Subcutaneous mycoses Flashcards
1
Q
Other term for subcutaneous mycoses
A
inoculation mycoses
2
Q
causes of subcutaneous mycoses
A
traumatic impantation
inhalation
3
Q
etiological agents of subcutaneous mycoses
A
soil
decaying vegetable saprophytes
4
Q
T or F: subcutaneous mycoses are of high virulence
A
False, low virulence, seldom develops into life-threatening disease
5
Q
characteristic of subcutaneous mycoses
A
nodular lesions which may suppurate and ulcerate
6
Q
T or F: secondary spread to articular surfaces, bone and muscle are common with subcut myco
A
true
7
Q
Biosafety level required for subcut myco
A
biosafety level 2
8
Q
causative organism of sporotrichosis
A
Sporothrix schenkii
9
Q
causative organisms for chromoblastomycosis
A
Phialophora verrucosa
Fonsecaea pedrosoi: most common
Fonsecaea compacta
Cladosporium carrionii
*dematiaceous fungi (contains melanin), slow-growing
10
Q
causative organisms for PHAEOHYPOMYCOSIS
A
Cladosporium Exophiala Wangiella Bipolaris Exserohilum Curvularia
11
Q
causative org for MYCOTIC MYCETOMA
A
Pseudallescheria
Madurella
Acremonium
Exophiala, etc.
12
Q
co for SUBCUTANEOUS ZYGOMYCOSIS (Entomophthoromycosis)
A
Basidiobolus ranarum
Conidiobolus coronatus
13
Q
co for subcutaneous zygomycosis (MUCORMYCOSIS)
A
Rhizopus Mucor Rhizomucor Absidia Saksenaea, etc.
14
Q
co for RHINOSPORIDIOSIS
A
Rhinosporidium seeberi
15
Q
co for LOBOMYCOSIS
A
Loboa loboi
16
Q
T or F: Fungal dimorphism is NOT exhibited by fungi that cause subcutaneous and systemic mycoses
A
false
17
Q
conditions at which saprophytic and mycelia fungi survive
A
25C temp
humidity
nutrients
18
Q
conditions at which spherules and yeast (parasitic) survive
A
37C temp
hormone
tissues
immune response
19
Q
Also known as “Rose gardener’s disease”, “Rose thorn
disease” or “Rose handler disease”
A
SPOROTRICHOSIS
*it is found in plants, soil, decaying vegetation
20
Q
T OR F: Sporothrix schenkii is an animal pathogen
A
false, human and animal
21
Q
T or F: Sporothrix schenkii is thermally dimorphic
A
True
*room temp: mycelia (saprophytic)-BRANCHING HYPHAE, white to dark brown
body temp: yeast (parasitic)- SPHERICAL TO OVOID BUDDING CELLS, cigar-shaped, cream to beige
22
Q
colonies of S. schenkii on saboraud’s agar characteristics
A
cream to black color
folded
leathery colonies
grows within 3-5 days
23
Q
modes of transmission for sporotrichosis
A
inhalation of conidia
cutaneous inoculation
zoonotic transmission
24
Q
most common type of sporotrichosis where lesions are usually localized at inoculation sites (fingers, hands, limbs)
A
fixed cutaneous s.
25
what kind of lesions appear in fixed cutaneous sporotrichosis
Ulcerative, verrucose, acneform, papular, or erythematoid at face, neck or trunk
*Painless nodules to palpable and ulcerate lesions, may
discharge purulent or serous fluid
26
sporotrichosis caused by traumatic inoculation of the fungus into the skin initially resulting to nodular lesion, which usually ulcerates
lymphocutaneous sporotrichosis
27
where do secondary lesions appear in lymphocut s.?
lymphangitic channels
*PATHOGNOMONIC OF LYMPHOCUT S.: SWELLING OF LYMPHATICS (nosystemic symptoms)
28
t or f: Lymphocut s. is very painful and patients exhibit febrile stage
false: afebrile and minimal pain
29
Pulmonary sporotrichosis is caused by
inhalation of conidia
* fatal if untreated due to massive hemoptysis, non-specific symptoms
* associated with COPD and ALCOHOLICS
30
sporotrich. caused by direct inoculation of the fungus or hematogenous spread with cutaneous lesions present on limbs near affected joints (long bones)
Osteoarticular sporotrichosis
31
characteristics of osteoarticular sporotrichosis
stiffness and pain in joint
occurs more than 10 years
may lead to inflammatory monoarticular arthritis
32
rarest sporotrichosis commonly occuring in immunocompromised and with alcohol abuse.
