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Systemic (Endemic) Mycoses Flashcards

1
Q

@ 37C

A

mold 2 yeast

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2
Q

@ 25C

A

yeast to mold

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3
Q

Coccidioidomycosis

A

C. immitis (CA), C. posadasii (outside CA)Valley feverSW US

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4
Q

Coccidioides spp MORPHOLOGY

A

DimorphicSPHERULE W/ENDOSPORESArthoconidium

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5
Q

Coccidioides spp PHYSIOLOGY

A

Soil organismWhite, wooly colony

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6
Q

Coccidioides spp SPHERULE

A

Lipid rich20-80um diameter, located inside giant cell”endosporulating spherule”Susceptible tissues: lungs, skin, cardiac, pericardium, bones, CNS

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7
Q

Coccidioides immitis

A

Sabouraud agar - woolyslow-growing (1-2wk)

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8
Q

Antigens for immunodx: C. immitis

A

CoccidioidinSpherulin

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9
Q

C. immitis PATHOPHYSIOLOGY

A

Involves pulmonaryInhale arthroconidia– transforms into pulmonary spherules that contain endospores.Endospores released, produce new spherulesSeptate hyphae & arthroconidia sometimes present in pulmonary cavitiesPrimary disease: self-limited influenza-like illnessMay develop into diffuse pneumoniaPossibly asymptomatic

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10
Q

C. immitis PATHOGENICITY (disseminated)

A

May involve lungs, skin, bones, joints, CNS (rarely)IMMItis affects IMMIgrants& preggos (elevated estradiol/progesterone enhances growth)Erythema nodosum - delayed hypersensitivity to fungal antigens (good prognosis)

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11
Q

Coccidioides EPIDEMIOLOGY

A

Airborne (not communicable)Soil-dwelling: arthroconidiaMore common in older adultsIncreasing number of cases

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12
Q

Coccidioides ID/DX

A

PAS exam: giant cells/spherulesCulture on Sabouraud agarincreased IgM/IgG

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13
Q

Coccidioides THERAPY

A

Fluconazole Itraconazole Amphotericin BFor disseminated disease - long term treatment

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14
Q

Coccidioides CONTROL

A

Dust protectionPave roadsPlant vegetaionNo vaccine

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15
Q

Coccidioides CASE STUDY

A

Scaly, verrucous rash (&lesions)Involvng nose, head, torso//chronic cough/low-grade fever//persistentrecurrent rashSouthern CAnight sweats/arthralgia/back painpositive IgG/IgM antibodiesGranulomatous inflammation & fungal spherules w/in multinucleated giant cells

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16
Q

Histoplasma capsulatum MORPHOLOGY

A

DimorphicUninucleate budding cells (blastoconidia)Mold features: micro & tuberculate macroconidia

17
Q

Histoplasma capsulatum PHYSIOLOGY

A

Facultative intracellular parasite (macrophages/PMNs)Culture: yeast @ 37C; mold: 25C

18
Q

Histoplasma capsulatum PATHOPHYSIOLOGY

A

Influenza-like to severe lung diseaseRETICULOENDOTHELIAL DISEASEMicroconidia are inhaledDevelop into yeast cellsCells may be phagocytosed/disseminated

19
Q

Histoplama capsulatum: HISTOHIO BATS YEAST IN ALL FIGHTS W/P’S & N’S

A

Granulomatous foci

20
Q

Histoplasma capsulatum

A

FeverPulmonary illnessWeight lossGI involvement

21
Q

H. capsulatum VFs

A

Yeast releases urease, ammonia, bicarbonateEnables yeast to raise pH & blunt or eliminate killing action of phagolysosome

22
Q

H. capsulatum - host resistance

A

PMN expresses fungistatic activity & functional T cell-mediated immunity is critical for clearance

23
Q

H. capsulatum EPIDEMIOLOGY

A

Ohio/MS River valleysNot communicableBat’s intestine

24
Q

H. capsulatum ID

A

Microscopic - intracellular yeastCulture - tuberculate macroconidiaDetection of antigen or antibody (histoplasmin)

25
Q

H. capsulatum THERAPY

A

Chronic pneumonia & disseminated disease - itraconazole /amphotericin B

26
Q

Antigen for immunodiagnosis (H. capsulatum)

A

Histoplasmin

27
Q

H. capsulatum CONTROL

A

Protection from dust

28
Q

H. capsulatum CASE STUDY

A

Marked weight loss, diarrhea, dry cough, fever, night sweats.Multiple nodular lesions found in lungVegetating ulcerous lesionYeast cells w/in macrophages

29
Q

Blastomycosis

A

Chronic granulomatous disease

30
Q

B. dermatitidis MORPHOLOGY/PHYSIOLOGY

A

Thermally dimorphicBroad - based yeast in tissue/exudateHyphae bear conidia/chlamydospores

31
Q

B. dermatitidis PATHOPHYSIOLOGY

A

Inhale infective stage (microconidium in soil)May produce acute/chronic pulmonary diseasePossibility of dissemination

32
Q

B. dermatitidis EPIDEMIOGY

A

Not communicable person to person: soil organism

33
Q

B. dermatitidis ID/DX

A

Metastatic skin lesionsBroad-based yeast (KOH, sputum/exudate/biospy)Culture on Sabouraud agar

34
Q

B. dermatitidis THERAPY

A

Disseminated disease requires aggressive therapyDOC: itraconazole / amphotericin B

35
Q

B. dermatitidis CLINICAL PERSPECTIVE

A

persistent fever/cough/yellow sputumChest radiograph: unilateral pleural effusionProfound weight loss/ulceronodular lesion on the handBroad-based budding yeast in PAS-stain reveals fungal etiology

36
Q

Paracoccidioidiomycosis

A

P. brasiliensis”mickey mouse”

37
Q

P. brasiliensis

A

Yeast w/multiple budsPossibly self-limitingConfined to central/south americaTherapy: itraconazole/amphotericin B

38
Q

P. brasiliensis CASE STUDY

A

71 y/o Chinese manchronic cough/malaise for 2 mo4-mo vaca in AZlow-grade fevernecrotic granulomatous inflammation w/multinucleated giant cells containing spherulespositive PAS

finalz (5 decks)

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