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EV ACVD Study > SQ and Systemic Mycoses > Flashcards

SQ and Systemic Mycoses Flashcards

1
Q

Which type of fungi (generally) are involved in eumycotic mycetomas, pheohyphomycosis, SQ hyalohyphomycosis, zygomycosis?

A

Saprophytic fungi

-SQ
-Traumatic implantation
-Localized
-Slow spread

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2
Q

Geography of Eumycotic mycetomas

A

Worldwide. Most frequent near Tropic of Cancer

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3
Q

Geography of phaeohyphomycosis

A

Worldwide

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4
Q

Where are Pheohyphomycosis organisms located (zoophilic, anthrophilic, etc)

A

Soil, wood, vegetation

OCCASIONALLY can be found on skin of healthy people and animals

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5
Q

Geography of Sporothrix schenckii

A

Tropical, subtropical, temperate zones

Central, South America
Africa

Esp Brazil

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6
Q

Geography of Oomycosis in the USA

A

Gulf coast of US

Otherwise, tropical/subtropical

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7
Q

Season of oomycosis

A

Late summer, fall

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8
Q

Climate of Zygomycosis

A

Tropical/subtropical

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9
Q

Most common organisms causing a eumycotic mycetoma

A

Saprophytes

BLACK GRAIN
*Curvularia geniculata
*Madurella

WHITE GRAIN
*Acremonium
*Pseudallescheria

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10
Q

Black grain mycetomas organisms

A

*Curvularia geniculata
*Madurella

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11
Q

White grain mycetomas organisms

A

*Acremonium
*Pseudallescheria

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12
Q

Phaeohyphomycosis’ other name

A

Chromomycosis

From PIGMENTED fungi

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13
Q

White animals develop phaeohyphomycosis

A

Cows, horses, cats

RARE in dogs

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14
Q

Phaeohyphomycosis organisms

A

Pigmented soil saprophytes. Can be normal animal flora. Dark walled, septate hyphae

*Alternaria
*Drechslera
*Exophiala
*Phialophora
*Bipolaris
(Cladosporium
*Curvularia
*Wangiella

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15
Q

Hyalohyphomycosis’ other names

A

Paecilomycosis
Adiaspiromycosis

NONPIGMENTED fungi

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16
Q

Hyalohyphomycosis Organisms

A

Nonpigmented fungi w/ septate hyphae

*Pseudallscheria
*Acremonium
*Fusarium
*Paecilomyces
*Geotrichum

*Aspergillus

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17
Q

Sporotrix species within Sporothrix schenckii complex

A

*Sporothrix brasiliensis
*Sporothrix schenckii
*Sporothrix globosa
*Sporothrix luriei

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18
Q

At what temperature is Sporothrix a yeast? At what temperature is Sporothrix a hyphae

(Dimorphic)

A

Yeast in TISSUE

Hyphae at ENVIRONMENTAL temperatures

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19
Q

Name 2 dimorphic water molds

A

*Pythium insidiosum
*Lagenidium

Oomycosis

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20
Q

What is “leeches” “bunkers” “Swamp cancer” “bursattee”

A

Pythium insidiosum

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21
Q

Why is Pythium not a true fungus

A

1) NO CHITIN in cell walls
-Instead: cellulose, B-glucan

2) NO ERGOSTEROL in cell membrane

3) Sexual process = oogamy
4) Infective biflagellate zoopspores in wet environments

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22
Q

2 infections classified as Zygomycosis

A

Entomophthoromycosis
Mucormycosis

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23
Q

Entomophthoromycosis (Zoopagomycota) organisms

A

Basidiobolus
Conidiobolus

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24
Q

Mucormycosis organisms

A

Order Mucorales

Rhizopus
Mucor
Lichthimia
Sakenaea

VERY uncommon in small animals

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25
Q

Species (and 1 breed) most likely to develop pheohyphomycosis

A

Cats&raquo_space;»

GSD dogs are predisposed

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26
Q

Which fungus can be spread via inhalation or trauma

A

Zygomycosis (Entomophthoromycosis, Mucormycosis)

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27
Q

Which fungus can be spread by free-standing water exposure or minor skin wounds

A

Oomycosis

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28
Q

How do oomycoses encyst in the skin

A

Zoospores contact skin, mucosa and encyst via a sticky glycoprotein (adhesion)

Germ tube (hypha) development is stimulated by host body temperature

Invade blood vessels

Proteases weaken host tissue

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29
Q

Characteristics of mycetomas (3)

A

1) Tumefaction (swelling)
2) Draining tracts
3) Grains (aggregates of fungi)