Disseminated sporotrichosis
*nodules: multiple, painless, cutaneous, subcutaneous
33
complications of disseminated sporotrichosis
Ulcers or abscesses in muscles, joints, eyes, bones, GIT, nervous system, and mucous membranes
Endophthalmitis (Aqueous or vitreous humor)
Chorioretinitis (Uvea/ middle layer of eye)
Meningitis
34
specimens needed for lab diag of sporotrichosis
pus or biopsy of lesions
sputum
CSF
35
stain used in tissue biopsy diagnosis of sporotrich.
Periodic Acid Schiff (PAS) & Grocott’s or Gomori Methenamine Silver (GMS)
**low sensitivity due to low fungal count
36
S. schenkii is cultured in
SDA, BHI (with 5% sheep RBC), blood agar plate
37
In culturing schenkii, what is used to confirm diagnosis?
yeast formation at 37C
*exception: fixed cut and lymphocut grow best at 35C
38
appearance of KOH mount of s. schenkii colonies at 25C (septate hyphae)
Rosette-like clusters of conidia at the tips of the conidiophores
microconidia: daisy-like
Short conidiophores at RIGHT ANGLE from thin hyphae
39
appearance of KOH mount of s. schenkii colonies at 37C (yeast colonies)
Round/cigar-shaped yeast cells
Presence of asteroid bodies (Splendore-Hoeppli phenomenon) in histologic specimens
- Not pathognomonic!!, (also seen in parasitic infxn)
40
serology tests for sera of sporotrich. patient
| not diagnostic
Yeast-cell (suspensions) agglutination test
Antigen-coated latex particle agglutination test
*not sera: Sporotrichin skin test
41
treatment for cutaneous-lymphatic form of sporotrichosis
oral potassium iodide
42
treatment for systemic sporotrich.
amphotericin b (intravenous)
43
drug of choice for sporotrich
itroconazole
44
Also known as: chromomycosis, verrucous dermatitis,
| cladosporiosis, phaeosporotrichosis, dermatitide verrucosa, chromoparasitaria, figueira, formiguero
chromoblastomycosis
*caused by black molds or copper- colored soil saprophytes found on rotting wood
45
T or F: chromoblastomycosis is acute and fast-progressing
false, chronic and slow-progressing involving subcutaneous and cutaneous tissues
*considered as post-traumatic chronic infxn.
46
progression of papules in chromoblastomycosis
papules develop into verruccoid, warty nodules resembling florets of cauliflower
*systemic infxn-rare
47
chromoblastomycosis is confined to
lower legs and feet
48
causative organisms of chromoblastomycosis are similar in
appearance
antigenic determinants
physiological properties
*difference: shape of spores and arrangement
49
development of papules for chromoblastomycosis
painless or itchy small scaly papules to small violet wart like lesion and clusters
*pathognomonic: CAULIFLOWER APPEARANCE
50
how is chromoblastomycosis introduced to the body
puncture wound
51
T or F: chromoblastomycosis follows lymphangitic channels
true
52
prominent clinical manifestations of chromoblastomycosis
hyperplasia (tissue proliferation)
fibrosis and microabscess formationg in the epidermis
*common complication: secondary bacterial infxn
53
T or F: in chromoblastomycosis, there is formation of fistula and bones and muscles are invaded
False, exact opposite
54
causative organisms isolated from the brain
F. pedrosoi and P. verrucosa
55
specimens used for lab diagnosis of chromoblastomycosis
Crusts, skin scrapings, aspirated debris and biopsy, excised material
56
pathognomonic of chromoblastomycosis seen in tissue biopsy
brown sclerotic fission cells resembling copper pennies
57
reagents/stain used in direct microscopy of chromoblastomycosis
10% KOH
India ink or calcoflour white
tissues: H&E, PAS, GMS
58
most reliable lab diagnosis of chromoblastomyc.
