A
NO
11
Q
Clinical syndromes associated with genus
aspergillus
A
- allergy
- aspergilloma
- Chronic necrotizing pulmonary aspergillosis
- toxicity
- systemic and fatal disseminated
disease - keratitis (cornea) and
traumatized tissue - Disseminated aspergillosis
- Tracheal ulceration in AIDS patients
12
Q
s: keratitis (cornea) and
traumatized tissue cause by
A
aspergillus niger causes what disease
13
Q
Affects CNSor central nervous system
- Multiple hemorrhagic areas of acute
necrosis in both cerebral hemisphere
A
- Disseminated aspergillosis
14
Q
Predisposing factors in aspergillosis -
A
- Immunocompromised host - Presence of other disease
15
Q
Initial and most usual site of infection in aspergillosis
A
Respiratory
(paranasal sinus and lungs)
16
Q
Tomogram in cavity would
show a fungus ball cavity of tb
lesion in right upper lobe area
of lung
A
LUNG ASPERGILLOMA
17
Q
grows on peanuts and grains produces
aflatoxin, one of the most
potent toxins known.
A
Aspergillus flavus grows on
18
Q
IN MICROSCOPIC EXAM FOR ASPERGILLOSIS YOU WOULD OBSERVE
A
- septate hyphae
- dichotomous hyphae
- Spores
19
Q
fruiting body
or fun like appearance of spores is
based on
A
aspergillus fumigatus APPEARANCE
20
Q
diagnostic for
invasive aspergilloma or aspergillosis or
candidiasis
A
Circulating galactomannan;
beta glucan
21
Q
TO TREAT invasive aspergillosis :
A
● Amphotericin
● Itraconazole
22
Q
ASPERGILLOSIS TREATMENT
A
● For invasive aspergillosis :
● Amphotericin
● Itraconazole
- For aspergilloma : “individualized treatment”
Lobectomy (removal of one lobe of lungs)
may benefit some
- If amphotericin b resistant use triazole and
posaconazole
- Allergic aspergillosis:
corticosteroids/disodium cromoglycate
23
Q
For aspergilloma : treatment
A
Lobectomy (removal of one lobe of lungs)
may benefit some
24
Q
is aspergilossis fumigatus is If amphotericin b resistant use
A
triazole and
posaconazole
25
Allergic aspergillosis:
treatment
corticosteroids/disodium cromoglycate
26
Zygomycosis aka
Mucormycosis or Phycomycosis
27
Caused by saphrophytic molds found in the
environment
Mucormycosis is due to
28
Spread from nasal mucosa to turbinate bone,
paranasal sinuses, orbit, and brainMucormycosis
Mucormycosis spreads from
29
Risk factor: immunocompromised, acidosis
(Associated with DM),leukemia, lymphoma ,
those taking corticosteroids, dialysis
Mucormycosis risk factors
30
mucormycosis is Includes infections caused by
- Rhizopus
- Rhiozomucor
- Absidia
31
genus rhyzopus most common specie
- Rhizopus
- Rhiozomucor
- Absidia
32
Having branched sporangiophores with
sporangium at terminal ends
Mucor
33
Sporangiophores in groups
Rhizopus
34
Most common form
● Rhinocerebral/Rhino-orbital route in mucormycosis
35
Germination of sporangiospores are
Usually found in nasal passages -
they can invade blood via this
● Rhinocerebral/Rhino-orbital in mucormycosis
36
Susceptible to patients with leukemia,
lymphoma and those taking
immunosuppressive
● Pulmonary mucormycosis
37
○ Bloodstained nasal discharge with left
sided ptosis and proptosis
Rhinocerebral mucormycosis
38
Infraction of hard palate
mucormycosis s/s
39
Advance case with necrosis of nasal and
maxillary tissue with black eschar. Note
periorbital edema and serosanguinous
discharge from eye
mucormycosis
40
how to grow mucormycoses
3-5 days incubation at room
temperature - To identify: LP
41
treatment for mucormycosis
● High doses of IV Amphotericin B for
disseminated mucormycosis or infections
● Surgical interventions in severe cases such
as nasal sinus damage
● Control of Diabetes as a basic requirement
for better clinical outcome
42
A subacute or chronic infection most
frequently involving the tissues of the CNS,
but occasionally producing lesions in the skin,
bones, lungs or other internal organs
Cryptococcosis
43
- found worldwide in the soil. - It flourishes in bird guano and is often found
in large numbers in pigeon roots, old barns
and in soil beneath trees used as bird roosts.