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30
Q

Clinical lesion of pheohyphomycosis

A

Pigmented nodule on face (nose, pinnae) and paws of cats

Can be mistaken for melanoma

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31
Q

Clinical lesions of hyalohyphomycosis

A

Well circumscribed ulcers or nodular masses

-Claws
-Head
-Eyes
-Joints

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32
Q

Sporotrichosis: 3 clinical forms

A

1) Primary cutaneous form (nodules or plaques at point of entry)
2) Cutaneous- lymphatic form (thick, corded)
3) Disseminated form

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33
Q

Which clinical form of Sporotrichosis is most common in humans and horses

A

Cutaneous-lymphatic form

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34
Q

Which species develop pythiosis

A

Horses, Cattle, Dogs, Cats

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35
Q

Which species develop lagenidiosis

A

Dogs

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36
Q

Species that develops Basidiobolus

A

Horse

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37
Q

Species that develops Conidobolus

A

Horses, llamas, sheep, dogs

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38
Q

If a cat has Sporotrichosis that spread to its joints (w/fever, anorexia), is the cat immunosuppressed?

A

Not necessarily! Disseminated Sporotrix does not require immunosuppression

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39
Q

Signalment for Pythiosis

A

Young, large breed dogs

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40
Q

Labwork finding common in pythiosis

A

Eosinophilia

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41
Q

Who is this

A

Sporothrix schenckii

Ovoid to cigar-shaped

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42
Q

Diagnosis of eumycotic mycetoma or pheohyphomycosis

A

Culture

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43
Q

Diagnosis of Sporotrichosis

A

1) Tissue culture (Sabouraud’s agar: white mold that turns brown as pigmented conidia grow.)
2) IHC
3) Antibody immunofluorescense

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44
Q

Diagnosis of pythiosis

A

1) ELISA (monitor response to treatment. Decreased Ab in 2-3 months after treatment)
2) Culture (careful!)
3) PCR

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45
Q

Diagnosis Lagenidiosis

A

1) Culture from fresh tissue
2) RNA gene sequencing

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46
Q

Why are dimorphic fungi dangerous to culture?

A

Mycelial phase is infective to humans

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47
Q

T or F: Splendore Hoeppli will be seen on Sporotrix histopath

A

True

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48
Q

Which species will have MORE Sporotrix organisms visible on histopath? Which typically has FEW organisms visible?

A

MORE: Cats

LESS: Dogs, hrses

49
Q

T or F: Pythium can be visualized on histopath with PAS

A

FALSE. Cell walls lack chitin

50
Q

Best stain to visualize Pythium

A

GMS

(thin splendore hoeppli)

51
Q

Best stain to visualize Zygomycosis

A

GMS

Stain poorly with PAS

Similar to oomycosis, but CAN be treated with antifungals.

(thick splendore hoeppli)

52
Q

T or F: cutaneous eumycotic mycetoma may be fatal

A

False. Not life-threatening

53
Q

T or F: Surgical excision of phaeohyphomycosis is usually curative

A

False. Recurrence is common

Make sure you d/c immunosuppressive meds!

54
Q

T or F: Hyalohyphomycosis is typically fatal if generalized

A

True. Disseminated + CNS signs are grave.

Systemic antfungals only help short turn.

Localized lesions only? Tx with surgery

55
Q

Treatment of Sporotrichosis in cats

A

Itrafungol >2 months. But difficult

56
Q

Treatment of Sporotrichosis in dogs, horses

A

Potassium iodide

*Toxic Iodize AE: oculonasal discharge, vomiting, collapse. D/C KI for 1 week then restart at lower dose

-Ketoconazole, terbinafine, amphotericin B, local hypothermia, surgical resection. Continue 1 mo past clinical cure

57
Q

Oomycosis prognosis, best treatment option

A

Prognosis = poor

Tx = wide surgical excision, amputation. AND itraconazole or terbinafine (but no ergosterol, so not great)

Consider Capsofungin (targets beta-glucan in cell wall)

58
Q

T or F: Sporothrix is zoonotic. Isolate infected cats

A

TRUE

59
Q

T or F: Oomycosis is zoonotic

A

FALSE. Infective zoospores only form in water, not in tissue

60
Q

T or F: If an animal has cutaneous Histoplasma capsulatum, you should assume they have systemic infection

A

True.

True for Blasto, Coccidiodes, Crypto, and Histoplasma

61
Q

Where in the USA is Blastomyces dermatidis most common

A

*Mississippi, MO, Ohio river valley, mid-Atlantic states, Eastern Canada

*Likes moist soil, like beaver dams. Spread when soil is disrupted

62
Q

Dogs at higher risk for Blastomycosis

A

Sporting dogs, hounds

Do not have to be immunocompromised

63
Q

Mode of transmission of Blastomycosis

A

1) Inhale conidia –> airway mucosa –> bind alveolar macrophages (adhesins aka BAD1)
2) Spread of conidia via leukocyte trafficking
3) Acute inflammation, tissue damage. Mediated by macrophages

64
Q

Blastomyces adhesion factor that can cause phagocytosis of conidia

A

BAD1

65
Q

Immune response needed to clear Blastomycosis

A

T-cell mediated
Directed to BAD-1 (adhesin)

66
Q

Where is Blastomycosis commonly found, other than the skin

A

Lungs (85%)

67
Q

Diagnosis of Blastomycosis

A

Urine ELISA is best!