culture
59
flask-shaped, flower in a vase appearance, conidia accumulate at end (chromoblasto)
phialophora
60
characteristics of rhinocladiella (chromoblasto)
- Acrotheca type of conidiation (Conidia at the ends and sides of conidiophore)
- Simple conidiospores
- May not differentiate from vegetative hyphae
61
type of conidiation for cladosporium
hormodendrum (conidia = simple stalk)
*two or more conidia found at the tip which may bud and form secondary conidia until chains are formed
62
Which causative org of chromoblasto can exhibit all three types of conidiation (hormodendrum, acrotheca, phialophora)
fonsecaea
63
difference between f. pedrosi and f. compacta
compacta has more compact conidia and smaller conidia while pedrosoi is linked with acrotheca type of conidiation
64
T or F: Serology tests are gold standard for diagnosing chromoblasto and phaeohypho
false, no available serological tests
65
Treatment for chromoblastomyc
Flucytosine with or without thiabendazole
Itraconazole (400 mg/day) and Terbinafine (500 mg/day)
*surgery=impractical
66
how do you differentiate phaeohyphomycosis from other fungal infections?
morphology of the organism while inside the host
67
mycotic infections of humans and lower form of animals (common in cats, chicken, turkey and horses) caused by dematiaceous mycelial fungal organisms
Phaeohyphomycosis
68
most common causative agents of phaeohyphomycosis
Phialophora
| Cladophialophora
69
other causative agents of phaeohy.
```
Exophiala
Bipolaris
Phaeoannelomyces
Exerohilum
Aureobasidium
Wangiella
Alternaria
Curvularia
```
70
modes of transmission of phaeohy.
traumatic inoculation from soil, plants, vegetation into the skin or subcutaneous tissue
inhalation ofconidia
71
its common causative agents are exophiala jeanselmei and wangiella dermatitidis (traumatic inocu)
Subcut phaeohyp
*adults have cystic lesions
immunocompromised have verrucous lesions
72
paranasal sinus phaeohyph sinusitis is caused by
exerohilum
alternaria
bipolaris
curvularia
*reported in immunocomp and with allergic rhinitis
73
rare infxn caused by inhalation of conidia with cladiophialophora bantiana* as its common causative agent
*neurotropic fungi and moderately fast growin
cerebral phaeohyphomycosis
74
specimens for lab diagnosis of phaeohyphomycosis
Biopsy, sputum or bronchial washing, skin scrapings, CSF, pleural fluid, and blood
75
T or F: phaeohyphomycosis has same staining as chromoblasto
true
*significant finding: BROWN,BRANCHING SEPTATE HYPHAE
76
Curvalaria characteristics
Fast-growing colonies
Suede-like to downy, brown to blacking brown with a black reverse
Pale brown conidia with ≥ 3 transverse septa that are formed at the apex of a pore (poroconidia)
Cylindrical conidia that are slightly curved
Bipolar germination
77
Slow growing
Green, black colonies
Cultures with mycelial and yeast-like growth forms
Small oval conidia cluster on tip of conidiophore
Exophiala jeanselmei
78
Wangiella dermatitidis characteristics
Slow-growing colonies
Initially yeast like and black then becomes suede-like, olivaceous-grey
Brown pigment is produced in agar
79
Cladophialophora bantiana characteristics
Moderately fast growing
Olivaceous-grey, suede-like to floccose colonies
Conidia develop in long, sparsely branched, acropetal chains of undifferentiated
80
treatment of choice for phaeohypho.