Cryptococcosis is found in
44
- Encapsulated, yeast-like - Reproduce by budding
Cryptococcosis
45
Most common infection in AIDS patients
Cryptococcosis
46
serotypes of cryptococcosis
Capsule basis for 4 serotypes - A : neoformans, most common - D: neoformans, rare linked with
primary cutaneous - B and C: gattii
47
grows at 37C on SAB or malt
agar (distinguishes it from non-pathogenic
species)
C. neoformans
48
In culture, colonies are visible after 72 hours
(white or tan colored, mucoid, smooth
colonies)
C. neoformans,
49
is the virulence factor of pathogenic
cryptococcus - it is a phenolic substrate
Laccase
50
Canavanine-glycol-bromothymol blue
(CGBB) agar: -
C. gattii grows to produce color change to_____
C. neoformans does not grow,
indicator remains _____
Canavanine-glycol-bromothymol blue
(CGBB) agar: -
C. gattii grows to produce color
change to cobalt blue -
C. neoformans does not grow,
indicator remains yellow
51
Appears to be related to the
distribution of the red gum tree
(Eucalyptus camaldulensis) which
harbors the organism
C. gattii
52
Most common site of dissemination in cryptococcosis
Most common site of dissemination affects
the brain
53
Disseminated cryptococcosis
- Chronic meningitis
- Systemic disease
- Cutaneous cryptococcosis
- Cryptococcosis and AIDS
- May lead to brain tumor, abscess, degenerative diseases
- Increased cfs pressure, and protein,
cell count,
- Glucose is normal or low
54
diagnosis of cryptococcosis and their sensitivity
india ink - 50%
SAB without
cyclohexidine - 75%
:detection of capsular antigen by
antibodies - 95%
55
lab test used for diagnosing cryptoccus in patient with disseminated disease
Demonstration of cryptoccocal antigen by
latex agglutination
56
First choice for mild to moderate
pulmonary disease and CNS or
chronic pulmonary, negative or
positive for HIV infections
fluconazole
57
: - Second choice mild to moderate
pulmonary disease, and CNS or
chronic pulmonary, negative or
positive for HIV infections
Amphotericin B
58
treatment for cryptococcosis
Amphotericin B
fluconazole
59
associated with a
number of clinical syndromes usually seen
among patients with abrogated immune
response, debilitating diseases, as well as on
those taking corticosteroids, anti-cancers and
on long antibiotic therapy.
Candida
60
Saprophytes in human and animal
digestive tract
Candida
61
Most common species associated
with human illness
Candida albicans
62
Saprophytes in soil, air, water, dairy
products, fermenting /rotting
vegetable products
candida
63
candida found in respiratory tract
● Candida tropicalis and pseudotropical
64
Candida
○ also in the skin
c. parapsilosis
65
Azole resistant candida
- A. glabrata
- only makes yeast cells and has no pseudohyphae
- A. krusei
- A. lusitaniae
66
● Exist primarily in the yeast form
● In tissue: It may be found in both yeast and
mold form ( pseudohyphae)
Candida albicans
67
appearance of candida albicans in agar medium
In agar medium:
● Surface - oval budding cell or yeast
● Lower layer - pseudohyphae
68
involves formation of germtube
candida albicans
69
when does germ tube grow
After incubation of media for 90 mins at
37Cdon magfoform mga germ tube or hyphae
70
Typical lesions are pinkish red
nodules
In disseminated candidiasis
71
can cause damage to skin resulting in
lesions or inflammatory reaction from
different abscesses and chronic
granulomatous infections
Mucosal and cutaneous candidiasis
72
Has notable budding yeast cells in
microscope
disseminated candidiasis
73
Patchy white or cheesy curly white sa
epithelial cells and palate
Oral candidiasis
74
Severe infection, plaques of white
exudate on the tongue and palate
Oral candidiasisOral candidiasis
75
- Severe infection in a patient with AIDS
- Earliest clinical sign of HIV infection
and may persist for months
Oral candidiasis
76
Caused by prolonged water exposure
Factors: obesity, DM, interdigital
candidiasi
Intertriginous candidiasis
77
- Resembles pyrogenic onichoinfection - Sinisira nail bed
Onychomycosis
78
Involves indwelling catheters, iv
drugs, drug use, surgery, damaged
skin or GI, macular lesions dye to use
of corticosteroids
Systemic or disseminarted candidiasis
79
Rare type of disease there is a
distinctive clinical manifestation -
formation of granulomatous lesion
Systemic or disseminarted candidiasis
80
Factors which predispose to infection
CANDIDA
- Damage skin and MM within GI tract - Abnormal cell-mediated immunity - Presence of other diseases such as AIDS,
cancer, diabetes - Presence of central venous line, indwelling
catheter - Infancy - Old Age - Pregnancy - Immunosuppression - Diabetes mellitus - Zinc and iron deficiencie
81
May present as asymptomatic or fulminant
sepsis
Candidemia and disseminated candidiasis
82
is confirmatory are for c. albicans and dermatophytoses
Skin lesions
83
TREATMENT FOR CANDIDA
- - - - -
Fluconazole is better choice than
amphotericin b
Topical nystatin
amphotericin b used in systemic and
oral ketoconazole
84
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