Serology: 41-90% sensitive, 90-100% specific

68
Q

Who is this

A

Blastomyces dermatitidis

Thick walled yeast, broad-based buds

69
Q

Treatment Blastomyces dermatitidis

A

Itraconazole is the best

Amphotericin B: nephrotoxic. Can be life saving if needed. Given IV

Fluconazole for urinary tract disease– excreted in urine

Low dose GCs to help with severe lung inflammation

70
Q

Blastomycosis virulence factors

A

*BAD1: mediates adherence to CD3, CD14. Decreases TNFa (needed for phagocytosis and disease clearance)

*Cell wall glucans

*Melanin helps resist phagocytosis and killing

*Change polysaccharides on surface to evade immune system; can hide in phagosomes

71
Q

Coccidiodes immitis, “Valley fever” USA geography

A

SW US, esp AZ

sporulate after rain –> Arthroconidia are then spread via the wind

72
Q

Predisposed dogs to Coccidiodes immitis

A

*Young, male dogs
*Boxers, Dobermans

+/- immunocompromised (more severely affected)

73
Q

What protects Coccidiodes immitis from phagocytosis

A

Spherules – too large to be phagocytosed + virulence factors to cause inflammation (mucosal injury and colonization)

Arthroconidia become spherules rapidly upon entering airway

74
Q

What happens inside Coccidiodes immitis spherules

A

Endosporulation

When spherules are damaged, endospores are relased and phagocytized by macrophages –> endospores WITHIN macrophages

75
Q

Most common form of Coccidiodes immitis infection in cats

A

Skin lesions (nodules w/draining tracts)

76
Q

Most common form of Coccidiodes immitis infection in dogs

A

Low grade lower respiratory infection

77
Q

Who is this

A

Coccidiodes immitis

Spherules with thick wall +/- endospores

78
Q

Who is larger: Blastomyces dermatitidis or Coccidiodes immitis

A

Coccidiodes immitis is MUCH larger.

Coccidiodes also may have endospores; Blasto will not

79
Q

Best stain to visualize Coccidiodes immitis spherules

A

Pap stain
(capsular wall = refractile, purple-black. Cytoplasm= yellow. Endospores = red-brown)

Can also use PAS, Wrights stain

80
Q

T or F: high Coccidiodes immitis IgG titers correlate with more severe disease

A

False.

There should be IgM within 2-5 weeks; IgG within 8-12 weeks.

81
Q

Treatment Coccidiodes immitis

A

Fluconazole for >1 year
(CNS penetration)

Lifelong immunity once animal recovers!

82
Q

Virulence factors Coccidiodes immitis

A

*Spherule outer wall glycoprotein: limits cell mediated immunity
*Host tissue arginase I, Coccidiodal urease (tissue damage)

*Laminin and collagen on surface = receptors for fungal ligands; enhances adhesion

83
Q

Predisposed breeds for Cryptococcus

A

Dobermans, GSD, Cocker spaniel

Siamese, Abyssinians

More common in immunocompromised, but can happen in healthy animals

84
Q

2 species of Cryptococcus (1 worldwide and from pigeon poop, 1 tropical and ubiquitous in environment)

A

Cryptococcus neoformans: worldwide, pigeon poop

Cryptococcus gatti: tropical/subtropical, ubiquitous in environment

85
Q

What for is the Cryptococcus neoformans in when it is inhaled by the host

A

Basidiospores or blastoconidia

Germinate into yeast in tissue

86
Q

What enzyme do Cryptococcus neoformans yeast have to survive in mucosae?

A

Glucosylceramide synthase

87
Q

What comprises the Cryptococcus neoformans capsule

A

1)Glucuronoxylomannan
2) Galactoxylomannan
(polysaccarides)

88
Q

Where do Cryptococcus neoformans make their capsule

A

Within phagosomes of macrophages.

Macrophages become distended wit hthe capsule.

89
Q

Other common clinical signs with Cryptococcus neoformans (other than nodules)

A

CNS, ocular, osteomyelitis

90
Q

Most common clinical presentation of Cryptococcus neoformans in cats

A

Intranasal granulomatous disease (80%)

91
Q

Who is this

A

Cryptococcus neoformans

Yeast w/narrow based budding
Mucinotic capsule (refractile halo)

92
Q

Culture media that can discern Cryptococcus neoformans from Cryptococcus gatti

A

Canavanine-glycine-bromothymol blue agar (CGB).