surgical excision
81
Chronic, progressively destructive morbid inflammatory disease usually of the foot but any part of the body can beaffected also known as Madura Foot or Maduromycosis
Mycetoma
*see table in trans for causative agents
82
nodules of mycetoma are described as
suppurative plaques affecting lower extremities
83
signs and symptoms of madura foot
```
Old sinuses close while new ones open
+/- pain
Itching sensation/pruritus
Regional lymphadenopathy
Nodules, abscesses, and fistulae or draining sinuses
```
84
three criteria that characterize mycetoma infection
Draining sinuses
Sulfur granules in tissue and in weeping drainage (Sclerotia or appearance of granules and grains)*
Lesions that develop into swollen extremities (Tumefaction)
*active phase of disease
85
what is the hallmark of mycetoma infxn
Sinuses discharge serosanguinous fluid containing granules
86
granules of mcyetoma vary in
size
color
degree of hardness
87
mycetoma commonly affects which part of the body
upper and lower limbs
88
two types of mycetoma
actinomycotic
| eumycotic
89
actinomycotic mycetoma is caused by
microaerophilic and weakly acid fast higher form of bacteria:
actinomyces
nocardia (most common)
*invades muscles
90
caused by black molds (true fungi) which invade subcut tissue
eumycotic mycetoma
91
T or F: lesions in actinomycetoma are non-encapsulated, more inflammatory, destructive and invades the bone at an earlier period
true
92
T or F: eymycotic mycetoma lesions grow more slowly, remain encapsulated for a long period, has clearly defined margins and late bone involvement (bone destruction;amputation is needed)
true
93
Mycetoma should be differentially diagnosed from
Kaposi’s sarcoma, Fibroma, malignant melanoma, Fibrolipoma, and thorn granuloma
94
Specimens used for lab diagnosis of mycetoma
Excised sinus or tissue biopsy
exudate
pus
serosanguinous fluid containing the granules (stained with parker ink/cw)
95
in direct microscopy, the exudate, pus or tissue should be examined for
sclerotia
96
culture of mycetoma is done in
BAP or SDA
97
granules of actinomycetes
filaments with diameter of 0.5-1.0 μm, coccoid, and bacillary elements
98
fungal hyphae of mycetoma
2-5 μm in diameter with any intercalary swollen cells
99
T or F: fusarium solani are rapidly growing and become bluish brown when sporodochia are present (from whitish to cream)
T
100
Madurella mycetomatis have slow-growing, flat and leathery colonies which turn from white to yellow to ___ to ____
yellowish brown to brown
101
two types of conidiation of madurella mycetomatis
Flask-shaped philides with rounded conidia
| Simple or branched conidiophores with pyriform conidia with truncated bases
102
not very common causative organisms of mycetoma
Leptosphaeria
| Pseudallescheria
103
Recommended lab diagnosis for mycetoma
imaging (CT Scan, bone radiography, MRI, ultrasound)
104
Rarely occurring infection caused by members of the phylum Zygomycetes (primitive, fast growing, saprophytic fungi) with cosmopolitan distribution
Zygomycosis
105
causes subcutaneous and systemic zygomycosis (acute infxn associated with diabetes, starvation, extensive burns, IV drug abuse, steroid-induced hyperglycemia, and chemotherapies)
mucorales
*rainforests
106
causes subcutaneous zygomycosis only
enthomophthorales
*horses
107
Part of the body involved in zygomycosis
Rhino-facial-cranial area
Gastro-intestinal tract
Lungs
Skin
108
type of mucormycosis which is a paranasal infxn following inhalation of fungal elements developed after germination of sporangiosphores in the nasal passage
Rhinocerebral
*major clinical form of mucormycosis
109
T or F: Diabetes, hypergylycemia and renal transplant can put you in a higher risk of acquiring pulmonary zygomycosis
Tralse, rhinocerebral mucor mainly
diabetes and renal transplant-true
110
caused by inhalation of sporangiospores into the bronchioles and alveoli leading to pulmonary infarction and necrosis with cavitation
Pulmonary mucormycosis
111
Rare mucormycosis commonly associated with GI diseases and Severe malnutrition
Gastrointestinal mucormycosis
* may cutaneous mucormycosis pa pero ez nalang yan
112
Entomophthoromycosis/Rhinoentomophthoromycosis is characterized by
appearance of polyps or palpable masses
bilateral distortion of subcut tissue
Splendore-Hoeppli phenomenon (eosinophils located around the hyphae)
lack of vascular invasion
113
causative agent of entomophthoromycosis which usually involves infections of lower extremities. Lesions appear as subcutaneous nodules followed by firm swelling attached to the skin (not muscle)
basidiobolus ranarum
114
causative agent of entomophthoromycosis which involves the nasal mucosa and development of polyp in the upper respi passage
Conidiobolus sp.
115
Specimens used for lab diagnosis of zygomycosis
Skin scrapings (cutaneous lesions)
Nasal discharges, scrapings and aspirates (rhinocerebral lesions)
Sputum and needle biopsies (pulmonary lesions)
Biopsy tissue from patients (GI/disseminated)
116
in direct microscopy for zygomycosis what is examined
broad, infrequently septate, thin-walled hyphae, showing focal bulbous dilations and irregular branching
117
describe colonies of ca of zygo in SDA
glabrous, radially folded with fine, powdery, white mycelium
118
Chronic granulomatous infection of mucous membranes of nasopharynx, oropharynx, conjunctiva, rectum, and external genitalia
rhinosporidiosis
119
usual clinical manifestation of rhinosporidiosis
vascular friable polyps on nasal mucosa or external eye structures (strawberry-like)
120
etiological agent of rhinosporidiosis now classified as parasite (never been cultured)
Rhinosporodium seeberi
121
Three stages of pathogenesis of rhinosporidium seeberi
1. Local replication
2. Hyperplastic growth of host tissue
3. Localized immune response
122
how does one usually acquire rhinosporidiosis
bathing or working in contaminated stagnant water
123
most common site of rhinosporidiosis
nose> palpebral conjunctiva> genitalia and rectum
124
seen in the nasal region of rhinosporidiosi infxn
Local pruritus, coryza, sneezing, rhinorrhea postnasal
discharge
Soft strawberry like polyps
Epistaxis or unilateral nasal obstruction
125
T or F: the eye region in rhinospori is symptomatic
false, although with redness, photophobia and tearing
126
The skin region in rhinospori exhibits
papillomas that gradually become verrucous
127
T or F: immunodeficiency is associated with the infection
false, it is not
128
what is used as confirmatory diagnosis for r. seeberi if it cant be cultured?
spherules in biopsy specimen observed using PAS
*macerated tissue is also used
129
"Lobo’s disease or lacasiozis" - Rare, chronic, localized, sub-epidermal infection
Lobomycosis
130
characteristics of lobomycosis
presence of keloidal, verrucoid, nodular lesions on the face, ears, or extremities (generally painless)
Resembles leprosy or leishmaniasis and other subcutaneous mycoses like sporotrichosis and chromomycosis
Self-limited infection
131
etiological agents of LOBOMYCOSIS
Loboa loboi
Paracoccidiodes loboi
Lacazia loboi
* not yet cultured in vitro in artificial specimens
* Slow-growing (kaya chronic) multiple budding yeast cells with a phagocytosis-resistant cell wall containing melanin
132
confused with lobomycosis
Blastomyces dermatitidis or Paracoccidiodes brasiliensis
133
who are affected with lobomycosis
humans and family Delphinidae (whales + dolphins)
| * no human to human transmission
134
lesions of lobomycosis
regress and form a scar (keloids)
135
what is examined for in tissue specimens for lobomycosis
long chains of darkly pigmented, spherical cells interconnected by tubules (yeast-like cells with a diameter of 5-12 μm)
136
stains used to distinguish yeast cells
PAS, GMS or Gram
137
stain used for atrophic dermis with fibrous, diffuse, inflammatory granuloma containing histiocytes and giant cells
H&E stain