C. gatti turns the agar blue

93
Q

What antigen does the latex agglutination test use for Cryptococcus neoformans

A

Polysaccharide capsule antigen

(latex particles coated with anticryptococcal ab)

94
Q

Stain to visualize capsule of Cryptococcus neoformans

A

Mucicarmine, Alcian blue

(PAS, methenamine silver, Fontana masson will stain organism, but not capsule)

95
Q

Best treatment for Cryptococcus neoformans

A

Amphotericin B.

Can work for CNS, despite poor penetration. Stimulates host immunity

BUT Fluconazole is great (CNS and urinary excretion)

96
Q

Virulence factors for Cryptococcus neoformans

A

*Phospholipase: injury alveolar type II epithelial cells, limit surfactant production, enhance adhesion, affects phagocytosis

*Polysaccharide capsule: antiphagocytic, immunosuppressive, complement depletion, inhibits leukocyte chemotaxis

*Melanin: yeast survival during CNS infection. Antioxidant.

97
Q

Histoplasmosis geography

A

Worldwide. Center of USA

98
Q

Breeds Histoplasmosis

A

Pointer, weimeraner, Brittany Spaniel, Working dogs

99
Q

Mode of transmission Histoplasmosis

A

Inhalation of microconidia

100
Q

Histoplasmosis immune response

A

*Turn from microconidia to yeast in tissue to avoid death by phagocytosis

*Yeast produce proteins to inhibit acidification of Phagolysosomes. Spread via macrophages.

101
Q

Common signs (other than cutaneous) for Histoplasmosis

A

GI (large bowel diarrhea)

102
Q

Who is this

A

Histoplasma capsulatum

VERY SMALL
Round, basophilic center with a halo (shrinkage from stianing)

103
Q

Treatment Histoplasmosis

A

Itraconazole +/- GCs for >4-6 months

Consider Amphotericin B

Voriconazole, Posaconazole

104
Q

Histoplasmosis virulence factors

A

*Heat shock proteins 70, 83
*M phase cell cycle enzymes
*Tubular proteins

*Cell wall chitin when in yeast form

*When phagocytosed, yeast RAISE the pH by releasing urease, ammonia, bicarbonate –> Absorb Fe).

*Yeast produce IL-4, interferes with immune resopnse

*Melanin

105
Q

What stain is this

A

Gomori’s methenamine silver – GMS (Pythium organisms)

106
Q

Signalment of cats that are predisposed to Sporothrix

A

Young adult, male, intact
Outdoor access
Fighting –> affects nose and limbs (also respiratory tract)

107
Q

Where are nodules from Conidiobolus typically formed on the body

A

Nares, nasal passages

Horses, dogs&raquo_space;> cats

Ulcerative

108
Q

How can you differentiate Entomophthoromycosis from oomyctes on histopath

A

BOTH have eosinophilic sleeve around the organisms
BUT
Basidiobolus/Conidiobolus will stain with PAS (and GMS), and Oomyctes only stain with GMS

109
Q

Which is more likely to cause pulmonary nodules and vascular invasion: Lagenidium or Pythium

A

Lagenidium

110
Q

“Kunkers”

A

Massive of necrotic debris 2’ Pythium in horses

111
Q

What has a better prognosis: Lagenidium or Paralagenidium

A

Paralagenidium. Usually slowly progressive; limited to cutaneous or SQ lesions (not lungs, vessels)

112
Q

Structures of dimorphic fungi in tissue vs in culture

A

Tissue: Yeast/spherules
Culture: Hyphae

113
Q

Name 5 dimorphic fungi important in vet med

A

1) Blastomycosis
2) Histoplasmosis
3) Coccidiomycosis
4) Sporotrichosis
5) Cryptococcus

114
Q

Which dimorphic fungus is most commonly associated with puncture or wound contamination, rather than inhalation

A

Sporothrix

115
Q

Which cell do most dimorphic fungi live in

A

Macrophages

116
Q

Which dimorphic fungus has a tropism for bone, with most cutaneous lesions over a site of osteomyelitis

A

Coccidiodes

117
Q

Which histopath stain can stain LIVING fungi ONLY? Which stain can stain BOTH living AND dead fungi

A

Living only: PAS
Living AND dead: GMS

118
Q

What characterizes chromoblastomycosis

A

Sclerotic bodies or Medlar bodies

= large, rounded, thick-walled fungal cells

Pigmented

119
Q

T or F: the SAME fungal organisms that cause pheohyphomycosis and hyalohyphomycosis can cause eumycotic mycetomas

A

TRUE

To be a mycetoma, they need to make tissue grains!

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